E1 Flashcards
Type 2 DM oral hypoglycemic preferd drug?
1-Metformin
2-GLP-1 agonist
2-SGT2 inhibitors
GLP-1 agonist Drugs?
Exenitide
Liraglutide
mechanism?
Slow gastric empiting
Inhibit glucagon secretion
Increase glucose-dependent Insulin secretion
Benefit?
Low hypoglycemia risk
Reduce appetite
Significant weight loss
Reduce mortality in CVD patients
S/E?
nausea
vomiting
A.Pain
Pancreatitis (Low risk)
What about SGT2 inhibitors (Glifozine)?
minimal weight loss
decrease B/P
decrease HF and CVE risk
Metabolic syndrome diagnosis algorithm?
3 of 5 criterion
what are these five criteria?
- A.Obesity( M: WC>40 and F: WC>35
- B/P > 130/80
- FBS> 100-110
- TGC>150 mg/dl
- HDL(M:<40mg/dl and F:<50)
What is the central pathogenesis?
Insulin resistance
IV fluid managment in DKA?
Rapid infusion with 0.9% NS
5% dextrose if RBS <200mg/dl(but cont.Insulie)
Insulin managment in DKA?
Give untile ketone free Continuous IV insulin(Stop in K<3.3) Change to SQ insulin when indication Overlap IV and SC insulin 1-2 hr NPH and glargine when DKA resolve
When will be SQ insulin indicated?
abele to eat
If RBS<200
Anion Gap<12
serum BC>=15meq/l
K managment In DKA?
IV K if K<5.3
assumed DKA patients are K depleted even if hyperkalemic
When to give BC?
if serum PH < 6.9
When to give phosphate?
Serum P < 1mg/dl
cardiac dysfunction
Respiratory depresion
Monitor serum CA frequentley
Hyponatremia and DKA?
DKA-pseudo hyponatremia due to Hyperglycemia
There is a 2 meQ decrease in serum Na for every 100mg glucose increment after 100 mg
Treat if severe hyponatremia or corrected calculated hyponatremia
corrected calculated hyponatremia?
Thru NA=Measured NA + 2x((mesured Serum G–100)/100)
MEN2 B triads?
Medullary tyroid CA
Pheochromocytoma
Marfanoid habitus
Mucosal neuroma
Marfanoid habitus and Mucosal neuroma presentation?
MH: Longhand to the trunk and long extremity
MN: Painless, Rubery tongue nodule
Managment?
Prophylactic thyroidectomy in Infancy
Regular serum fractionated metanephrine level
the first thing to do in patient with Hypocalcemia?
Repeat
Correct for hypoalbuminemia
Rule out hypomagnesemia(Cause PTH resistance)
Check for transfusion(Citrate bind serum ca)
Correct for hypoalbuminemia?
Low albumin deplete total, not free ca
Corrected Ca=measured ca + 0.8(4-S.Albumin level)
what to do next after checking the above?
PTH level-Should be High(normal: 14 to 65 pg/mL)
If low: Primary HPT
If high do VIT D level
Hormonal regulation of CA?
PTH: short term
VitD: Long term
FBGF 23 and Phosphate level?
Increase in high P level
Increase intestinal and renal loss P
High in hypocalcemia due to RF(Hyperphosphatemia)
Testes must be done in HTN patients?
Renal:(Elect.,Cr,urinalysis)
Endocrine:(FBG/H1C,Lipid P and TSH)
cardiac:ECG
other CBC
Optional tests?
Urine Cr/Ab ratio
Echo
Uric acide
acromegaly local symptoms?
Pituitary enlargement(headache, BHA, and focal neurologic D.)
MSK/Skine symptom?
Giantism Malocluded jaw Arthritis/arthralgia Proximal myopathy Hyperhidrosis Skin TAG Carpal tunnel syndrome Coarse facial features
CVS manifestation?
MCC of death CMP(Concentric HTP---DHF) VHD(AR, MR) LV dilation--Global hypokinesis HF arrhythmia
Pulmonary/GI?
OSA
Narcolepsy
Colonic polyp/ca
Diverticulosis
end-organ?
enlargement of tongue thyroid salivary gland liver kidney prostate
endocrine?
Galactothea DM Decrease libido Hyperparathyroidism Hypertriglyceridemia
pathophysiology?
Increase ILGF-1 production
clinical manifestation of glucagonoma?
Wight loss--due to catabolism Necrolytic migratory erythema Diarrhea--Inc Glucagon/secretin DM/Hyperglycemia Venous thromboembolism Neuropsychiatric Sx(depression and psychosis) Maybe MEN 1 component
Laboratory?
merked elevated glucagon(>500)
CTMRI–tumor and metastasis
N.N anemia(ACD,glucagon hematopoiesis inhibition)
Necrolytic migratory erythema feature?
painful pruritic papule
coalesce and form plaque with central scaling
commonly involve the face, groin, and extremity
A common cause of testicular atrophy?
Primary(testicular)
Secondary(Pituitary and hypothalamus)
combined(P and Sec)
Primary(testicular)?
Congenital(KS,cryptorchidism)
Drug(Alkylating agent and ketoconazole)
Orchitis(mumps),trauma and torsion
Chronic kidney disease
Secondary?
Gonadothroph damage(tumour,trauma,infiitrative disease9hemochromatosis) and apoplexy Gonadothroph suppression: Exogenous androgen, hyperprolactinemia,DM and morbid obesity)