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
2
Q
flat nonpalpable lesion less than 10mm
A
macule
3
Q
flat non-palpable lesion greater than 10mm
A
patch
4
Q
solid rased lesion
A
less than 10mm is a papule
greater than 10mm is a nodule
5
Q
raised, flat topped lesion greater than 10mm
A
plaque
6
Q
circumscribed elevated fluid-filled lesions
A
vesicle is less than 10mm greater than is bulla
7
Q
pus-filled vesicle of bulla
A
pustule
8
Q
transient elevated lesion
A
wheal
9
Q
small punctate hemorrhages that don’t blanch
A
petechiae
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
11
Q
Tx for atopic dermatitis
A
topical corticosteroids antihistamines
12
Q
dermatitis
Dyshidrosis
lichen simplex chronicus
are all part of what category of derm disorders
A
eczematous eruptions
13
Q
drug eruptions
lichen planus
pityriasis rosea
and psoriasis
all fall under what category of derm d/o
A
papulosquamous dzs
14
Q
cold nodules are indicative of
A
not malignancy
15
Q
rosacea and acne vulgaris are both
A
acneiform lesions
16
Q
name the 5 P’s oflichen planus
A
purple, poylgonal, planar, pruritic, papules
w/ scales
17
Q
wickham striae can be seen with this papulosquamous dz
A
Lichen planus
18
Q
fine white lines on the skin lesions of the oral mucosa seen with lichen planus
A
wickham’s striae
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
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
21
Q
tertiary and secondary disorders of the endocrine system are usually seen with lab values
A
that are in the same direction
22
Q
if you were to see elevated levels of ACTH and cortisol what would you suspect
A
cushing’s dz (pituitary adenoma)
23
Q
possible sources of increase in T4 and decrease in TSH
A
graves, toxic goiter, toxic adenoma
24
Q
possible causes of decrease in free T4 and increase in TSH
A
hasimoto’s thyroiditis
25
decrease in cortisol and increase in ACTH
addison's
26
increase in cortisol and decrease in ACTH
adrenal ademona
27
which test is used to follow pts on levothyroxine
TSH
28
what should you do if your pt has s low TSH
decrease the dose of levothyroxine
29
what type of AB would we expect to see in graves
thyroid stimulating (TSH receptor) Ab
30
radioactive iodine seen with decreased uptake is indicative of
thyroiditis (hashimotos, postpartum, deQuervian)
31
diffuse uptake seen with RAIU is indicative of
Grave's dz or TSH secreting pituitary adenoma
32
a hot nodule is indicative of
toxic adenoma
33
cold nodules are indicative of
not malignancy
34
what are the etiologies of hypothyroidism
```
iodine deficiency
hashimoto's thyroiditis
postpartum thyroiditis
pituitary thyroiditis
hypothalmic hypothyroidism
cretinism
Riedel's thyroiditis
```
35
etiologies of hyperthyroidism
```
Graves
toxic multi nodular goiter
TSH secreting pituitary adenoma
excess intake of T3/T4
iatrogenic thyotoxoicosis
```
36
hoarseness of voice is associated with what endocrine d/o
can be seen with hypothyroidism
37
cretinism can be due to
congenital hypothyroidism or maternal hypothyroidism or infant hypopituitarism
38
clinical manifestations of thyroid storm and tx
palpations, tachycardia, atrial fibrillation, high fever, nausea, vomiting, psychosis, tremors
anithyroid meds like propylthiouracil or methimazole (IV)
beta block
IV glucocoticoids
39
grave's dz MC in what populoation
20-40yr women
40
lid lag and pretibial myxedema are clinical manifestations of what dz
grave's
41
TRAb plus iregular RAIU uptake =
toxic multinodular goiter
42
nodular uptake of RAIU seen with TRab is indicative of
toxic adenoma
43
when would ESR help us diagnose hyperthyroidism
in the case of subacute
44
Describe the Iatrogenic cause of Hypothyroidism
resulting from hyperthyroid or thyroid cancer treatment (RAI, thyroidectomy)
45
Describe what an Endemic goiter indicates
iodine deficiency goiter
46
What are additonal tests that confirm hypothyroidism?
