E2 Flashcards
Benefits of pharmacologic intervention for adequate blood glucose control?
Reduce microvascular(retinophaty,nephrophaty and nurophaty) complication
What about macrovascular complications and mortality?
show no benefit
What factors reduce Macrovascular complications?
smocking sensation
Lipid level control
Exercise
BP. control
Indication for treatment in prolactinoma?
Macroprolactinoma(>10 mm )
Symptomatic macroprolactinoma
Treat with a dopamine agonist(Capergolin,bromocriptine)
surgery indication?
Sise > 3 cm
Enlargement during treatment
Antithyroid drug S/E?
Allergic rxn(MC)
Agranulocytosis(rare,do CBC if patient have infection symptom)
MTZ:1st TM teratogenic(aplasia cuitis),cholestasis
PTU:Hepatic failure,ANCA associated vasculitis
Osteomalacia symptoms?
maybe asymptomatic bone pain muscle weakness muscle cramp difficulty of walking waddling gait
Diagnosis?
Inc.ALP and PTH Dec.Ca, P, Low urinary ca low VIT D thining of bone cortex and decrease density bilateral symmetric psudo#
pathophysiology?
Vitamin D deficiency
Cause of diabetic foot ulcer?
Neuropathic (MCC)
Previous DFU
Vascular insuficiency
Foot deformity
Neuropathic ulcer?
Mainly affect plantar bony prominence area
Punched out ulcer with undermined border
diagnosis?
test with monofilament
PAD and diabetic foot ulcer?
AKI assess macrovascular obstruction
But diabetic foot ulcer is related to microvascular lesion
Arterial ulcer cmon location?
Tip of toe
Confirmatory Diagnosis of PAD?
Adrenal suppression test after normal saline
But adrenal venous sampling is important to assess which adrenal is hypersecretory(The mass is not always an indicator of the hypersecreting adrenal)
Managment?
For unilateral
Surgery
Aldosterone antagonist for refusing or non-candidates for surgery
For bilateral
Aldosterone antagonist(eplerenone–selective)
What form of estrogen can not affect TBG level?
Transdermal estrogen pach(bypass liver)
In Hashimoto thyroiditis which complication can happen even in a subclinical state with high TPO titer?
Recurrent miscarriage This patient(HTPO) is also at high risk for progression to clinical hypothyroidism. So Levetyroxin Tx is recomended
Initial test to assess the cause of PAI?
8-AM cortisol and ACTH
If low cortizole<5ug/dl and high TSH?
Confirmatory for PAI
If High cortizole>15ug/dl ?
Rule out PAI
If Cortisol 5-15?
Non-confirmatory Do cosyntropin(HM ACTH) test
If low cortisone and High ACTH after CT?
PAI
Low Cortisol and Low ACTH after the test?
Therithery/secondary AI(will have blunted response due to adrenal athrophy)
The normal response after CT >20?
rule out PAI
Indeterminate?
Asses pituitary
the first test to do in hypercalcemia?
PTH level
If have low PTH?
PTHrP
Vit D level
The first test to do in thyroid nodule in patients with low risk and non-suggestive PE for ca?
TSH and U/S
Indication for FNAC?
Noncystic >2 cm
malignancy feacher in U/S with size > 1cm
malignancy feature?
microcalcification
internal vascularity
irregular margin
other feature for malignancy?
Low TSH with low RIU relative to surrounding tissue
First-line Tx for DN?
TCA(amitriptyline)–Inhibit pain signaling
SNRI(Duloxetine)—Inhibit pain signaling
AC(Pregabaline, Gabapentine)–Central NS inhibition
TCA C/I?
Age > 65
Underling cardiac disease
What to rule out in hyperprolactinemia?
Hypothyroidism
RF(Cr)
AT drug indication In graves?
Mild symptoms Low Anti TSHR Ab In old age pregnants small goiter
surgery and Radiation?
Moderate and severe symptoms
w/o above mentiond list
Diabetic Gastropathy pathogenesis?
Long-standing DM(T1)
Enteric nerve damage
Failure of fundal relaxation
Uncoordinated peristelisis
Diagnosis?
nuclear gastric emptying study
Managment?
Metoclopramide
Erythromycin
CM?
Postprandial bloating and vomiting
Early satiety
Impaired nutrition
Wight loss
GI S/E of DM?
Gastroparesis
esophageal dysmotility
Intestinal disorder(diharoa,constipation and incontinence)
VIPoma Syndrome CM?
W.Diarrhea--secretory(low stool OG<50) Hypokalemia Sx--Due to GI loss Metabolic Alkalosis---GI BC loss Hypo/ achlorhydria---Decrease GA production Nausea, Vomiting, and flushing Hyperglycemia---Glycogenolysis Maybe Ass. with MEN1
Diagnosis?
