E1 Flashcards

1
Q

Type 2 DM oral hypoglycemic preferd drug?

A

1-Metformin
2-GLP-1 agonist
2-SGT2 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GLP-1 agonist Drugs?

A

Exenitide

Liraglutide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

mechanism?

A

Slow gastric empiting
Inhibit glucagon secretion
Increase glucose-dependent Insulin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Benefit?

A

Low hypoglycemia risk
Reduce appetite
Significant weight loss
Reduce mortality in CVD patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

S/E?

A

nausea
vomiting
A.Pain
Pancreatitis (Low risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What about SGT2 inhibitors (Glifozine)?

A

minimal weight loss
decrease B/P
decrease HF and CVE risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Metabolic syndrome diagnosis algorithm?

A

3 of 5 criterion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are these five criteria?

A
  1. A.Obesity( M: WC>40 and F: WC>35
  2. B/P > 130/80
  3. FBS> 100-110
  4. TGC>150 mg/dl
  5. HDL(M:<40mg/dl and F:<50)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the central pathogenesis?

A

Insulin resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

IV fluid managment in DKA?

A

Rapid infusion with 0.9% NS

5% dextrose if RBS <200mg/dl(but cont.Insulie)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Insulin managment in DKA?

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When will be SQ insulin indicated?

A

abele to eat
If RBS<200
Anion Gap<12
serum BC>=15meq/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

K managment In DKA?

A

IV K if K<5.3

assumed DKA patients are K depleted even if hyperkalemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When to give BC?

A

if serum PH < 6.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When to give phosphate?

A

Serum P < 1mg/dl
cardiac dysfunction
Respiratory depresion
Monitor serum CA frequentley

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hyponatremia and DKA?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

corrected calculated hyponatremia?

A

Thru NA=Measured NA + 2x((mesured Serum G–100)/100)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MEN2 B triads?

A

Medullary tyroid CA
Pheochromocytoma
Marfanoid habitus
Mucosal neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Marfanoid habitus and Mucosal neuroma presentation?

A

MH: Longhand to the trunk and long extremity
MN: Painless, Rubery tongue nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Managment?

A

Prophylactic thyroidectomy in Infancy

Regular serum fractionated metanephrine level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

the first thing to do in patient with Hypocalcemia?

A

Repeat
Correct for hypoalbuminemia
Rule out hypomagnesemia(Cause PTH resistance)
Check for transfusion(Citrate bind serum ca)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Correct for hypoalbuminemia?

A

Low albumin deplete total, not free ca

Corrected Ca=measured ca + 0.8(4-S.Albumin level)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what to do next after checking the above?

A

PTH level-Should be High(normal: 14 to 65 pg/mL)
If low: Primary HPT
If high do VIT D level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hormonal regulation of CA?

A

PTH: short term
VitD: Long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

FBGF 23 and Phosphate level?

A

Increase in high P level
Increase intestinal and renal loss P
High in hypocalcemia due to RF(Hyperphosphatemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Testes must be done in HTN patients?

A

Renal:(Elect.,Cr,urinalysis)
Endocrine:(FBG/H1C,Lipid P and TSH)
cardiac:ECG
other CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Optional tests?

A

Urine Cr/Ab ratio
Echo
Uric acide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

acromegaly local symptoms?

A

Pituitary enlargement(headache, BHA, and focal neurologic D.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MSK/Skine symptom?

A
Giantism
Malocluded jaw
Arthritis/arthralgia
Proximal myopathy
Hyperhidrosis
Skin TAG
Carpal tunnel syndrome
Coarse facial features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

CVS manifestation?

A
MCC of death
CMP(Concentric HTP---DHF)
VHD(AR, MR)
LV dilation--Global hypokinesis
HF
arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pulmonary/GI?

A

OSA
Narcolepsy
Colonic polyp/ca
Diverticulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

end-organ?

A
enlargement of
tongue
thyroid
salivary gland
liver
kidney
prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

endocrine?

A
Galactothea
DM
Decrease libido
Hyperparathyroidism
Hypertriglyceridemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

pathophysiology?

A

Increase ILGF-1 production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

clinical manifestation of glucagonoma?

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Laboratory?

A

merked elevated glucagon(>500)
CTMRI–tumor and metastasis
N.N anemia(ACD,glucagon hematopoiesis inhibition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Necrolytic migratory erythema feature?

