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Level 2 Boards > Dermatology/ Endocrinology > Flashcards

Dermatology/ Endocrinology Flashcards

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1
Q

Infant with history of eczema give corticosteriods develops new rash and fever

Group monomorphic vesicles involving eczematous areas of infants extremities and face

Tx

A

Eczema herpeticum

Medical emergency

Due to propensity for HSV infection to spread systematically potentially affecting the brain

IV acyclovir immediately

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2
Q

Tx eczema

A

Corticosteroids are first line

Topical calcineurin inhibitors (tacrolimus) used for moderate to severe

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3
Q

Tx contact dermatitis

A

Corticosteriods

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4
Q

Severe red diaper rash with yellow scale, erosions and blisters

Cradle cap

Tx

A

Seborrheic dermatitis

Tx: adult- keroconazole, selium sulfide or zinc pyrithione shampoos and topical antifungals

Infant- routine bathing and application of emollients

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5
Q

Rash on extensor surface

A

Psoriasis

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6
Q

Rash on flexor surfaces

A

Atopic dermatitis

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7
Q

Biopsy of psoriasis

A

Elongated rete ridges

THickened epidermis

Absent granular cell layer

Preservation of nuclei in stratum corneum (parakeratosis)

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8
Q

Drug rash typically occurs

A

7-14 days later

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9
Q

Target lesions

Negative Nikolsky

A

Erythema multiforme

Supportive tx

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10
Q

Drugs that cause Stevens johnson syndrome or toxic epidermal necrosis

A 
Sulfonamides
Penicillin
Seizure medication (phenytoin, carbamazepine)
Quinolones
Cephalosporins
Steriods
NSAIDS
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11
Q

Erythema nodosum

A

Painful nodules on shins

Inflammatory process of subcutaneous adipose tissue triggered by infection (Strep, coccidioides, Yersinia, TB) drugs (sulfonamides, antibiotics, OCP) and chronic inflammatory disease (sarcoidosis, Crohns, UC, Behcet disease)

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12
Q

Blister

  • Nikolsky sign
A

Bullous pemphigoid

Autoantibodies against hemidesomes

Topical steroids

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13
Q

Flaccid blister

A

Pemphigus Vulgaris

Anti-desmosoglein

+ Nikolsky sign

High dose steroids (prednisone) + immunomodulatory therapy (azathioprine, mycophenolate mofetil, IVIG, rituximab)

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14
Q

Vesicles and erosions

Pruritic papules, vesicles, bullae, on elbows, knees, buttock, neck and scalp

Associated with

Tx

A

Dermatitis herpetiformis

Celiac disease

Dapsone and gluten free diet

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15
Q

Giant cells on Tzank smear

A

Herpes

Multinucleated

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16
Q

Cervical cancer

Genital warts

A

CC: HPV 16 and 18

Genital warts: HPV 6 and 11

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17
Q

Test for HPV

A

PCR

or Acetic acid turns lesion white

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18
Q

Tx Genital warts

A 
Cryotherapy
Podophyllin
Trichloroacetic acid
Imiquimod
5-FU
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19
Q

Impetigo caused by

Tx

A

Streptococcal
Staph

Localized: Mupirocin

Severe (Non-MRSA) : Oral Cephalexin, dicloxacillin or erythromycin

Severe (MRSA): Oral trimethoprim- sulfamethoxazole, clindamycin, or doxycycline

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20
Q

Bullous Impetigo

A

Always Staph aureus

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21
Q

Small pink papules on trunk in groups 10-20

Fever

GI involvement

Dx?
Tx?

A

Salmonella typhi

Fluoroquinoles and third generation cephalosporins

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22
Q

Necrotizing fasciitis caused by

Tx

A

S aureus
E. Coli
Clostiridium perfringens

TX: Surgical debridement
Pencillin (strep)
Clindamycin (decrease exotoxin production)

Anaerobic coverage: metronidazole or third gen cephalosporin

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23
Q

Tx Folliculitis severe

A

Topical mupirocin

Severe: cephalexin or dicloxacillin orally, escalating to clindamycin or doxycycline if MRSA

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24
Q

Progression of acne tx

A

Topial benzoyl peroxide, retinoid, or antibiotic —> oral antibiotic —> oral isotretinoin

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25
Q

Papules that drain odorless fluid

Gardener

A

Sporotrichosis

Sporothrix schenckii- fungus in plants

Lesion along lymphatic drainage lines

Itraconazole

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26
Q

Isotretinoin check what

A

B-HCG

LFT

Cholesterol

Triglycerides

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27
Q

Fish like scales

Dry

A

Ichthyosis vulgaris

Inherited mutation of filaggrin gene

Tx: Emollients, keratolytics, and topical tertinoids

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28
Q

Brown waxy papules

stuck on

A

SEborrheic keratosis

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29
Q

Ulcer on site of scar, burns or ulcer

A

Marjolin ulcer

Rare SCC

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30
Q

Multiple red to violaceous macules, papules or nodules that can progress to plaques

Lower limbs, back, face, mouth and genitalia

A

Kaposi sarcoma

Vascular proliferative disease
HHV-8

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31
Q

Pigmented patch on palm or sole
Slowly spreading

African american or Asians

A

Acral lentiginous

Type of Melanoma

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32
Q

Melanoma tx

A

Systemic chemotherapy

Doxorubicin
Paclitaxel
Interferon-alpha

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33
Q

Inhibits hepatic gluconeogenesis and increases peripheral sensitivity to insulin

SE

CI

A

Metformin (first line)

WL
GI upset
Lactic acidosis

CI: Elderly >80 with

  • renal insufficiency
  • hepatic failure
  • or heart failure
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34
Q

Increases endogenous insulin secretion

SE

A

Sulfonylureas

  • Glipizide
  • Glyburide
  • Glimepiride

SE

  • Hypoglycemia
  • Weight gain
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35
Q

Increase insulin sensitivity

SE

CI

A

Thiazolidinediones

  • Rosiglitazone
  • Pioglitazone

SE

  • WG
  • Edema
  • Hepatotoxicity
  • Bone loss

CI in those w/ heart failure

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36
Q

Inhibit degradation of GLP-1
Increase insulin secretion
Decrease glucagon secretion

