Challenge Bowl Flashcards
1
Q
3 Classes of drugs that can be used for PUD
A
PPI
H2RA
Sucralfate
2
Q
The existence of this Hep requires the coexistence of Hep B
A
Hep D
3
Q
2 different test to dx bacterial ulcer disease
A
Urea breath test and Stool antigen
4
Q
Rash w/herald patch and christmas tree distribution
A
Pityriasis Rosea
5
Q
1st line treatment for AOM for bilateral w/o otorrhea in 5 mo old
A
Amoxicillin 80-90mg/kg/day in 2 divided doses and pain management (APAP/ibuprofen)
6
Q
Define CO
A
HR*SV
7
Q
Toddler with scratch on lips, and now there’s a yellowish golden scalp over the scratch
A
Impetigo
8
Q
Abdominal pain in RLQ after deep palpation in LLQ
A
Rovsing’s Sign
9
Q
H. pylori regimen
A
> 2 antibiotics and antisecretory drug (PPI/H2RA)
10
Q
Study of action of drugs on the body
A
Pharmacodynamics
11
Q
What is atelectasis?
A
Dependent collapse of the alveolar sac
12
Q
Define a heave
A
Pulsation felt due to a distention of an underlying structure
13
Q
Most sensitive instument for detection of gallstones
A
US
14
Q
3 parenteral routes of drug administration
A
IV, IM, sublingual, SQ, transdermal, rectal, intranasal
15
Q
What is a thrombus?
A
A clot that is formed at the site in the vessels
16
Q
What % of body is burnt in anterior chest and entire left arm?
A
27%
17
Q
Clear and consice reason for a pt seeking care is what?
A
Chief complaint
18
Q
Which generation of Cephs has the best gram - coverage?
A
3/4th generation
19
Q
What FQ has the best activity against Pseudomonas?
A
Cipro
20
Q
Common complaint with varicella is pruritus? T/F
A
True
21
Q
Bradycardia is definedd as a HR < how many beats?
A
<60
22
Q
Which skin cancer is the most likely to metastasize
A
Melanoma
23
Q
What initial therapy is recommended when sinusitis begins?
A
Antipyretic, Analgesics, nasal irrigation, hydration, +/- intranasal corticosteriod
24
Q
Which lab test is best used to monitor for long term nutritional status?
A
Albumin
25
What should you instruct your patient to take w/each dose of metamucil and why?
8oz. of water so it doesn't get impacted
26
Name on organism that causes walking pneumonia?
Mycoplasm
27
When treating anaphylaxis which med has fastest onset of action?
EPI, middle is antihistamine, slowest is corticosteriod
28
On which structure is an acoustic neruoma located?
CN VIII (8)
29
What two advantages do 2nd generation antihistamines have over 1st generation antihistamines?
Less sedation and less anticholinergic effects
30
Two most common nutrition vitamin deficiencies with ETOH dependence?
Thiamine and Vit B12, Vit K, folic acid
31
Why do you need to use caution when prescribing cimetidine in a patient on other medications?
CYP Inhibitor - will increase the serum levels of other medications
32
Listening to pt heart sound, suspicious for aortic stenosis; what would happen to heart sound if you listen when the patient stands up?
It gets softer
33
What is the treatment recommendation for uncomplicated HTN?
Thiazide diuretic
34
What is the most common cause of death following an MI
Arryhthmia
35
What can be used to treat AOM with ammoxicillin allergy?
Ceftriaxone, cefdinir, cefuroxime, ceptidoxine
36
What are 2 of the 3 core competencies that you can bring to a pt as a provider
Empathy, Genuine, Respect
37
What is the most effective drug tx for tx of persistent or moderate allergic rhinitis
Intranasal corticosteriod
38
The rash of rubella starts on which part of the body?
Head or face
39
Proclorperazine and metoclopromide can cause what type of side effect
EPSE
40
Is erosion a primary or secondary lesion when describing derm findings?
Secondary
41
What is the treatment of choice for acute constipation in adults
Bisacodyl
42
The atrial rate in a flutter is approx between how many BPM
250-300
43
Which lipid lowering agents lowers LDL and TG, increases HDL, and often causes flushing
Nicotinic Acid
44
What is the MC sx associated with MVP
Asymptomatic
45
What labs are used to monitor warfarin and UFH?
