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medicine I Final > Derm overview > Flashcards

Derm overview Flashcards

1
Q

when free T4/T3 are up and TSH is also up what should we suspect

A

TSH secreting pituitary adenoma

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2
Q

flat nonpalpable lesion less than 10mm

A

macule

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3
Q

flat non-palpable lesion greater than 10mm

A

patch

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4
Q

solid rased lesion

A

less than 10mm is a papule

greater than 10mm is a nodule

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5
Q

raised, flat topped lesion greater than 10mm

A

plaque

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6
Q

circumscribed elevated fluid-filled lesions

A

vesicle is less than 10mm greater than is bulla

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7
Q

pus-filled vesicle of bulla

A

pustule

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8
Q

transient elevated lesion

A

wheal

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9
Q

small punctate hemorrhages that don’t blanch

A

petechiae

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10
Q

pruritus
MC in flexor creases
eythematous, ill-defined blisters/papules/plaques
w/ localized development of hives when stroked

A

atopic dermatitis

aka eczema

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11
Q

Tx for atopic dermatitis

A

topical corticosteroids antihistamines

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12
Q

dermatitis
Dyshidrosis
lichen simplex chronicus

are all part of what category of derm disorders

A

eczematous eruptions

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13
Q

drug eruptions
lichen planus
pityriasis rosea
and psoriasis

all fall under what category of derm d/o

A

papulosquamous dzs

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14
Q

cold nodules are indicative of

A

not malignancy

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15
Q

rosacea and acne vulgaris are both

A

acneiform lesions

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16
Q

name the 5 P’s oflichen planus

A

purple, poylgonal, planar, pruritic, papules

w/ scales

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17
Q

wickham striae can be seen with this papulosquamous dz

A

Lichen planus

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18
Q

fine white lines on the skin lesions of the oral mucosa seen with lichen planus

A

wickham’s striae

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19
Q

lichen planus usually resolves in

what is the tx

A

1-2yrs
topical steroids are 1st line AH for pruritis and occlusive dressing

2nd line is PO steroids UVB therapy or retinoids

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20
Q

what is the Tx for pityriasis rosea

A

B/C this is viral it is self limiting

tx for pruritis
uv exposure
doxepin 5%
calamine lotion

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21
Q

tertiary and secondary disorders of the endocrine system are usually seen with lab values

A

that are in the same direction

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22
Q

if you were to see elevated levels of ACTH and cortisol what would you suspect

A

cushing’s dz (pituitary adenoma)

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23
Q

possible sources of increase in T4 and decrease in TSH

A

graves, toxic goiter, toxic adenoma

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24
Q

possible causes of decrease in free T4 and increase in TSH

A

hasimoto’s thyroiditis

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25
Q

decrease in cortisol and increase in ACTH

A

addison’s

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26
Q

increase in cortisol and decrease in ACTH

A

adrenal ademona

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27
Q

which test is used to follow pts on levothyroxine

A

TSH

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28
Q

what should you do if your pt has s low TSH

A

decrease the dose of levothyroxine

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29
Q

what type of AB would we expect to see in graves

A

thyroid stimulating (TSH receptor) Ab

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30
Q

radioactive iodine seen with decreased uptake is indicative of

A

thyroiditis (hashimotos, postpartum, deQuervian)

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31
Q

diffuse uptake seen with RAIU is indicative of

A

Grave’s dz or TSH secreting pituitary adenoma

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32
Q

a hot nodule is indicative of

A

toxic adenoma

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33
Q

cold nodules are indicative of

A

not malignancy

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34
Q

what are the etiologies of hypothyroidism

A 
iodine deficiency
hashimoto's thyroiditis 
postpartum thyroiditis
pituitary thyroiditis 
hypothalmic hypothyroidism 
cretinism
Riedel's thyroiditis
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35
Q

etiologies of hyperthyroidism

A 
Graves
toxic multi nodular goiter
TSH secreting pituitary adenoma
excess intake of T3/T4
iatrogenic thyotoxoicosis
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36
Q

hoarseness of voice is associated with what endocrine d/o

A

can be seen with hypothyroidism

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37
Q

cretinism can be due to

A

congenital hypothyroidism or maternal hypothyroidism or infant hypopituitarism

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38
Q

clinical manifestations of thyroid storm and tx

A

palpations, tachycardia, atrial fibrillation, high fever, nausea, vomiting, psychosis, tremors

anithyroid meds like propylthiouracil or methimazole (IV)
beta block

IV glucocoticoids

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39
Q

grave’s dz MC in what populoation

A

20-40yr women

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40
Q

lid lag and pretibial myxedema are clinical manifestations of what dz

A

grave’s

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41
Q

TRAb plus iregular RAIU uptake =

A

toxic multinodular goiter

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42
Q

nodular uptake of RAIU seen with TRab is indicative of

A

toxic adenoma

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43
Q

when would ESR help us diagnose hyperthyroidism

A

in the case of subacute

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44
Q

Describe the Iatrogenic cause of Hypothyroidism

A

resulting from hyperthyroid or thyroid cancer treatment (RAI, thyroidectomy)

45
Q

Describe what an Endemic goiter indicates

A

iodine deficiency goiter

46
Q

What are additonal tests that confirm hypothyroidism?