A

DDP-4 inhibitors
- Sitagliptin
- Linagliptin
( liptins )

Weight neutral

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37
Q

GLP-1 agonists
Delays absorption of food
Increases insulin secretion
Decrease glucagon secretion

SE

A

Incretins
- Exenatide
- liraglutide
(-tides)

Injected subcutaneously

SE:
Slow GI motility
Nausea
Pancreatitis
WL
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38
Q

Inhibit SGLT2 in proximal tubule to decrease glucose reabsorption

SE

A

SGLT2 inhibitors
- Dapagliflozin
(-flozin)

UTIs
Vulvovaginal candidiasis
WL
Decrease blood pressure

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39
Q

Decrease intestinal absorption of carbohydrates

SE

A

Alpha-glucosidase inhibitors

  • acarbose
  • miglitol

Flatulence
Diarrhea
Hypoglycemia

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40
Q

SE Insulin

A

WG

Hypoglycemia

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41
Q

1) Glipizide
2) Rosiglitazone
3) Sigagliptin
4) Exenatide
5) Glyburide
6) Acarbose
7) Liraglutide
8) Linagliptin
9) Pioglitazone
10) Dapagliflozin
11) miglitol
12) glimepiride

A

1) Glipizide= Sulfonylurea
2) Rosiglitazone= Thiazolidinediones
3) Sitagliptin= DDP-4 inhibitors
4) Exenatide= Incretins
5) Glyburide= sulfonylurea
6) Acarbose= alpha-glucosidase inhibitor
7) liraglutide= Incretins
8) linagliptin= DDP-4 inhibitors
9) pioglitazone= Thiazolidinediones
10) Dapagliflozin= SGLT2 inhibitors
11) miglitol= alpha-glucosidase inhibitor
12) glimepiride= sulfonylurea

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42
Q

Type 1 Diabetes diagnosis

A

1) Random plasma glucose level >= 200 plus symptoms
2) Fasting >8 hr plasma glucose >= 126 on two occasions
3) 2 hr postprandial glucose level >= 200 following an oral glucose tolerance test. Hemoglobin A1C > 6.5%

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43
Q

Type 2 diabetes diagnosis

A

Fasting glucose (first line)
HbA1C > 6.5% is diagnostic
2 hr oral glucose tolerance test

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44
Q

When to test for diabetes

A

at 45 y.o

every 3 years if < 5.7%

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45
Q

Drug that can cause thyroid issues

A

Amiodarone

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46
Q

Hyperthyroidism tx

A

Propranolol to manage symptoms

Antithyroid medication

  • Methimazole
  • Propylthiouracil
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47
Q

Tx Thyroid storm

A

AF
Fever
Delirium

Beta blockers
Antithyroid drugs (propylthiouracil or methimazole)

Give high dose potassium iodine 1 hr after antithyroid medication

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48
Q

Propythiouracil SE

A

Allergic reaction
Rash
Arthralgias

Agranulocytosis

Vasculitis

Liver failure (black box)

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49
Q

Methimazole SE

A

Allergic reaction

CI in pregnancy

Agranulocytosis

Cholestasis*

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50
Q 
Severe hypothyroidism
Decrease mental status
Hypothermia
Hypotension
Bradycardia
Hypoglycemia
Hypoventiliation
A

Myxedema coma

IV levothyroxine
IV hydrocortisone

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51
Q

Most common thyroid neoplasm

A

Papillary

Slow growing

Thyroid hormone producing follicular cells

Psammoma bodies

Lymphatic spread

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52
Q

Thyroid tumor

Calcitonin

A

Medullary

Calcitonin-producing C cells

Conside MEN2A or 2B

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53
Q

Bisphosphonates

A

Alendronate
Risedronate
Ibandronate
Zoledronic acid

SE

  • Reflux
  • Esophagitis
  • Esophageal ulcers
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54
Q

DEXA scan when

A

Women >65

Men > 70

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55
Q

1) Teriparatide
2) Denosumab
3) Raloxifene

A

1) Teriparatide
- PTH analogue
- Tx Osteoporosis

2) Denosumab
- A monoclonal ab to RANK-L
- TX osteoporosis

3) Raloxifene
- SERM
- Tx osteoporosis

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56
Q

Increased Alkaline phosphatase

Normal gamma-glutamyl transpeptidase (GGT)

A

Bone etiology

not liver

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57
Q

Hats dont fit anymore

  • disease
  • associated symptom
  • x ray appearance
  • lab values
  • tx
A

Paget disease of bone

Hearing loss

Plain X ray shows: lytic and sclerotic lesions (diagnostic)
Mosaic lamellar bone pattern

Increased Alk Phos
Normal Ca and phosphate levels

Bisphosphonates (first line)
Calcitonin (if intolerant to bisphosphonates)
Calcium and Vit D supplements

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58
Q

Bone pain

Hearing loss

A

Paget disease of bone

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59
Q

Elevated PTH
Hypocalcemia
Hyperphosphatemia

Associated with

A

Pseudohypoparathyroidism

PTH resistance

Albright hereditary osteodystrophy
- shortened fourth and fifth metatarsal or metacarpal bones
[Marshmallow baby]

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60
Q

Elevated PTH
NL/Decreased Calcium
Elevated/NL PO4

A

Secondary hyperparathyroidism

  • Renal insufficiency (causes decrease production of 1-25 dihydroxyvitamin D)
  • Calcium deficiency
  • Vit D deficiency
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61
Q

Decreased PTH
Increased Calcium
Nl/Decreased Po4

A

Ectopic PTHrP

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62
Q

Cushing syndrome vs Cushing disease

A

Cushing syndrome
- Too much cortisol

Cushing disease

  • Too much cortisol from an ACTH producing pituitary adenoma
  • Low dose dexamethasone= remains elevated
  • Suppressed with high dose
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63
Q

Acromegaly diagnosis

Tx

Complication

A

IGF-1 levels (increased)

Confirm w/ oral glucose supression test (GH levels will remain elevated despite glucose administration)

Tx: Transphenoidal surgical resection
Octreotide or lanreotide (somatostatn analogues) suppress GH secretion
Pegvisomant (GH receptor antagonist) block peripheral actions of GH