Warfarin: INR
UFH: aPPT
46
What are the 2 pleural linings called?
Visceral and Parietal
47
How many half lives does it take to reach steady state
5
48
What is the major intracellular cation
K+
49
2 Minor Jones criteria for endocarditis (rheumatic)?
Fever, prolonged PR interval, arthralgia, increased CRP, ESR, evidence of +strep culture, antigen test, elevated antibody titer
50
How much K+ should be in IV fluid for 50kg pt?
?
51
COPD, pneumovac, when should she be revaccinated?
Pneumovac at age of diagnosis, revaccinated at age 65; older than 65 if it has been greater than 5 years since last dose
52
Pathologic process for acute appendicitis?
Obstruction of lumen. (fecolith)
53
What med should a pt with persistent asthma be on
ICS, SAB2A PRN
54
Massive hemoptysis w/advance liver disease is most likely assoc with what condition
Esophageal varicies
55
Recommended tx for moderate acne
PO antibiotics +/- Benzoyl peroxide
56
Psoriasis MC affects the flexor surfaces of elbows and knees? T/F?
False
57
What 3 bacterial should be treated with more than one abx
H.pylori, pseudomonas, enterococcus
58
What would be the percussion note heard over the area of a consollidation in the lung?
Dullness
59
Which lipid lowering agent lower TG substantially, increase HDL?
Fibric acid
60
List 3 possible causes of chronic cough
Asthma, GERD, PND, ACEI
61
Scopolimine and anticholinergic agents are suspected to show what type of AE
Anti SLUD: dry eyes, dry mouth, urinary retention, constipation
62
What is the drug tx of choice for pityriasis rosea
Symptomatic, no drug
63
Which generation of FQ has the best gram + coverage
4th generation (respiratory FQ)
64
What is herpatic whitloe?
Herpatic infection of the finger
65
Name the drug classes used to treat GERD from least to most aggressive:
Least: Antacid, H2RA
Most: PPI
66
Which common GI diagnostic procedure should not be used with pts with acute diverticulitis
conoscopy
67
what is necessary after a long term of topical corticosteroids
Taper
68
What is an appropriate first line tx w/paroxysysmal ventricular tachycardia
Valsalva or carotid sinus massage
69
What is the recommended tx for anticipatory N/V?
Lorazepam (Benzo)
70
what are 3 conditions that cause symmetric enlargement of the abdomen?
Gas, fat, fluid
71
Three possible AE of topical corticosteroids
Acne, striae, atrophy, purpura
72
Two modifiable risk factors for heart disease
Exercise and diet, smoking, ETOH, decrease cholesterol, HTN
73
Which class of medication decreases gastric acid secretion the most?
PPI
74
What physical exam finding would you expect to hear auscultating the heart of the pt who you suspected to have an atrial septal defect?
A fixed split S2
75
What should the maintenance IV fluid rate be in an otherwise healthy euvolemic patient?
90ml/hr
76
Which lab test confirms active infection and infectivity of Hep B virus?
Hep B surface antigen
77
What is the recommended drug treatment for COPD management for a pt in group B?
SA + LA + influenza and pneumococcal vaccine
78
What are the major jones criteria
Carditis, polyarthritis, chorea, nodules and erythema mirginata
79
Tx of choice for highly chemo induced N/V
Zofran, dexamethasone
80
3 sxs of end organ damage from HTN
ventricular hypertrophy, AV nicking, rental failure, carotid disease, TIA
81
Which GI drug is CI in pregnancy and why?
Misoprostol b/c its a prostaglandin and it induces labor and causes uterine contractions
82
2nd heart sound is caused by the closer of what valves
Aortic and pulmonic valves
83
What should you start at the same time you prescribe a narcotic analgesic?
Fluids, physical activity and my need Bisacodyl (stimulate)
84
Which electrolyte imbalance causes flattening of the T waves on the EKG
K+
85
What is the LD goal for a pt with DM
<70
86
You are assessing the pt for problem drinking, you describe to them that the normal amt of alcohol in one drink is?
1.5 oz in a single mixed drink
87
What outcomes do ACEI have in heart failure treatment
Slow the progression, ventricular remodeling (BB reverse remodeling)
88
What is the name of the criteria used to predict morbidity and mortality in pancreatitis?
Ranson's criteria
89
What agen can be used in diabetic gastroparesis and GERD?
