Endo Clinical 3 Flashcards
What does chronic diabetes do to your kidneys? To your nerves?
Hyaline arterioloscelerosis due to non enzymatic glycosylation. Kidneys will have glomeruloscelerosis ,which is scarring. Kimmelstiel-Wilson nodules and microalbuminuria are present due to thickening of basement membrane, expansion of Mesangium and leakage of serum albumin. Schwann cells freely admit glucose and lead to sorbitol accumulation which leads to an osmotic gradient and water comes in and damages them so demyelination is affected.
Patient comes in with deep and labored breathing,nausea and vomiting. Presents with high anion gap acidosis and and hyperkalemia. Why is he acidotic and how would you treat?
Diabetic keto acidosis due to insulin resistance. Liver is trying to make as much glucose in the blood and uses free fatty acids to make ketone bodies. Treat with fluids for dehydration, insulin and replacement of electrolytes.
Patient presents to the nephrologist who has been following his chronic renal failure. The pt also has a reduced bone density. What would his blood work show?
Secondary hyperparathyroidism with increased PTH, increased phosphate due to defect in its excretion and it binds up free calcium, low calcium, and increased alkaline phosphotase. It is necessary to lay down bone and is a sign of osetoblastic activity which stimulates osteoclasts afterwards.
Patient presents with numbness and tingling around the mouth. When you take his blood pressure, he started to have a muscle spasm. What is causing this disease? What would blood work shows?
Hypoparathyroidism with a trousseau sign for the blood pressure and also Chvostek sign by pinching face. Low PTH and low calcium.
Pt presents with muscle spasm and twitches. He is a short man and has short 4th and 5th digits. What does he have? What would blood work show?
Albright’s disease aka pseudohypoparathyroidism. Autosomal dominant. Increased PTH and low calcium. End organ resistance to PTH.
You are an ER attending and a woman presents with vomiting, arrythmia and hyperthermia. You find out that she had given birth two days ago. Blood work shows increased levels of catecholamines. What does she have ? Treatment?
Thryoid stern cause by stress such as child birth. Treat with 3 Ps. Propiothiouracil, prednisone and propranolol.
Patient presents to you with diarrhea and complaining of insomnia. You notice he has a staring gaze and is sweating profusely. He mentions that he has lost weight despite having an increased appetite. You run his blood and find that he has interesting glucose and cholesterol findings. What are the levels of these markers? What does he have?
Hyperthyroidism. Hyperglycemia due to increased basal metabolic rare. He has increased synthesis of Na Katpwsr. Insomnia due to increased sympathetic activity via Betw adrenegeric receptors. Cholesterol level is low even though everything else is ramped up.
What is the difference between a thyroglossal duct cyst and a lingual thyroid?
Thyroglossal duct cyst presents as an anterior neck mass while lingual thyroid appears at the base of the tongue.
Patient presents with headache and a complaint of bilateral temporal hemianopsia. Her blood work shows that she is anemic and has had several IVF consultations because she has had issues getting pregnant. What could be causing these symptoms?
Pituitary Adenoma that is benign showing mass effect by compressing optic chiasm. Her anemia and infertility are due to hypopituitarism becasue the adenoma is compressing the gland.
Patient presents to you with complaints of having no periods for the past four months. Upon examination, you find that she has been having a milky discharge from her nipples. What does she have? How would you treat her?
Proclactinoma that explains the milky discharge and amenorrhea by blocking the release of GnRH. Give her dopamine agonist (bromocriptine) which blocks prolactin or surgery for larger lesions.
A 43 year old lawyer comes to visit you. He mentions that he has been looking a little different these days. His expensive Italian shoes don’t fit him anymore. His jaw appears larger than usual and when doing a neuro exam, you see his tongue is enlarged. What is causing these issues? You run a blood test and find that his glucose level is increased. What is he at risk of? How would you diagnose him? How about treatment ? If you give home oral glucose, would you expect him to improve?
Acromegaly. At risk for secondary DM because of hyperglycemia. GH likes glucose in the blood and ramps up the liver to undergo Gluconeogenesis. Dx by measuring GH and IGF-1 levels in the blood. Oral glucose does not suppress GH. Tx is Octreiotide (somatostatin analog which suppresses GH.
Pt presents to you with complaining that she can’t breast feed her baby because the milk isn’t coming out. She also complains that she is tired all the time, and has notices that since she gave birth, she has started to lose her pubic hair without shaving. What happened to her?
Sheehan syndrome which is infarction of the pituitary due to pregnancy. During pregnancy, the size of the pituitary doubles, without a similar increase in blood supply. Blood loss during giving birth precipitates infarction.
Patient comes to your clinic with complaints of always being thirsty and peeing out clear water. This started after she had a terrible car accident and bumped her head. Her blood work shows that she is hypernatremic. You decide to do a water deprivation test and the urine is still clear. What is going on? How can you treat her?
Patient has central diabetes Insipidus which is a deficiency of ADH which prevents her form having a concentrated urine. Treatment is the ADH analog Desmopressin.
Patient comes to your clinic with complaints of always being thirsty and peeing out clear water. You check her medication list and she has a script for demeclocycline. Her blood work shows that she is hypernatremic. You decide to do a water deprivation test and the urine is still clear. You give her desmopressin and she is still having the same issue. What does she have? Is this an inherited disorder?
Nephrogenic diabetes Insipidus meaning normal or low ADH but the receptor is not working. It can be inherited
You are at the lymphoma clinic to see a patient who has been taking cyclophosphamide. She complains of new onset of seizures and Her panel shows that she is hyponatremic. What complications are you worried about? Why is she having these symptoms? How would you treat her?
SIADH. most often caused by ectopic production from lung cancer , pulmonary infection and CNS tumors. Retention of free water leading to hyponatremia and low serum osmolality. Concerned about cerebral edema. Tx vis water restriction or demeclocycline.