CHF leading cause of death

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64
Q

Hyperprolatinemia tx

A

Dopamine agonists

  • Cabergoline
  • Bromocriptine

Resection if >= 3 cm

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65
Q

Diabetes insipidus MOA

Diagnosis

A

Cant concentrate urine due to ADH dysfunction

Central: Posterior pituitary fails to secrete ADH

Nephrogenic: ADH resistance

  • Renal disease
  • Lithium
  • Demeclocycline

Water deprivation test fails

Desmopressin acetate replacement test (DDAVP)

  • Central: Decrease urine output increase urine osm
  • Nephr: NO effect
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66
Q

SIADH

Tx

A

Inappropriate ADH secretion

Tx: Fluid restriction
If severe ADH antagonists
- Tolvaptan
- Conivaptan

Chronic SIADH: Demeclocycline

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67
Q

Low cortisol

Increased ACTH

A

Primary adrenal insufficency

Skin pigmentation
Decreased glucocorticoids
Decreased minerlocortcioids

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68
Q 
HTN
Headache
Polyuria
Muscle weakness
Hypokalemia

Tx

A

Hyperaldosteronism

Tx:

  • Adenoma: resection
  • Bilateral hyperplasia: aldosterone receptor antagonist (eplerenone)
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69
Q

Elevated 17-hydroxyprogesterone

A

21-hydroxylase deficiency

Fluid resuscitation
Salt repletion
Give Cortisol to decrease ACTH and adrenal androgens
FLudrocortisone if severe

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70
Q

Precocious puberty in male

Salt wasting

A

21 hydroxylase

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71
Q

Female: Virilization

Increased renin activity

A

21 hydroxylase

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72
Q

Female virilzation
Decrease Renin activity
Decreased aldosterone
Increase BP

A

11beta-hydroxylase

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73
Q

Fmale virilzation
Ambiguous external genitalia

NO electrolyte or BP abnromalities

A

Congenital aromatase deficiency

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74
Q

MEN 1

A

Pancreas
Pituitary
Parathyroid

Gastrinomas/ Insulinomas

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75
Q

MEN 2A

A

Medullary carcinoma of thyroid
Pheochromocytoma or adrenal hyperplasia
Parathyroid gland hyperplasia

RET proto-oncogene

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76
Q

MEN 2B

A

Medullary carcinoma
Pheochromocytoma
Oral and intestinal ganglioneuromatosis (mucosal neuromas)

Marfanoid habitus

RET proto-oncogene

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77
Q

Basal cell carcinoma margins

A

Surgical excision with narrow margin

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78
Q

Eczema
Nonblanching purple lesions on buttocks and thighs

Pain w/ passive range of motion of hips

Abdominal pain

Also see

A

Henoch Schonlein purpura

Hematuria followed by mild proteinuria

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79
Q

Elevated Ca

Low Phos

A

Decreased secretion of PTH

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80
Q

Elevated BUN
Elevated Creatinine
Hypercalcemia

Polyuria
Polydipsia

A

Milk-Alkali syndrome

Excessive intake of calcium and absorbable alkali

Antiacids (Calcium carbonate) for heart burn

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81
Q 
Hypercalcemia 
WL
Temporal wasting
Low phos
Increased Creatinine
Increased Alk phos
A

Elevated PTHrP

Hypercalcemia of malignancy

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82
Q

Irregular periods

Coarse hair on chin

A

Polycystic ovary syndrome

Give OCP

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83
Q

Musty odor

Dx

A

Pheylketonuria

AR

Mutation in phenylalanine hydroxylase

Dx: Quantitative amino acid analysis (increased pheylalanine levels)

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84
Q

Infant given Fruits and vegetables

Vomiting
Poor feeding
Lethargy

Seizures

A

Aldolase B deficiency

Hereditary fructose intolerance

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85
Q

First few days of life

Jaundice
Hepatomegaly
Failure to thrive after consumption of breast milk or formula

A

Galactosemia

Absence of galactose-1 phosphate uridyl transferase

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86
Q

Forced flexion of wrist when taking blood pressure

Hyperreflexia

A

Hypocalcemia

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87
Q

Hemorrhage during labor

Unable to breast feed

ACTH
Serum Na
Serum K

A

Sheehan syndrome

Adrenal insufficiency

Cortisol deficiency

Cortisol normally inhibits ADH —> SIADH and hyponatremia

Adrenal cortex not affected, aldosterone synthesis unaffected, potassium is normal

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88
Q

Craniotabes (skull bones that depress w/ pressure)

Widened wrists

Delayed fontanel closure

Swelling of wrist

A

Rickets

Vit D deficiency

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89
Q

Fontanel closure

A

9-18 months from anterior fontanel to close

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90
Q

HTN
Hemangioblastomas
Painless vision loss
Headaches

Father has hearing impairment and intracranial hemorrhage

Cause of HTN

A

Von Hippel Lindau disease

Pheochromocytoma

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Perfectly
91
Q

Episodic flushing
Wheezing
Diarrhea
Murmur

Risk of deficiency of

A

Carcinoid syndrome

Tricupsid regurgitation

Niacin deficiency

Dx: 5-HIAA
CT/MRI of abdomen and pelvis for tumor

Ocetreotide prior to surgery

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92
Q

Started breast feeding and then vomiting

Jaundice
Hepatomegaly

Ecoli infxn

Elevated liver enzymes
Conjugated hyperbilirubinemia

A

Galactosemia

GALT deficiency

Inability to metabolize galactose to glucose

AR

Cataracts

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93
Q

Inadequate NADPH production for oxidative injury protection

A

G6PD deficiency

Jaundice
Hemolytic anemia
Liver enzymes normal

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94
Q

Loss of function mutation in the WAS gene

A

Wiskott-Aldrich syndrome

Recurrent infxn
Eczema
Thrombocytopenia

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95
Q

Mutation in proteins linking the red blood cell membrane to its cytoskeleton

A

Spherocytosis

Jaundice
Hemolytic anemia
Increased MCHC

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96
Q

Single amino acid substitution within the beta globin chain

A

Sickle cell disease

Hemolytic anemia

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97
Q

Exercise on glucose

A

Exercise increased uptake of glucose

Exercise induced hypoglycemia

If diabetic need to reduce insulin dose

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98
Q

Prolactinoma 1.5 cm

A

Prolactin level > 200

ow LH

Normal TSH

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99
Q

Tx Tinea pedis

A

Miconazole cream

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100
Q

Cephalexin is for

A

Cellulitis

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101
Q

Triamcinolone

A

Topical corticosteroid

Tx acute contact dermatitis

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102
Q

Nystain used for

A

Candida infections

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103
Q

Primary polydipsia vs Diabetes insipidus

A

Primary polydipsia
- low Na and dilute urine

Diabetes insipidus
> Na w/ dilute urine

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104
Q

Tx Ring worm

A

Topical antifungals (clotrimazole, terbinafine)