A

painful pruritic papule
coalesce and form plaque with central scaling
commonly involve the face, groin, and extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

A common cause of testicular atrophy?

A

Primary(testicular)
Secondary(Pituitary and hypothalamus)
combined(P and Sec)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Primary(testicular)?

A

Congenital(KS,cryptorchidism)
Drug(Alkylating agent and ketoconazole)
Orchitis(mumps),trauma and torsion
Chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Secondary?

A
Gonadothroph damage(tumour,trauma,infiitrative disease9hemochromatosis) and apoplexy
Gonadothroph suppression: Exogenous androgen, hyperprolactinemia,DM and morbid obesity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Combined?

A

Hyperchorticolism

Cirhosis

42
Q

Gonadothrope adenoma?

A

Usually secret alpha subunit(Non-functional)
Present pan pitutarism
Prolactine may be mildly elevated due to dopaminergic neural compression(unlike in prolactinoma, which has significant PL elevation >200)

43
Q

Milk alkali syndrome pathphysiology?

A

Exessive intake of Ca and absorbed alki
Renal vasoconstriction & decreased GFR
Renal loss of Na and h2O
Reabsorbition of bicarbonate

44
Q

Symptome?

A

Nausea,vomiting and constipation
Polyuria and polydypsia–Due to Na/K/Cl transporter and ADh receptor inhibition
Nuropsychiatric symptome

45
Q

lab finding?

A

hypercalcemia
metabolic alkalosis
AKI
Surpressed PTH

46
Q

Treatment?

A

D/C causetiv agent
Isotonic saline
Furosamide

47
Q

TSH normal values are?

A

0.5 to 5.0 mIU/L

48
Q

Ethnology of primary adrenal insufficiency?

A

Autoimmune
Infection
Malignancy

49
Q

Hormonal finding?

A

Low cortisol
Low aldosterone
Low adrenal androgen
High ACTH

50
Q

Clinical manifestation?

A
fatigu,loss of apitite and abdominal pain
Hypovolumia
Hyponatrimia
Hyperkalemia
Hyperpigmentation
metabolic acidosis
eosinophilia
51
Q

When is common?

A

postpartum period(autoimune)

52
Q

How to d/t from secondary(pituitary and hypothalamic defect)?

A

In secondary aldosterone is normal as a result of minimal symptoms, normovolemic, no electrolyte disturbance, and no hyperpigmentation

53
Q

Special indication of statine in DM?

A

Age >40
LDL>160
10-year risk ASCVD > 7.5

54
Q

Characteristics of glucocorticoid-induced myopathy?

A

Progressive proximal muscle weakness
Atrophy w/o pain and tenderness
Normal ESR and CRP
Distal LE more involved

55
Q

mechanism?

A

catabolism/inhibition of Akt-1 signaling/ILGF inhibition—Muscle atrophy

56
Q

Characteristics of primary hyperparathyroidism?

A

LOW TSH

High T3 and T4

57
Q

approach?

A

If the sign of grave(ophthalmopathy)–Diagnose Graves

If have no–Do radioisotope uptake scan

58
Q

Based on radioisotope scan?

A

High–asese focal or diffuse

if low–measure serum thyroglobulin

59
Q

high uptake and nodal?

A

Toxic adenoma/(autonomous mean independent of TSH thyroid hormone production

60
Q

High uptake and diffuse?

A

Graves disease

61
Q

Low uptake and low TG?

A

Exogenous hormone

62
Q

Low uptake and high TG?

A

Thyroiditis

iodine exposure

63
Q

effect of cirrhosis on TFT?

A

Low total T3 and T4
Low free T3 and T4–euthyroid state
Normal TSH
Due to decreased TBG protine

64
Q

Cirrhosis and testicular atrophy?

A

Due to direct injury

Due to affecting HPA

65
Q

The first test to do inpatient with hypercalcemia?

A

Measure PTH level

66
Q

Precipitating factor for thyroid storm inpatient with hyperthyroidism?

A

Surgery
Acute illness(infection and trauma)
Childbirth
Acute iodine load(contrast)

67
Q

Clinical presentation?

A

High fever
CVS–HTN, Tachycardia, CHF, and Arhthemia
CNS-Agitation, delirium, seizure, and comma
Goiter, lid lag treamour
Nausea, vomiting, diarrhea, and jaundice

68
Q

Indication of ACE/ARB in Diabetic nephropathy?