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
What is the other name for Hashimoto’s Thyroiditis and why
Chronic Lymphocytic Thyroiditis because lymphocytic infiltration and destruction of thyroid tissue
48
What is the dosing for levothyroxine
1.7mcg/kg po qd (once daily dose, best taken on empty stomach in the morning)
49
What are the side effects of methimazole
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
What are the side effects of PTU
hepatoxicity & agranulocytosis- need to monitor LFT’s, CBC
51
List the Classification of Thyroid Carcinoma
1] Papillary, 2] Follicular, 3] Medullary, 4] Anaplastic
52
Describe the cause of Papillary Thyroid Carcinoma
genetic, radiation exposure
53
second most common, Peak onset ages 40-60, Occurs in females > males (3:1), Rarely associated with radiation exposure
Describe the incidence rate of Follicular Thyroid Carcinoma
54
Describe the prognosis of Follicular Thyroid Carcinoma
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
3-5% of all thyroid cancers; Females affected more than males; Not associated with radiation exposure
Describe the incidence rate of Medullary Thyroid Carcinoma
56
Neuroendocrine tumor that produces calcitonin
Describe Medullary Thyroid Carcinoma
57
Describe the presentation of factors of Anaplastic Thyroid Carcinoma
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
What is the treatment of Anaplastic Thyroid Carcinoma
Requires aggressive treatment plan with surgical resection, radiation and chemotherapy; Low overall cure rate: 5 year survival rate around 5%
59
best initial diagnostic test if you suspect thyroid nodules
fine needle aspiration
60
name the populations you see thyroid cancers in
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
Tria of hypoparathyroidism
hypocalcemia, decreased PTH, increased phosphate
manage with Ca and Vit d
62
MCC of decreased Ca
hypoparathyroidism
63
hypoCa is associated with what QT finding
prolonged
64
shortened QT is associated with what Ca disorder
hyperCa is seen with prolonged PR and QRS widening with shortened QT
65
what type of osteoperosis do we see most commonly associated with postmenopausal pts
mostly trabecular bone loss leading to vertebral compression and wrist fractures
66
what type of bone loss do we mostly commonly see associated with age
trabecular and cortical bone loss leading to hip and pelvic fractures
67
osteopenia score
-1 to -2.5
68
when should you repeat a DEXA scan for pts with a score of - 1.0- -1.5
q5yr
69
when should you repeat a DEXA for pts with a score of - 1.5 to -2.0
q3-5 yr
70
when should you repeat a DEXA for pts with a score less than -2.0
q1-2 yr
71
body weight at risk for osteoperosis
less than 127
72
what type of diuretics have been associated with decreased Ca excretion
Thiazide diuretics
73
genetics occur for what percent of osteoporosis development
40-80%
74
heparin affects of bone
causes bone loss by decreasing bone formation.
75
hormones that effect bone development
estrogens
androgens
vitamin D
parathyroid hormone –
also other factors in the circulation (IGF-1, ILs, prostaglandins, TNF, cytokines)
76
Peak bone mass reached by around
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
Cortical bone changes seen with age
Increased activation/remodeling leads to more porous bones
78
25-OHD3
measure endogenous production and supplementation
79
25-OHD2-
measure of exogenous sources- diet, supplementation
80
normal range of vitamin D
Normal range: 30-100 ng/mL
81
vitamin D deficiency levels
Vitamin D Deficiency: <20ng/mL
82
Vitamin D Insufficiency:
Vitamin D Insufficiency: <30ng/mL
83
maintenance dose of vitamin d3 for deficiency
with maintenance dose of
D3 400-1000IU qd to maintain 25-OH vitamin D level >30
84
Vitamin D Insufficiency tX
Cholecalciferol (D3) 1000-2000IU for 8 weeks, OR
| Ergocalciferol (D2) 50,000IU QW or QOW for 6-8 weeks
85
If PTH elevated and vitamin D low
replace vitamin D, then recheck PTH and D- levels should normalize
86
early onset of this endocrine disorder is associated with increased risk of osteoporosis
DM1
While bone turnover is suppressed in patients in poor glycemic control, bone metabolism returns to normal with normalization of glycemia
87
common tetrad of multiple myeloma
```
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
DEXA stands for
Dual-Energy Xray Absorptiometry
89
T-score value used for
diagnosis in reference to standard database
90
Z-score value used
in reference to age-, sex-, and ethnicity-matched population
91
screening guidlines for osteoperosis
```
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
who should we initiate tx for in osteoperosis
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
Denosumab (Prolia)
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
vitamin D general recommendation
Vitamin D 800-1000 IU/day
95
Ca general recommendation
Calcium 1000-1200 mg/day in divided doses with food intake
96
how to remember the layers of the adrenal cortex and hormones
Glomerulosa
Fasciculata
Reticularis
aldosterone
cortisol
estrogens
97
how to dx addison's
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
clinical manifestation of adrenal crisis
shock is the primary manifestation see n with decrease in blood pressure
as well as abd pain, n//v fever weakness lethargy --> coa
99
tx for adrenal crisis
IV fluids and IV hydrocortisone if addison's dexamethasone if undiagnosed
100
Conn's syndrome
adrenal aldostenoma that causes hyperaldosteronism
tx is excision and spironolactone
101
MCC of hyperaldosteronism
idiopathic seen in women
102
2ndary cause of hyperaldosteronism
renal artery stenosis leading to increased RENIN and secondary increase in aldosterone
CHF, hypovolemia, nephrotic syndrome
103
chronic HTN palpitations headaches and excessive sweating are seen in what endocrine d/o
PHEOCHOMOCYTOMA
tx adrenalextomy
104
growth hormone secreting pituitary adenoma
somatotropinoma
seen with DM and glucose intolerance
confirm with IGF
second most common type
105
adrenocorticotropinomas secrete
ACTH (cushings)
3rd MC type of anteripr pit tumor
106
impaired tolerance seen with what 2 hour glucose test level
140-199
107
hemoglobin A1C that is diagnostic of impaired tolerance
5.7-6.4
108
when should you screen for DM
all adults over 45 every three years or any adult with a BM1 greater than 25 with 1 additional risk factor
any
109
key component of metabolic syndrome
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