105
Q

Tx Bartonella henselae

A

Cat scratch

Azithromycin

106
Q

HTN
Undetectable plasma renin level

Hypokalemia

A

Primary hyperaldosteronism

Hypernatremia
Metabolic alkalosis

107
Q

Upper lip cancer

A

Basal

108
Q

Lower lip cancer

A

SCC

109
Q

Blisters on back of hands after being in sun

Untreated Hep C

A

Porphyria cutanea tarda

Disorder of heme synthesis

Painless blisters taht heal w/ scarring

Increased skin fragility

Triggered by ethanol and estrogen

Tx Phlebotomy or hydroxychloroquine

110
Q

Sweating
Headache
Tremor
Palpitation

Confused

A

Insulin excess

Hypoglycemia

111
Q

Acanthosis nigricans associated with

A

DM
Obesity
Polycystic ovarian syndrome

112
Q

Young patient w/ HTN

Mass on left adrenal gland

Renin level
Aldosterone
Bicarbonate

A

Conn’s syndrome

Primary hyperaldosteronism

Low renin
Elevated aldosterone
High bicarb

113
Q

Dark patch with hairs on infant

A

Congenital melanocytic nevus (CMN)

114
Q

Congenital dermal melanocytosis

A

Mongolian spots

115
Q 
WG
Muscle weakness
HTN
Easy bruising
Hyperpigmentation
Dark hair on upper lip/chin

Acne

A

Cushing syndrome

Key features

  • Muscle weakness
  • Bruisability
116
Q

DM leads to what neuronal problems

A

Sensorimotor polyneuropathy

Small fiber

  • positive symptoms
  • Pain
  • Paresthesia
  • Allodynia

Large fiber

  • Negative symptoms
  • Numbness
  • Loss of proprioception
  • Loss of vibratory sense
  • Diminished ankle reflexes
117
Q

Salt craving

Reduced body hair

A

Primary adrenal insufficiency

(Addison disease)

Stimulation testing w/ cosyntropin

Low production of cortisol following cosyntropin administration= PAI

118
Q

Precocious puberty check what

A

Bone age

119
Q

HTN
Impaired fasting glucose
Dyslipidemia

A

Metabolic syndrome

Central abdominal fat distribution

Insulin resistance

120
Q

Tx Hair loss

A

Men

  • Minoxidil
  • Finasteride

Women
- Moinoxidil

121
Q

Diabetic gastroparesis

Tx

A

Nausea
Vomiting
Early satiety
Postprandial fullness

Tx: Metoclopramide

122
Q

What is reduced in DKA

A

Total body potassium

123
Q

Acne

Hair loss

Get what test

A

Polycystic ovary syndrome

Oral glucose tolerance test

124
Q

Normal TSH
Low T3 T4

Erectile dysfunction

A

Chronic liver disease

T3 T4 produced in liver

125
Q

Mycosis fungoides

A

Hypopigmented rash on trunk

Severe pruritus

Presentation less acute

Lesions relapse and remit over time regardless of sun

126
Q 
Hyperglycemia
Cant lose weight
Muscle weakness
HTN
Depression
A

Cushing syndrome

Overnight low-dose dexamethasone suppression test

127
Q

1) Early morning cortisol
2) Overnight low-dose dexamethasone suppression test
3) Serum ACTH
4) Serum aldosterone to plasma renin activity ratio
5) Serum testosterone level

A

1) Early morning cortisol will be low in patients with primary adrenal insufficiency
2) Overnight low-dose dexamethasone suppression test to identify cushing syndrome
3) Serum ACTH measured to determine if ACTH-dependent hypercortisolism (cushing disease, ectopic ACTH) or ACTH-independent (adrenal adenoma)
4) Serum aldosterone to plasma renin activity ratio used to evaluate priamry hyperaldosteronism (HTN, hypokalemia)
5) Serum testosterone level to check hyperandrogenism

128
Q

Evaluating precocious puberty

A

1) Check bone age
2) Check LH level
- If high= central precocious puberty
3) If Low, check GnRH stimulation test
- If increased w/ stimulation= central precocious puberty
4) If Low LH after stimulation= peripheral precocious puberty

Peripheral precocious puberty
- nonclassic congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency

Central precocious puberty (gonadotropin-dependent)
- idiopathic precocious puberty (premature activation of hypothalamic-pituitary-gonadal axis)
- pituitary microadenomas
[Have High LH]

129
Q

Precocious puberty
Hypopigmented patches
Fibrous dysplasis of bone

A

McCune-Albright syndrome

130
Q

Maternal hx of graves disease

Low birth weight

Tachycardia
Irritable
Warm skin

  • Name
  • MOA
  • Tx
A

Neonatal thyrotoxicosis

Transplacental passage of anti-TSH receptor antibodies

Tx: Methimazole plus beta blocker

Resolves in wks

131
Q

Polyarteritis nodosa

A

Nodular lesions resembling erythema nodosum

Associated with fever, arthralgias, WL

Renal insufficiency
Abdominal pain

132
Q

Elevated T4
Normal TSH

Fatigue
Anxiety

Normal thyroid
Normal vitals

OCP use

A

Normal thyroid function with estrogen induced increase in T4 binding globulin

133
Q

Things that increase thyroid binding globulin

A

Estrogens

  • Pregnancy
  • OCP
  • Hormone replacement therapy
  • Estrogenic medications (ttamoxifen)

Acute hepatitis

134
Q

Things that decrease thyroid binding globulin

A

Androgenic hormones

High dose glucocorticoids/ hypercortisolism

Hypoproteinemia (nephrotic syndrome, starvation)