A

Albuminuria irespective of B/P level

69
Q

Mechanism?

A

Since Hyperglycemia–pro-inflammation–RAAS activation–EA constriction–Elevated GHP–Proinurin–Irreversible BMD and Glomerulosclerosis
This drug halt this

70
Q

Most sensetive test for protinuria?

A

Urine A/CR ratio

71
Q

Normal Urine A/CR ratio?

A

less than 30 is

72
Q

Faucher of central(secondary Hyperthyroidism)?

A

mostly macroadenoma(headache and visual disturbance)
Normal or high TSH
Other hypo pituitary symptoms

73
Q

Factor increase TBG?

A
estrogen increment(Px,OCP,HRT)
Aute hepatitis
74
Q

Factor decrease TBG?

A

Cirrhosis
Nephrotic syndrome
Hyperandrogenism
Hypercortisolism

75
Q

Lab characters and CM in both?

A

Euthyroid(may have minimal symptom but absent physical E finding)
May have normal THS
Affected total T4 and T3(normal free T4 and T3)

76
Q

Painless thyroiditis feaucter?

A
Chronic autoimmune thyroiditis variant
Mild brief hyperthyroid phase
Small non-tender goiter
Spontaneous recovery
Low isotope uptake
Positive TPO
If occur within a year of postpartum--We call PPT
77
Q

How to d/t from Hashimoto and subacute(Quervain thyroiditis)?

A

HT–predominant hypothyroidism/Variable RIU

QT–Painful goiter and elevated ESR/CRP

78
Q

Gave disease managment option?

A

Antithyroid drug(mainly for mild and old pt)
Radioactive iodine
Thyroidectomy

79
Q

Radioactive iodine S/E in graves?

A

Hypothyroidism in 99 patients after months/ years(unlike in the case of NG(autonomous nodule only affected)
need 6-18 week
We may use minimal radiation

80
Q

Benefits of OCP in PCOS?

A
Treat menstrual irregularity
Tx hirsutism (by decreasing androgen secretion and elevation of TBG)
81
Q

Does HHS occur in?

A

T2DM

Older age

82
Q

Clinical symptoms?

A

Hyperglycemia sx

AMS

83
Q

Lab studies?

A
RBS>600
Normal PH and BC
Normal anion gap
Normal/mild ketonuria
serum osmolarity>320
84
Q

Managment?

A

Normal saline
IV insulin
Plasma K suplement if <5.3 Meq/L

85
Q

which type of renal disease causes hypocalcemia due to Low Vit D activation?

A

CKD

86
Q

The first test to do inpatient with HTN and Hypokalemia?

A

Plasma renin activity

morning Plasma aldosterone consentration

87
Q

HigPRA and PAC?

A

Secondary cause

88
Q

High PAC and low PRA(ratio >20)?

A

Primary hyperaldostronism

Do adrenal CT

89
Q

Both low?

A
CAH(21HD)
Exogenous  GC
GC resistance
Cushing
AMS
90
Q

Radiation ablation S/E in graves?

A

Persistent hypothyroidism
Exacerbation of ophthalmopathy
Possible radiation exposure
Temporary hyperthyroidism(old pt not tolerate)

91
Q

Exacerbation of ophthalmopathy prevention and mechanism?

A

start GC before Radiation Tx

due to R induced increment of TB Ab

92
Q

Treatment of primary adrenal I?

A

GC(prednisolone..)

MC(fludrocortisone..)

93
Q

Skin color in PAI?

A

Hyperpigmentasion(MSH In.)–MC

Vitiligo(AI destruction)–Rare

94
Q

Prevension of DN progresion?

A

ACE/ARB
Agresive Htn Tx
Good glucose control(HA1C <7)

95
Q

What next to see if the patient has HA1C 8-10?

A

Fasting and RBS

96
Q

Both high?

A

consider insulin neutralizing Ab(But rare in human recombinant form)
Also, consider basal insulin deficiency(increase LA I dose)

97
Q

Normal FBS and High RBS?

A
Consider post praedial hyperglycemia
Add RAI(Aspart...)
98
Q

Normal RBS and High FBS

A

Down phenomena (Due to morning increment of Gh &cortizole)

99
Q

If HA1C>10

A

Indicate hyperglycemia throughout the day

100
Q

oral hypoglycemic should not be used in RF?

A

metformin

SGCT2 inhibitors