Metocloperamide
90
What tests assess the % of bound Hgb on the RBCs?
O2 sat
91
What is the tx of choice for Cdiff?
Metronidazole
92
What are osler nodes?
Lesions on the hand in endocarditis
93
What are the most likely bacterial pathogens in CAP?
C, M, S pneumo, Legionella
94
Which ENT condition is a true emergency?
Epiglottitis
95
What is the recommended therapy for pregnancy induced N/V?
Pyridozine and Doxylamine
96
Which part of the artery do atherosclerotic lesions form
Intima
97
What is used to treat sever recalcitrant acne?
Isotretinoin
98
Which two viral Hep agents are usually transmitted by annoculation of blood?
B, C
99
What are the 3 MC causes of PUD?
MC to least: H. pylori, NSAID, Stress induced
100
Ludwigs angina is an infection of what area?
Between hyoid bone and floor of mouth
101
One month hx of pain and tinging in index finger. What maneuvers would you perform?
Tinnels, Phalens
102
Excess DA sxs?
Hallucination, confusion, GI (N/V), orthostasis
103
How long can sutures be left on the face?
3-5 days
104
Chronic back pain, decreased proprioception. What part of the spinal cord is most likely affected?
Posterior columns
105
Total duration of abx for complicated pyelo
Inpt: 14 days
Outpt: 7-10 days
106
Function of the lens
Focus light on retina
107
Right sided eye pain, blurred. Dendritic ulcer on Right cornea. Most likely diagnosis?
Herpes opthalmicus
108
What class of migraine treatment can cause chest pain in some pts
Triptan
109
4 risk factors for stroke?
HTN, age, Afib, smoking
110
Hernia MC in females
Direct
111
Class used to treat open angle can cause bradycardia
BB (Tenolol)
112
Cause of legal blindness >65 yrs in the US?
Macular degeneration
113
Features of the Smith Fracture?
Transverse fracture of the distal radius with volar displacement of the distal fracture.
114
what non opoid analgesic has analgesic and antipyretic effects
APAP
115
Decreased production vs increase distruction?
Reticulocyte count
116
T or F. Digital rectal exam has been known to reduce mortality and morbidity in colon CA
False
117
What meds used to shorten acute MS exacerbation
Prednisone (corticosteroid)
118
3 common sxs of lower UTI
Suprapubi pain, urgency, frequency
119
2 test of evaluting meningial irritation?
Brudzinski and kernig
120
Antidiabetes decreses hepatic production and rarely causes lactic acidosis
Metformin. Class biguanide
121
Abbreviation TTP stand for?
Thrombotic thrombocytopeic purpura
122
MC ortopedics dx for joint treatment in primary care
OA of the knee
123
Anemia of chronic renal failure tx with what agent? MC AE?
EPO, causes HTN
124
Normal fasting BG rate?
70-100
125
Tx maneuver for BPPV
Epiley maneuver. (Hallpike to dx)
126
Opthalmic corticosteroid? What do you need to monitor?
IOP
127
How is a TIA different from a stroke?
Duration, transiet. Resolved <24 hrs (Some say 2 hrs)
128
Feature of a colle's fracture?
Transverse fracture of the distal radius, with dorsal displacement
129
AED causes hirsutism, ataxia, nystagmus?
Phenytoin (PHT)
130
Causes of epididymitis in men <35 vs older men?
Men whores :)
STI's
131
Pt suffers trauma to the knee, laxity of valgus stress. What injury likely to sustain?
MCL tear
132
What 3 things are recommended to slow the progression of diabetic neuropathy.
ACEI, BP control, BG control
133
T or F. Varicose veins may results as a complication of DVT.
True
134
What are considered first line treatment for urge incontinence?
Antispasmotics and oxybutynin
135
What is the MC organism causing a UTI
E. coli
136
What is the onset of typical cases of food poisoning?
1-8 hours after ingestion
137
What is the recommended treatment for anemia, high TIBC, low ferritin, low serum iron
200mg elemental iron PO in 2-3 divided doses.
325mg PO TID
138
Name the two coagulation pathways
Intrinsic and Extrinsic
139
After satisfactory surgical repair of any hernia how long is traditionally recommeded to avoid heavy lifting
4-6wks
140
Pharm therapy for obesity should be considered for patients with a BMI of what?