Chronic liver disease

135
Q

Displacement of thyroid hormones from binding proteins

A

Normal hypothalamic pituitary feedback, displace of T4 leads to decreased thyroid hormone production

Low T4

Normal free hormone levels

Medication that cause this

  • Salicylates
  • furosemide
  • heparin
136
Q

Urine albumin-creatinine ratio

A

< 30

30-300 moderately increased albuminuria

Diabetic nephropathy

Give ACE-I

137
Q

Toxic adenoma

A

Single hot spot

Hyperthyroidism

138
Q

Congential hypothyroidism

A

Thyroid dysgenesis

  • asplasia
  • hypoplasia
  • ectopic gland

[Not transplacental TSH-receptor Ab or defect in synthesis of T4]

139
Q

Firm
Hyperpigmented nodule

Lower extremities

Dimpling in center when pinched

A

Dermatofibroma

140
Q

Dome shaped firm moveable nodule

Small central punctum

No drainage

A

Epidermal inclusion cyst

141
Q 
Weakness
WL
Hyponatremia
Hyperkalemia
Normal cortisol

Reduced appetite
Intermittent diarrhea

Hypotension

A

Primary adrenal insufficiency (Addison disease)

Measure ACTH

142
Q

Small papules and pustules

Erythematous rash on checks and chin

waxes and wanes

Tingling sensation after sun exposure

Tx

A

Papulopustular Rosacea

Tx: Topical metronidazole
Azelaic acid
Ivermectin

143
Q

Flushing cheeks
Dilated blood vessels in cheeks
Erythematous

A

Erythematotelangiectatic rosacea

Topial brimonidine

Laser/ intense pulsed light therpay

144
Q

18 month old
Vaccinated

Fever
Facial rash
- numerous painful clear vesicles over erythematous skin on both cheeks

Scattered lesions with overlying dark red crusting

Submandibular lymphadenopathy

A

Herpes simplex virus

Atopic dermatitis

Eczema herpeticum

Hemorrhagic crusting

Acyclovir tx

145
Q

Graves tx that worsen proptosis and swelling of periorbital tissues

A

Radioactive iodine

—> increases levels of thyrotropin receptor antibodies (TRAB)

Which can worse ophthalmopathy

Tx: Give glucocorticoids w/ RAI

146
Q

Pruritic rash on back

Unrelenting for months

Antihistamines not help

Flat irregular plaques

Purple/pink

  • Name
  • Assoc with (3)
  • Tx
A

Lichen planus

Associated with

  • Hep C
  • ACE-I
  • Thiazide

Tx: High potency glucocorticoids (betamethasone)

147
Q

Pityriasis rosea

A

Herald patch

Outbreak macules and papules across neck, trunk and proximal limbs

Resolves 4-6 weeks

148
Q

Chronic skin condition

Little red bumps over posterior arms

A

Keratosis pilaris (IP)

retained keratin plugs in hair follicles

149
Q

Miliaria

A

Heat rash

Due to blocked eccrine sweat ducts

150
Q

Pseudofolliculitis

A

Ingrown hair

151
Q

Acne Tx

Develops sun sensitivity

A

Doxycycline (Tetracycline)

152
Q

Infant ambiguous genitalia

Elevated testosterone

46, XX

  • Na
  • K
  • Glucose
A

Congenital adrenal hyperplasia

AR

21- hydroxylase deficiency

Salt wasting syndrome

Decreased Na
Elevated K
Decreased Glucose
[Not seen till 1-2 wks]

Elevated 17-hydroxyprogesterone
[17-OHP is converted to testosterone in peripheral tissues]

153
Q

Infant ambiguous genitalia

Normal testosterone

If masculinize at puberty

A

5-alpha reductase deficiency

154
Q

Lack of menarche

Breast tissue

vagina ends in blind pouch

46 XY

A

Androgen insensitivity syndrome

Elevated testosterone, estrogen, and LH

155
Q

Virilization of fetus and mother

A

Placental aromatase deficiency

156
Q

6 months after birth

first 2-3 months had anxiety and worried frequent

Now fatigued and irritable
Constipation

A

Postpartum thyroiditis

157
Q

Well demarcated depigmented macules on face and distal extremities

Associated with

A

Vitiligo

Associated with other autoimmune conditions

158
Q

Pulmonary embolism effect on calcium

A

PE —> hyperventilation and respiratory alkalosis

Hypocalcemia

  • crampy pain
  • paresthesias
  • carpopedal spasm

Increase in extracellul pH from respiratory alkalosis causes hydrogens to dissociate from albumin free albumin to bind w/ calcium

Increased affinity of albumin for calcium —> decreased levels of ionized calcium

159
Q

Hyperosmolar hyperglycemic state

A

Hyperventilation

Increase in serum osmolality with little to no keronemia or acidosis

Normal or mildly elevated potassium level due to insulin deficiency and hyperosmolality

But have total body potassium deficit due to excessive urinary loss

Insulin therapy for HHS can shift potassium back into cells —> abruptly lowering K levels —> severe hypokalemia

160
Q

Tense bullae

Parkinson disease

Linear IgG and C3 deposits

A

Bullous pemphigoid

Tx Topcial clobetasol

IgG autoantibodies against hemidesmosomes

161
Q

Celiac sprue

Bone pain

Increased PTH
Increased Alk Phos
Decreased Ca
Decreased Phos

A

Osteomalacia

Impaired osteoid matrix mineralization

162
Q

Osteoporosis characterized by

A

Low bone mass

Bone has adequate mineralization

Normal
- Ca, Phos, PTH, Alk phos

163
Q

Hyperprolactinemia

-Risperidone vs pituitary adenoma

A

Risperidone has no effect on TSH level

164
Q

High PTH
Normal Ca
Low Phos

A

Vit D deficiency

165
Q

Pediculosis capitis

A

Head lice

166
Q

Telogen effluvium

A

Diffuse hair loss (not patchy)

Emotional distress

167
Q

High serum osmolaity

Urine studies show low osmolality

Specific gravity

A

Diabetes insipidus

Specific gravity < 1.006

168
Q

Scaly annular plaques that come together to form giant plaque

Potassium hydroxide microscopy shows segmented hyphae

A

Dermatophyte infection (Tinea corporis)