VIP>75 pg/ml
CT: Mass at Tail
Management?
Rehydration
Octreotide
SUrgery if have hepatic metastasis
Hyperthyroid bone disease?
High thyroid–Activate osteoclast—B.Reasorbition-D.Bone density/I.# risk—Hypercalcemia–I.PTH–Dec R.Ca and L.Vit D–Renal loss of ca despite hypercalcemia
euthyroid sick syndrome?
Thyroid hormonal abnormality due to pheripherial T4 to T3 conversion in acute illnes.
Cxs?
Low T3
Normal T4 and TSH
High rT3
a patient will have no CM
Causes ESS?
Inc. endogenous glucocorticoid
Inflammatory cytokine(TNF)
Starvation
Drug(amiodarone,CS,BB )
How to d/t primary (testicular) male hypogonadism from Secondary(P/H) disorder?
PH: High LH/FSH
SH: Normal/Low LH/FSH
Is a test next to do?
SH: Prolactine and Transferrin saturation +-MRI
PH: karyotype and based on risk
Ovarian androgen?
Testosterone
Androstenedione
DHEA
Adrenal Androgen?
All three ovarian A.
DHEA sulfate
The first test to do in an old patient with hirsutism with no other disease manifestation like Cushing?
Testosterone and DHEAS level
Cause of Hypoglycemia in non-diabetics?
B cell tumor(high C-P,>20% of insulin C)
surreptitious insulin usage(low C-p)
ILGFII producing mesenchymal tumor (Low I and C.P)
D/T using C-Peptide level
CM of Cushing?
Central obesity Skin atrophy wide purplish stria proximal muscle weakness HTN Glucose intolerance Skin Hyperpigmentasion Depression and anxiety Hirsutism
Diagnosis?
2 of these 3 criteria positive
1-24-hour urinary cortisol level
2-Late-night salivary cortisol assay
3-Low dose DEXA supresion test
Next to do?
TSH level
MEN 1 genetic?
Autosomal dominant
Due to
CXS?
3 P tumor
1) pituitary(mainly prolactinoma)
2) P.Hyperparathyroidism
3) Pancras/Gi tumor
- –Gastrinoma(recurrent, resistant PUD)
- –Insulinoma
- –VIP oma
- –Glucagonoma
Comorbidity can occur in PCOS?
Metabolic syndrome(DM,HTN)
OSA
Non-alcoholic liver disease
Endometrial hyperplasia
The best test to diagnose DM in PCOS?
Oral glucose tolerance test
the precipitating factor for HHS?
Acute illness(MI) and trauma
Infection
Insulin therapy interruption
Medication impacts CH metabolism(GC, thiazide, and atypical antipsycotic)
things should do before measuring PAC/Renin ratio?
Stop drugs that alter aldosterone mechanisms like spironolactone, el, tr, and amiloride.
Hypercalcemia of malignancy cause?
Squamous Ca(high PTHrP, Low PTH, and Low P) Bone metastasi(Low PTH and PTHrP)
Treatment for hyperthyroidism due to thyroid distruction?
Propranolol
What about prednisolone?
In dequrivian thyroiditis not respond to NSAID
Amidadron induced destructive thyrotioxicosis
Hormonal abnormality in primary hypothyroidism?
Hign TSH
HIGH TRH(lead to high prolactin )
Low FSH/LH(due to high prolactin)
Large fiber neuropathy in DM manifestation?
pressure, proprioception, and balance loss
numbness and poor balance
diminished /absent AR
Reduced/absent VIB,LT, and proprioception
small fiber neuropathy in DM manifestation?
pain and temprature loss
numbness and poor balance
reduced pinprick
Ankle reflex preserved
The first test to do in hypocalcemia?
Serum Mg level(low mg cause PTH resistance and low production)
the major cause of milk-alkali syndrome?
excessive intake of CaCo3
Cause of hypercalcemia with low PTH?
Hypercalcemia of malignancy Vit D toxicity Granulomatous disease Drug-induced(thiazide) Milk alkali syndrome Thyrotoxicosis Vitamin A toxicity Immobility
MEN2A?
Medullary thyroid ca(calcitonin)
Pheochromocytoma
parathyroid adenoma
why we should screen for pheochromocytoma before resectioning of MTca?
prevent catecholamine surge(pheochromocytoma should be first resected)
how to screen?
Plasma fractionated metanephrine assay
NA level in three types of DI?
Central–High
Nephrogenic–Normal
Psychogenic–Low
Is hypocalcemia secondary to RF feature?
High PTH
High P
Low Ca
Low Vit D