>27 with greater than 2 obesity related risk factors or >30
141
Single most important factor in obesity
Genetics
142
Macular degeneration looses sight in what area of vision
Central
143
Bacterial meningitis what empiric tx is recommended in 1mo to 50yo?
Ceftriaxone and Vancomycin
144
Define thrombocytopenia
Low platelet count (nl 150,000-450,000)
145
What % of men with elevated PSA levels are ultimately diagnoses with prostate cancer?
30%
146
What drug class is recommended BPH when prostate is over 30 grams and when will it start to work?
5 alpha reducatse inhibitor (Finasteride); 6 months
147
What is the danger in testicular torsion
Losing a testicle; infarction
148
T or F. Verbal orders are commonly used and are acceptable.
False, 25% of error
149
Name the insulin with the longest action
Glargine
150
What is the goal of tx fo all movement D/Os
To restor normal function and improve QOL
151
Name 4 symptoms of concussion
N/V/HA/amnesia, fogginess, difficulty concentrating, easily confused, difficulty remembering, lack of energy, dizziness, balance difficulties, mood changes, irritability
152
What class of antidiabetic delays carbohydrate absorption and helps with posprandial hyperglycemia
Alpha glucosidase inhibitors
153
Leading worldwide cause of microcytic anemia in children
Iron deficiency due to parasitic infections
154
MC presenting sign of hodgkins dz
Painless lymphadenopathy
155
Which type of NSAID decreases GI AE?
Cox 2
156
What is the tx of type 1 and 2 AC separations
RICE, immobilization, pain management
157
MC type of kidney stone associated with proteal infections
Struvate
158
What commonly used AED is eliminated renally and does not have significant drug intx
Gabapentin
159
What is the most serious dz assoc with painless jaundice
Pancreatic Cancer
160
What is the recommended dash daily intake for a normal healthy individual
<2gm
161
What is the antidote for the following 4 congested toxins: opiates, iron, TCA, APAP
Opiates: Naloxone
Iron: Desfuroxime
TCA: Bicarb
APAP: Acetylcistine
162
What is the term used to describe a HA that wakes you from sleep, assoc w/tearing
Cluster HA
163
3 AED that are cytochrome P450 Inducers?
PB
CBZ
PHT
164
What is the name of class of heminopsia confined to one visual quadrant
Quadrantopsia
165
What is the tx of subconjunctival hemorrhage
Watch and wait
166
Cornea something....exudates
Refer to optho
167
MC AE of interferons used to tx MS
HA, myalgia, flu like sxs, injection site rxn, depression
168
Sickle shape collection of blood on a head CT is consistent w/what type of traumatic head injury
Subdural hematoma
169
What is the name of the deformity seen with progressive RA with hyperextension of the PIP, with flexion of the DIP
Swan neck deformity
170
AED for status epilipticus
Lorazepam first, phenytoin second
171
What is a greenstick fx
Incomplete fracture found in children with a portion of the periosteum remaining intact
172
A hospital H&P should be completed within how long?
24 hrs of admission
173
What are the Hgb A1C, LDL, BP goals for a pt with DM
LDL <7%
174
12 yo child is accused of starring off into space a lot?
Absence seizures
175
Interpret the visual acuity score of 20/40
They can see at 20 feet what a normal person can see at 40
176
MC opoid AE and most severe
NVC are most common, respiratory depression most severe (Pts dont develop tolerance to Constipation)
177
2 possible causes of macrocytic anemia
B12, Folate
178
2 diagnostic tests for ataxia
Tandem gait, RAM, finger taps, toe taps
179
3 classes of meds MC used for migraine prophylaxis
BB, TCA, AED
180
Presence of Bence Jones proteins in urine
Multiple Myeloma
181
If an athlete has physiologic anisicoria, what should be done and why
Document! incase they have a concussion/injury later on. (>0.5mm and reactive to light)
182
Drug for tx of acute uncomplicated cystitis
Cipro and TMP/SMX but it depends on E coli resistance patters. <20% use TMP/SMX
183
What are the major cellular targets of HIV
CD4+ cells and Tcells
184
What is the name of sensorineuro hearing loss assoc with aging
Presbycussys
185
How long does aspirin inhibit platelet function
Life of a platelet (7-10 days)
186
The first 3 months following a TIA, what % will progress onto having a stroke?
15%
187
Which toxidrome is characterized by pinpoint pupils?