Check for HIV, DM, or glucocorticoid use

169
Q

Red papules yellow hard growth coming out of it

Painful
Rapid growth

A

Keratoacanthoma

170
Q

Flat topped itchy violet papules

A

Lichen planus

171
Q

Cradle cap

A

Seborrheic dermatitis

172
Q

Antibodies to thyroid peroxidase (TPO)

A

Hastimoto thyroiditis

173
Q

Stones, bones, groans and psychiatric overtones

A

Hypercalcemia

174
Q

HTN
Hypokalemia
Metabolic alkalosis

A

Primary Hyperaldosteronism

175
Q

Patient presents with weakness, nausea, vomiting, WL, and new skin pigmentation

Lab results show hyponatremia and hyperkalemia

A

Primary adrenal insufficiency (addison)

Tx Glucocorticoids
Mineralocorticoids
IV fluids

176
Q

Tx DKA

A

Fluids
Insulin
Electrolyte repletion (K+)

177
Q

Bone pain
Hearing loss
Increased Alk phos

A

Paget disease

178
Q

Dermatitis herpetiformis

Assoc with
Tx

A

Associated with celiac

Dapsone
Gluten free diet

179
Q

Chronic scaly irregular plaques with ulceration

Central hypopigmentation surrounded by hyperpigmentation

A

Discoid lupus erythematous

180
Q

Patchy nonscarring hair loss

Itches before falls out

A

Alopecia areata

Tx: Intralesional triamcinolone (corticosteriods)

181
Q

Tx Tinea versicolor

A

Selenium sulfide lotion

182
Q

Nummular eczema

A

Coin shaped lesion

Tx Topical glucocorticoids

183
Q

Acute diffuse, noninflammatory hair loss

Hair loss in audlt

> 20 % fibers are pulled out

A

Telogen effluvium

Self limiting

184
Q

Androgenetic alopecia

A

Uneven hair loss

Men have thinning at the frontotemporal hairline and vertex

185
Q

Trichorrhexis nodosa

A

Fragility of hair with breaking of strands

186
Q

Pruritic rash on feet

Hyperkeratosis and flaking

A

Tinea pedis

Miconazole
Tolnaftate

187
Q

Discrete firm hyperpigmented nodule

< 1 cm in diameter

Dimpling in center

A

Dermatofibroma

Cryosurgery or shave excision

188
Q

Persistent facial erythema/ flushing

Telangiectasias

Worsen with alcohol

A

Rosacea

189
Q

Staphylococccal scalded skin syndrome

A

Seen in children <6

190
Q

Psoriasis caused by

A

HIV

Glucocorticoid withdrawal
Antimalarials
Indomethacin
Streptococcal pharyngitis

191
Q

Thickening of toe nails

A

Onychomycosis

Risk factors

  • Advanced age
  • Tinea pedia (Trichophyton rubrum)
  • Diabetes
  • Peripheral vascular disease

Tx: Terbinafine, itraconazole

192
Q

Tx acne

A

Topical retinoids
Benzoyl peroxide

Add Antibiotics

  • Erythromycin
  • Clindamycin

If becomes cystic: oral isotretinoin

193
Q

Facial tumor

Hypopigmented lesion

A

Tuberous sclerosis

Facial angiofibromas

194
Q

Ichthyosis vulgaris

A

Diffuse dermal scaling

Mutations in filaggrin gene

195
Q

Toxic adenoma with hyperthyroidism is left untreated at risk for

A

Hyperthyroidism can develop rapid bone loss

Leading to osteoporosis

196
Q

N/V
Constipation

Hypercalcemia
Low PTH
Cr 1.9
Glucose 180

Normal 25- hydroxyvitamin D

1,25- dihydroxyvit D (normal)

A

Hypercalcemia of malignancy

197
Q

WL
Nausea
Abdominal pain
Postural dizziness

Prednisone for asthma

Hypotension
Tonsillar enlargments

Hyperpigmentation
Vitiligo

Hyponatremia
Hyperkalemia
Eosinophilia

Low serum cortisol

A

Autoimmune adrenalitis

Primary adrenal insufficiency

198
Q

Hyperosmolar hyperglycemic state (HUS) tx

A

NS

IV insulin
Potassium

199
Q

Painless muscle weakness

WG
Bone loss
HTN
Hirsutism

A

Cushing syndrome

Hypercortisolism —>

Muscle atrophy

200
Q

Low serum cortisol
Abnormal ACTh
Hyperpigmentation

A

Primary adrenal insufficiency

Tx Hydrocortisone

If continue to have deficiency then add Fludrocortisone

201
Q

Tx Orthostatic HTN

A

Midodrine

202
Q

Adrenal mass
Hirsutism
Virilization ( clitoromegaly

Acne, facial hair on woman

A

High androgen levels due to androgen producing neoplasm

Elevated DHEA
Elevated testosterone
Low LH

203
Q

WL
Anemia
Glucose 176

Erythematous plaques with central clearing and eroded border on the right thigh

Painful pruritic rash

Watery stools

A

Glucagonoma

Necrolytic migratory erythema

204
Q

HTN
Hypokalemia

Check what

A

Plasma aldosterone/ renin ratio

If elevated check adrenal suppression test

If positive get adrenal imaging

[Suspected primary hyperaldosteronism]

205
Q

Dexamethasone suppression test

A

Can diagnose Cushing syndrome

206
Q

Cosyntropin stimulation testing

A

Adrenal insufficiency

207
Q

How to monitor resolution of DKA

A

Monitor anion gap

Looking for it to normalize

208
Q

Causes of myopathy (7)

A

Polymyositis/ dermatomyositis

Hypothyroidism
Thyrotoxicosis
Cushing syndrome
Electrolytes (decreased K, Ca, Phosphorous)

Corticosteriods
Statins

209
Q

45 y.o
Myalgias
Proximal muscle weakness
Elevated creatine kinase level

Reduced DTR

What test?