A

1] Positive TPOAb or TgAb in autoimmune disease, 2] Decreased uptake on thyroid scan, 3] Additional lab findings can include anemia, elevated LDL, hyponatremia

47
Q

What is the other name for Hashimoto’s Thyroiditis and why

A

Chronic Lymphocytic Thyroiditis because lymphocytic infiltration and destruction of thyroid tissue

48
Q

What is the dosing for levothyroxine

A

1.7mcg/kg po qd (once daily dose, best taken on empty stomach in the morning)

49
Q

What are the side effects of methimazole

A

agranulocytosis/neutropenia. Should have baseline CBC w/diff prior to tx and monitor during tx. Neutropenia typically occurs in first couple months and higher dose of therapy increases likelihood of ADE.

50
Q

What are the side effects of PTU

A

hepatoxicity & agranulocytosis- need to monitor LFT’s, CBC

51
Q

List the Classification of Thyroid Carcinoma

A

1] Papillary, 2] Follicular, 3] Medullary, 4] Anaplastic

52
Q

Describe the cause of Papillary Thyroid Carcinoma

A

genetic, radiation exposure

53
Q

second most common, Peak onset ages 40-60, Occurs in females > males (3:1), Rarely associated with radiation exposure

A

Describe the incidence rate of Follicular Thyroid Carcinoma

54
Q

Describe the prognosis of Follicular Thyroid Carcinoma

A

Considered more aggressive, Prognosis directly related to tumor size <1.0 cm = good prognosis, can be Angioinvasive with hematogenous spread but Spread to lymph nodes is uncommon (~10%) and so is Distant spread, Cure rate 95% for small lesions in young patients

55
Q

3-5% of all thyroid cancers; Females affected more than males; Not associated with radiation exposure

A

Describe the incidence rate of Medullary Thyroid Carcinoma

56
Q

Neuroendocrine tumor that produces calcitonin

A

Describe Medullary Thyroid Carcinoma

57
Q

Describe the presentation of factors of Anaplastic Thyroid Carcinoma

A

1] rapidly growing hard neck mass
2] long-standing goiter that suddenly increases in size
3] rapid growth with extensive local invasion and metastasis

58
Q

What is the treatment of Anaplastic Thyroid Carcinoma

A

Requires aggressive treatment plan with surgical resection, radiation and chemotherapy; Low overall cure rate: 5 year survival rate around 5%

59
Q

best initial diagnostic test if you suspect thyroid nodules

A

fine needle aspiration

60
Q

name the populations you see thyroid cancers in

A

papillary=females w/radiation exposure

follicular=40-60 yo with iodine deficiency

medullary= not associated w/ radiation and associated with MEN 2

Anaplastic= MC in males over 65 and can occur after many years of radiation exposure

61
Q

Tria of hypoparathyroidism

A

hypocalcemia, decreased PTH, increased phosphate

manage with Ca and Vit d

62
Q

MCC of decreased Ca

A

hypoparathyroidism

63
Q

hypoCa is associated with what QT finding

A

prolonged

64
Q

shortened QT is associated with what Ca disorder

A

hyperCa is seen with prolonged PR and QRS widening with shortened QT

65
Q

what type of osteoperosis do we see most commonly associated with postmenopausal pts

A

mostly trabecular bone loss leading to vertebral compression and wrist fractures

66
Q

what type of bone loss do we mostly commonly see associated with age

A

trabecular and cortical bone loss leading to hip and pelvic fractures

67
Q

osteopenia score

A

-1 to -2.5

68
Q

when should you repeat a DEXA scan for pts with a score of - 1.0- -1.5

A

q5yr

69
Q

when should you repeat a DEXA for pts with a score of - 1.5 to -2.0

A

q3-5 yr

70
Q

when should you repeat a DEXA for pts with a score less than -2.0

A

q1-2 yr

71
Q

body weight at risk for osteoperosis

A

less than 127

72
Q

what type of diuretics have been associated with decreased Ca excretion

A

Thiazide diuretics

73
Q

genetics occur for what percent of osteoporosis development

A

40-80%

74
Q

heparin affects of bone

A

causes bone loss by decreasing bone formation.

75
Q

hormones that effect bone development

A

estrogens
androgens
vitamin D
parathyroid hormone –

also other factors in the circulation (IGF-1, ILs, prostaglandins, TNF, cytokines)

76
Q

Peak bone mass reached by around

A

age 30bone remodeling continues, but you lose slightly more bone mass than you gain.
Osteopenia refers to having bone mineral density (BMD) that is below normal levels but not low enough to be classified as osteoporosis. A precursor to Osteoporosis.