Opioid
188
T or F. Hot nodules in thyroid signifies malgignancy.
False
189
Name 2 classes of meds that work well in the tx of chronic neuropatic pain
TCA, AED
190
What is the best test to evaluate a patient for gallstones
US
191
3 sxs that suggest psycogenic erectile dysfunction
morning wood, early ejaculation, erection with visual stimuli, intermittent occurrence, able to obtain erection with masturbation
192
Differentiate dizziness with vertigo?
Dizziness has no motion, vertigo is the room spinning
193
Name 2 conditions that petechia may be suggestive of?
ITP, thrombocytopenia
194
3 agents to tx hyperthyroidism
BB, Iodine, antithyroid (PTU, methimazole) K+ iodine, surgery
195
Veravax (Varicella vaccine) in CI in who?
Immunocomprimized, prego
196
Which pts are at high risk for a GI bleed with NSAIDS
>60, ASA use, antiplatelet use, Clopidogrel, bisphosphonates, corticosteriod, hx ulcers, SSRIs, chronic use
197
4 main sxs of parkinson's dz
Tremor, bradykinesia, ataxia, pill rolling
198
Acute bacterial prostatitis in men with a low risk of STI
Cipro, levo, TMP/SMX for 10-14 days
199
Dx of hodgkins dz is based on what diagnostic procedure
Lymph node biopsy
200
Which specific lab tests are required for participation in sports in MN
None
201
What is the single greatest risk factor for hip fx
Age
202
Which radiographic view is most useful in evaluating the cervical spine
Lateral
203
Lateral C-spine xray detects what % of injury
70%
204
Name 3 abx that can be used to tx a UTI in a prego pt
TMP, nitrofurantoin, cephalexin, Augmentin
205
Lump and tightness of throat unrelated to swelling
globus
206
Which toxidrome is characterized by dilated pupils, diaphroesis, elevated temp, elevated BP
Sympathomimetics (Stimulants)
207
What is the MC etiology of duodenal ulcers
H pylori
208
19 yo pt comes in to ER after a car accident in a C collar and spine board. PE reveals no midline tenderness, GCS of 15, not intoicated, complans of his knee which is sore with any movement.
Cannot take of C collar due to distracting injury
209
What empiric abx tx is recommended for epiditimitis for men <35
Ceftriaxone 250mg x1 IM and doxy 100mg PO BID 10-14 days
210
On the exam of a prego pt you notice a bluish purple discoloration of the cervix
chadwick's sign
211
A potentailly life threatening complication of an antipsychotic therapy, altered LOC, rigidity, and fever
Neuroleptic malignant syndrome
212
What are the manes of the specific physical exam findings in carpel tunnel syndrome
Tinnel's and Phalen's
213
Which class of commonly used asthma medicatioon has the most rapid onset of action and the slowest
Shortest is SAB2A and the longest is ICS. LAB2A and oral prednisone are inbetween
214
3 drug classes that can be used to slow the ventricular rate in A fib
BB, CCB (Nondihydropyridine) Dilt/verap and DIgoxin
215
What is the name given to avascular necrosis of the capital femoral epiphysis in children
Leg calve perthes
216
A woman has been on the same oral contraceptive and complains of early to mid cycle break through bleeding and has been on it for 4 months
increase estrogen, check adherence
217
Two categories or classes of drugs used to treat an acute mainic episode in a pt with bipolar disorder
VPA, lithiu, (mood stabilizers) and SGA
218
In a prego pt, where would you expect to find the fundus at 12 and 20 wks
12 wks: just outside the pelvis; 20 wks: at level of umbilicus
219
1st line tx for GAD
SSRI
220
Distant heart sounds, mid line trachea and difuse hyperresonnance to percussion indicative of
COPD
221
Prego woman develops DVT, what should she be D/C on
LMWH or UFH
222
During the luteal phase of the menstrual cycle, which hormones are affecting the endometrium
Progesterone and estrogen
223
3 yr old boy seen in office with 5 days of fever, edema of hands and feet, rash over body, fissuring and erythema of lips and cervical adenopathy. Throat and ASA titer is negative
Kawasaki?