A

Hypothyroid myopathy

TSH/ Free T4

If normal chest ANA and muscle biopsy

210
Q

Correct calcium level due to low albumin

Ca 7.5
Albumin 2.2

A

Correct Ca= (measure calcium) + 0.8 (4.0- serum albumin)

Ca= 7.5 + 0.8( 4-2.2)
= 8.94

Hypocalcemia due to hypoalbuminemia

211
Q

25-hydroxylation of vit D occurs

A

In liver

212
Q

1-alpha- hydroxylation occurs

A

in kidney

213
Q

Irregular menses
Every 2-3 months
Heavier bleeding

Difficulty concentrating at work

Irritable
Depressed mood

FSH
TSH
Prolactin

A

Low FSH
High TSH
High Prolactin

Hypothyrodism

Disruption of hypothalamic pituitary ovarian axis

214
Q

24 y.o with lump in neck

TSH and calcium normal

Calcitonin is elevated

U/S biopsy shows malignancy

What following test to get?

A

Plasma fractionated metanephrine assay

To rule out MEN

If positive, RET mutation testing and screening for pheochromocytomas with plasma fractionated metanephrine (can cause life threatening hypertensive crisis)

215
Q

Urine albumin/ creatinine ratio

A

Normal < 30

If elevated (30-300) then add ACE-I

216
Q

Testing for acromegaly

A
  1. Check IGF-I level
  2. If elevated check oral glucose suppression test
  3. If inadequate GH suppression get MRI brain
217
Q

Proximal muscle weakness
Anxiety
Tachycardia
WL

Muscle atrophy

A

Chronic hyperthyroid myopathy

218
Q

Approach to hypocalcemia

A
  1. Low serum calcium
    - correct for serum albumin
  2. Is magnesium level low?
  3. PTH
219
Q

Physiologic defense against hypoglycemia

A
  1. Decrease insulin
    - Decrease peripheral glucose utilization
    - Increase hepatic gluconeogenesis and glycogenolysis
  2. Increase Glucagon
    - Increase hepatic gluconeogenesis and glycogenolysis
  3. Increase Epinephrine
    - Increase hepatic gluconeogenesis and glcogenolysis
    - Increase mobilization of gluconeogenic substrates
  4. Increase cortisol and growth hormone
    - Alters transcription of many genes to conserve glucose

Results in decreasing blood glucose level

220
Q

Patient with diabetes and chronic pancreatitis resulting in adult onset cystic fibrosis

A

Lose glucagon secreting alpha cells

Risk for insulin induced hypoglycemia

221
Q

Adrenal mass on imaging

Abdominal pain

HTN

Hypokalemia
Mild Hypernatremia

Elevated plasma aldosterone/plasma renin level

Refuses surgery, what medication to give

A

Primary hyperaldosteronism

Aldosterone antagonists

  • Spironolactone
  • Eplerenone

Surgery (if unilateral)

222
Q

DKA vs thyrotoxicosis

A

DKA
- Hyperglycemia
- Low bicarb
Increased anion gap metabolic acidosis

Thyrotoxicosis

  • Hyperglycemia
  • Normal bicarb
  • Palpitations, WL
223
Q

Thyroid storm caused by

A

Thyroid or non thyroid surgery

Acute illness (trauma infection)

Childbirth

Acute iodine load (iodine contrast)

224
Q

DM on metformin

HTN and previous MI

What medication to add (2)

MOA
Effect
SE

A

Option 1: Canagliflozin
Empagliflozin
[SGLT-2 inhibitors]

Increased urinary glucose excretion (blocks PT glucose reabsorption) also increase Na excretion

Induce WL
Slow progression of albuminuria

AE: genitourinary tract infections

Option 2: GLP-1 receptor agonists

  • Semaglutide
  • Liraglutide

Slows gastric emptying, suppressing glucagon secretion and increases glucose-dependent insulin release

SE: Gi disturbances
Pancreatitis

225
Q

Hyperthyroidism vs thyrotoxicosis

A

Hyperthyroidism: characterized by increased thyroid hormone synthesis and secretion from thyroid gland

Thyrotoxicosis: clinical syndrome of excess circulating thyroid hormones, irrespective of source

226
Q

HTN in patient with hyperthyroidism due to

A

Increased myocardial contractility

Decrease in systemic vascular resistance (BP rises due to positive inotropic and chronotropic effects)

227
Q

Hypercalcemia of malignancy labs

A

Hypercalcemia > 14

Suppressed PTH level

228
Q 
Crohn disease
Proximal muscle weakenss
Osteopneia
Bone pain
Pseudofractures

Ca
Phos
PTH

A

Osteomalacia

Reduced mineralization of osteoid at bone forming sites

Common in malabsorptive disorders

Chronic deficiency of Vit D

Low Ca
High PTH
Low Phos

229
Q

Menopause

Hypothyroidism on Levothyroxine

Addition of estrogen effect of thyroid

A

Requirement for L-thyroxine would increase

Increase dose

Oral estrogen decreases clearance of thyroxine binding globulin leading to elevated TBG levels

[If normal thyroid can readily increase thyroxine production to saturate TBG binding sites, if not results in decreased free thyroxine and increased TSH]

230
Q

Hypotension

Hyperpigmentation in palmar crease

Labs

A

Primary adrenal insufficiency (autoimmune adrenalitis)

Addison disease

Cosecretion of melanocyte stimulation hormone with ACTH

Hyperkalemia
Hyponatremia

Low morning cortisol
High ACTH

231
Q

Hyperpigmentation

A

Cushing’s syndrome
- HTN

or

Primary adrenal insufficiency
- Hypotension

232
Q

Foul smelling diarrhea, WL, fatigue

A

Steatorrhea and malabsorption

Steatorrhea prevents usual fat emulsification and disrupts chylomiron mediated absorption of Vit D

Vit D deficiency

Mediated Ca and phos reabsorption

233
Q

Diagnosis of hypercalcemia

A
  1. Correct albumin concentration
  2. Measure PTH level
  3. If suppressed, measure PTHrP, 25-hydroxyvit D, and 1,25dihydroxyvitD
234
Q

Male
Loss of sexual desire and failure to attain erections

Intermittent bilateral hand pain

DM
Peripheral neuroapthy

Has a child

Small testes

Sensation decreased in both ankles

What next step?

A

Hereditary hemochromatosis

Excessive absorption of iron and deposition of iron in tissues

Hyperpigmentation
Arthropathy
Hepatomegaly
HCC
DM
Hypogonadism
Hypopituitarism

Elevated liver transaminases

Elevated ferritin, transferrin saturation

Tx Phlebotmy if ferritin > 1000

235
Q

thin habitus
Dry skin
Excoriation of forearms

Pitting edema of ankles
Distended abdomen

Hypotension

BMI 17

Also see?