77
Q

Cortical bone changes seen with age

A

Increased activation/remodeling leads to more porous bones

78
Q

25-OHD3

A

measure endogenous production and supplementation

79
Q

25-OHD2-

A

measure of exogenous sources- diet, supplementation

80
Q

normal range of vitamin D

A

Normal range: 30-100 ng/mL

81
Q

vitamin D deficiency levels

A

Vitamin D Deficiency: <20ng/mL

82
Q

Vitamin D Insufficiency:

A

Vitamin D Insufficiency: <30ng/mL

83
Q

maintenance dose of vitamin d3 for deficiency

A

with maintenance dose of

D3 400-1000IU qd to maintain 25-OH vitamin D level >30

84
Q

Vitamin D Insufficiency tX

A

Cholecalciferol (D3) 1000-2000IU for 8 weeks, OR

Ergocalciferol (D2) 50,000IU QW or QOW for 6-8 weeks

85
Q

If PTH elevated and vitamin D low

A

replace vitamin D, then recheck PTH and D- levels should normalize

86
Q

early onset of this endocrine disorder is associated with increased risk of osteoporosis

A

DM1

While bone turnover is suppressed in patients in poor glycemic control, bone metabolism returns to normal with normalization of glycemia

87
Q

common tetrad of multiple myeloma

A 
A mnemonic sometimes used to remember the common tetrad (four parts) of multiple myeloma is
 CRAB
C = Calcium (elevated),
 R = Renal failure,
 A = Anemia,
 B = Bone lesions.
Bone pain common in MM
88
Q

DEXA stands for

A

Dual-Energy Xray Absorptiometry

89
Q

T-score value used for

A

diagnosis in reference to standard database

90
Q

Z-score value used

A

in reference to age-, sex-, and ethnicity-matched population

91
Q

screening guidlines for osteoperosis

A 
For post-menopausal women younger than age 65 a bone density test is indicated if they have a risk factor for low bone mass such as;
     Low body weight
     Prior fracture
     High risk medication use
     Disease or condition 
    associated with bone loss.
-
Women during the menopausal transition with clinical risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use.

Men aged 70 and older.

For men < 70 years of age a bone density test is indicated if they have a risk factor for low bone mass such as;
Low body weight
Prior fracture
High risk medication use
Disease or condition associated with bone loss.

92
Q

who should we initiate tx for in osteoperosis

A

Initiate pharmacologic treatment:
– In those with hip or vertebral fractures (clinical or asymptomatic)

– In those with T-scores ≤−2.5 at the femoral neck, total hip, or lumbar spine by DXA

– In postmenopausal women and men age 50 and older with low bone mass (T-score between −1.0 and −2.5, osteopenia) at the femoral neck, total hip, or lumbar spine by DXA and a 10-year hip fracture probability ≥3 % or a
10-year major osteoporosis-related fracture probability ≥20 % based on the USA-adapted WHO

93
Q

Denosumab (Prolia)

A

RANK-Ligand inhibitor
Indicated for PMP women with high risk of fracture, or failure of other therapy options

Reduces incidence of vertebral, non-vertebral and hip fractures
ADE include back pain, hypercholesterolemia, hypocalcemia

94
Q

vitamin D general recommendation

A

Vitamin D 800-1000 IU/day

95
Q

Ca general recommendation

A

Calcium 1000-1200 mg/day in divided doses with food intake

96
Q

how to remember the layers of the adrenal cortex and hormones

A

Glomerulosa
Fasciculata
Reticularis

aldosterone
cortisol
estrogens

97
Q

how to dx addison’s

A

high dose cosyntropin if little or no increase in cortisol it is adrenal insufficiency

normally we would see a ris in cortisol in response to increase in ACTH (corsyntropin)

98
Q

clinical manifestation of adrenal crisis

A

shock is the primary manifestation see n with decrease in blood pressure

as well as abd pain, n//v fever weakness lethargy –> coa

99
Q

tx for adrenal crisis

A

IV fluids and IV hydrocortisone if addison’s dexamethasone if undiagnosed

100
Q

Conn’s syndrome

A

adrenal aldostenoma that causes hyperaldosteronism

tx is excision and spironolactone

101
Q

MCC of hyperaldosteronism

A

idiopathic seen in women

102
Q

2ndary cause of hyperaldosteronism

A

renal artery stenosis leading to increased RENIN and secondary increase in aldosterone

CHF, hypovolemia, nephrotic syndrome

103
Q

chronic HTN palpitations headaches and excessive sweating are seen in what endocrine d/o

A

PHEOCHOMOCYTOMA

tx adrenalextomy

104
Q

growth hormone secreting pituitary adenoma

A

somatotropinoma

seen with DM and glucose intolerance
confirm with IGF

second most common type

105
Q

adrenocorticotropinomas secrete

A

ACTH (cushings)

3rd MC type of anteripr pit tumor

106
Q

impaired tolerance seen with what 2 hour glucose test level

A

140-199

107
Q

hemoglobin A1C that is diagnostic of impaired tolerance

A

5.7-6.4

108
Q

when should you screen for DM

A

all adults over 45 every three years or any adult with a BM1 greater than 25 with 1 additional risk factor

any

109
Q

key component of metabolic syndrome

A

insulin resistance

FFA are released which increases TG and glucose production as well as insulin sensitivity

at least 3 of the 5

  1. decreased HDL
  2. increased BP
  3. increased fasting TG
  4. increased fasting BG
  5. increased abdominal obesity

medicine I Final (2 decks)

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