224
3 risk factors for developing PE
Immobility, hypercoagulable state, vascular injury
225
3 clinical uses of TCA
Depression, migraine prophylazis, neuropathic pain
226
MC finding on EKG of person w/longstanding HTN
LVH
227
T or F. Starting ibuprofen will cause someone on warfarins's INR to increase
False. Just will increase bleeding risk
228
4 IADLs
phone use, cooking, shopping, paying bills
229
Which condition is prostatic massage CI and why
Acute prostatitis, risk of bacteremia
230
3mo old infant, single red macular nodular rash on back, causes child no problem Dx/
Hemangioma, watch it and it will resolve on its own
231
Gestational diabetes is treated with what?
Insulin
232
10 yo obese boy pain in left knee, slight limp, displaced femoral head. likely dx?
SCIFE (slipped capital femoral epiphysis?
233
Hernia at internal inguinal ring?
indirect hernai
234
MC cause of CAP in kids >5yo
S. pneumo, Mycoplsma (MC for atypical pneumonia)
235
Endocrine AE for SGA
weight gain, hyperglycemia, increased TG, increase BP, BMI
236
3 main components of advanced directives
Living will, health care agent, DNR/DNI order
237
40 yo female, multiple painful ulcerative lesions on labia? Dx
Herpes
238
Child with sore throat, small vesicles and punched out lesions in mouth and circular rash on palm and sole.
Hand foot mouth: coxacki
239
Moro reflex disappears in
3-6 months
240
3 HTN meds that cause hyperkalemia
ACE, ARB, spironolactone
241
PE specific for acute pericarditis
Pericardial friction rub
242
2 drugs that cause kernicterus in neonate
TMP/SMX and Ceftriaxone
243
TCA with high anticholinergic effects. What are the effects
Anti-SLUD
244
Organism causing botulism
Clostridium botulininum
245
Agent to tx obesity decreases dietary fat absorption
Orlistat
246
Skin condition is greasy yellowish scalp involving eyebrows and eye folds?
Seborrheic dermatitis (Cradle cap)
247
Which aminoglycoside works agains Pseudomonas
Tobramycin
248
How to remove a tick
Use tweezer and pull straight up
249
Translucent papules with keratotic plug and umbilication
Molluscum contagiosum
250
2 phases of roseola infantum
Fever for 3-5 days, rash on neck and trunk
251
Which class of med should not be used to tx parkinson's in pts >60
Anticholinergics
252
How many dtaps and polios should be received by age 7
5dtaps and 4 polio
253
Recommended tx for osteoporosis
bisphosphonate, calcium 1500mg, vit d 800IU, wt bearing exercise
254
4 PE findings in Kawaskai disease
fever, erythema and edema of hands and feet, desquamation of hands and feet, cervical lymphadenopathy, fissuring tongue and strawberry tongue
255
Most signicant thing different in pharmacotherapy for older aldults
Decreased renal clearance
256
Coryza, conjunctival injection, cough, koplik spots, elevated temp
Measles
257
What type of dementia has step wise decline in cognition
vascular
258
3 yo bitten by black widow spider
Antivenom
259
Only indication for oral vanco
C diff
260
Neonates eyes treated at birth for what
Neisseria gonorrhea
261
Tx for pt with sever MS exacerbation
Oral or IV prednison
262
Why is polyuria seen in uncontrolled DM
Due to osmotic diuresis
263
Grasp reflex disappears
3-6mo
264
Which AED is renally eliminated
Gabapentin
265
Pain and laxity to knee on valgus stress
MCL
266
4 risk factors for pressure ulcer
Decreased mobility, nutrition, moisutre, incontinence, friction, age, decreased arteral or blood pressure
267
Colonoscopy findings in Chron's dz
Cobblestonning, skip lesions, rectal sparring
268
Appropriate 1st line tz for smoking cessation
Nicotine replacement, buproprion, wellbutrin, behavioral therapy
269
What does the macula provide in regards to vision
Central vision acutiy, color, night vision
270
3 components of human balance system
biomechanical, sensory, neuromotor
271
MC head trauma in elderly
Subdural hematoma
272
PUD with Hpylori tx
Amoxicillin, clarithromycin and tinidazole with PPI
273
Swan neck deformity associated with what autoimmune contion
RA
274
What med should a pt with persistent asthma be on
ICS and SABA
275
MC extra hepatic source of an elevated alk phose
Bone, placenta
276
What is the endocrine condition mainifested by anorexia, wt loss, increased pigmentation
Addisons disease