A

Anorexia nervosa

Decreased bone mineral density

236
Q

Antimitochondrial Ab

A

Primary biliary cholangitis

Fatigue
Pruritus

Elevated Alk phos

237
Q

Recurrent miscarriage

Enlarge non tender firm thyroid gland

High TSH
Normal T4

What antibody

A

Chronic lymphocytic thyroiditis (Hashimoto)

Antithyroid peroxidase (anti-TPO)

238
Q

Anticardiolipin antibodies

A

Antiphospholipid antibody syndrome

SLE

239
Q

Thyroid stimulating immunoglobulin

A

Graves

240
Q

TSH receptor blocking antibody

A

Less common hypothyroidism than Antithyroid peroxidase

Have thyroid atrophy (not enlargement)

241
Q

Fatigue
Weakness

Decrease appetite

Cold intolerance
Constipation
Erectile dysfunction
Low libido
Skin dry and pale
Testes small

Hypotension
Bradycardia

Delayed DTR

Anemia
Hyponatremia
Hypoglycemia

T4?
Serum cortisol?
Aldosterone?

A

Hypopituitarism

ACTH deficiency

  • Postural hypotension
  • Tachycardia
  • Fatigue
  • WL
  • Hypoglycemia

Hypothyroidism

  • Cold intolerance
  • Constipation
  • Dry skin
  • Bradycardia
  • Slowed DTR

Gonadotropins
- Loss libido

Low free T4
Low Cortisol and ACTH
Low FSH, LH and testosterone

Aldosterone not affected

242
Q

Watery diarrhea
Flushing
N/V
Muscle weakness/cramps

Hypokalemia
Hyperglycemia

Mass at pancreatic tail

A

VIPoma

243
Q

VIPoma vs carcinoid syndrome

A

Flushing
Diarrhea

Carcinoid
- small intestine

VIPoma
- pancreas

244
Q

Heat intolerance
Increased appetite
WL

Enlarged nontender thyroid

Free T4 increased
Total T3 increased
Low TSH

Radioactive iodine uptake <5% (normal 8-25%)

A

Painless thyroiditis

Brief hyperthyroid phase

Small nontender goiter

Spontaneous recovery

+TPO antibody (seen in hashimoto)

Low radioiodine uptake

245
Q

Struma ovarii symptoms

A

Pelvic mass
Ascites
Abdominal pain

Thyroid not enlarged

246
Q

Acromegaly seen on

1) Echo
2) Pulm (2)
3) GI (2)
4) Enlarged organs (7)
5) Endocrine (5)

A
  1. Echo: Concentric left ventricular hypertrophy (Heart failure, arrthymias)
    2: Pulm: Sleep apnea, narcolepsy
  2. GI: Colon polyps/cancer, diverticulosis
4. Enlarged organs: 
Tongue
Thyroid
Salivary glands
Liver
Spleen
Kidney
Prostate
5. Endocrine
Galactorrhea
Decreased libido
DM
Hyperparathyroidism
Hypertriglyceridemia
247
Q

Fatigue
WG
Mild HTN

Elevated lipids

Check what

A

Hypothyroidism

Check serum TSH

Hypothyroidism causes decreased LDL turnover due to decreased expression of LDL receptors —> elevated circulating levels of total cholesterol and LDL

Decreased activity of lipoprotein lipase —> hypertriglyceridemia

[If untreated hypothyroidism and statin started —> statin myopathy, can cause worsening on hypothyroid myopathy]

248
Q

Propylthiouracil
Methimazole

SE

A

Agranulocytosis

  • Occurs in 90 days
  • WBC < 1000 discontinu eddrug
249
Q

Hyperthyrodism

Given propylthiouracil

Two weeks later complains of sore throat
Fever

Tonsils are red and swollen

Do what?

A

Discontinue propylthiouracil

Agranulocytosis*

250
Q

Intense glycemic control (A1c between 6-7%) with insulin reduces risk of

A

Retinopathy

Nephropathy

251
Q

Urine osm > 600

A

Primary polydipsia

252
Q

Demeclocycline

A

Tx SIADH

Inhibits ADH mediated aquaporin insetion in the CT and helps dilute urine

253
Q

Tolvaptan

A

V2 vasopressin receptor antagonist

Causes selective water loss in the kidney without affecting sodium or potassium excretion

Cost
SE: increased liver enzymes

Reserved for significant hypervolemic (due to heart failure) or euvolemic (SIADH) hyponatremia that doesnt improve with fluid restrictions

254
Q

Immunocompromised

Erythematous and edematous lesions that develops into a bulla surrounded by erythema

Bulla ruptured and left painless ulcer with black center

Organism

A

Ecthyma gangrenosum

P aeruginosa

255
Q

Subepidermal blisters

A

Bullous pemphigoid

256
Q

Long term HTN

Leg cramps

Tx

A

Primary hyperaldosteronism

Tx Aldosterone antagonists

  • Spironolactone
  • Eplerenone
257
Q

39 y.o progressive muscle weakness. Difficulty combing hair. 20 lb weight gain, irregular menses with vaginal dryness and low libido. HTN, hyperlipidemia and seasonal allergies. Oily facial skin with prominent acne and scattered bruises on her arms and lower legs. Abdomen is obese soft and nontender.

Elevated K
Elevated Bicarb
Hyperglycemia

A

Cushing syndrome

Hypercortisolism

High level of ACTH —> increase androgen production from the zona reticularis of the adrenal cortex —> androgenic symptoms (irregular menses, acne)

258
Q

DKA caused by

A. Fatty acid breakdown in the liver
B. Glycogenolysis in the skeletal muscles
C. Impaired bicarbonate reabsorption in the Proximal renal tubules
D. Impaired urine acidification in the distal renal tubules
E. Increased renal excretion of ketoacids
F. Peripheral lipolysis due to decreased catecholamine levels

A

A. Fatty acid breakdown in the liver

Insulin deficiency —> increased lipolysis of peripheral fat stores due to high catecholamine levels

Fatty acids are delivery to the liver and broken down into ketones

Ketone accumulation responsible for clinical manifestations of DKA

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