Endocrine

Question 1

بررسی میکروآلبومین‌اوری ۲۴ ساعته در چه کسانی توصیه می‌شود؟ (٣ مورد)

Answer 1

دیابت نوع ۲ به محض تشخیص
دیابت نوع ۱، ۵ سال بعد از تشخیص
دیابت در دوران حاملگی

Question 2

Multinodular toxic goiter
ttt?

Answer 2

Radioiodin ablation

Question 3

Elderly ICU low thyroid lab

Answer 3

Sick euthyroid synd

Euthyroid sick syndrome is also known as nonthyroidal illness syndrome and refers to changes in thyroid function tests that were administered in the inpatient or intensive care setting during critical illness

Question 4

What is Trousseau sign

Answer 4

The Trousseau sign of latent tetany is a way to determine if an individual may have hypocalcemia. Trousseau’s sign is considered positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes

Question 5

SE of treatment of DKA

Answer 5

Brain oedema

Question 6

Which electrolytes could be imbalance in treatment of DKA

Answer 6

K

Question 7

OGTT

Answer 7

The most common glucose tolerance test is the oral glucose tolerance test (OGTT). Before the test begins, a sample of blood will be taken.

A nurse or doctor will take a blood sample from a vein in your arm to test your starting blood sugar level. You’ll then drink a mixture of glucose dissolved in water. You’ll get another blood glucose test 2 hours later.

Question 8

SIADH def, causes, ttt

Answer 8

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water. Symptoms of SIADH tend to be those related to the low sodium level in blood (hyponatremia. A low sodium level has many causes, including consumption of too many fluids, kidney failure, heart failure, cirrhosis, and use of diuretics… read more ) that accompanies it. Symptoms include sluggishness and confusion.

The most common causes of SIADH are 1️⃣malignancy, 2️⃣pulmonary disorders, 3️⃣CNS disorders and 4️⃣medication

The most commonly prescribed treatment for SIADH is fluid and water restriction

Question 9

DI definition

Answer 9

Diabetes insipidus (DI) is an uncommon condition in which the kidneys are unable to prevent the excretion of water. DI is not the same as diabetes mellitus types 1 and 2. However, untreated, both DI and diabetes mellitus cause constant thirst and frequent urination

Diabetes insipidus is caused by problems with a chemical called vasopressin (AVP), which is also known as antidiuretic hormone (ADH). AVP is produced by the hypothalamus and stored in the pituitary gland until needed. The hypothalamus is an area of the brain that controls mood and appetite.

Question 10

Conn’s syndrome

Answer 10

Primary hyperaldosteronism:
a hormonal condition in which one or both adrenal glands produce more of the hormone aldosterone than normal.

Conn syndrome is most often caused by an adrenal tumor, such as aldosterone-producing adenomas. Commonly, these tumors are benign but in rare cases, they can be malignant

1️⃣High blood pressure, 2️⃣poor vision, 3️⃣headaches, 4️⃣muscular weakness, 5️⃣muscle spasms, 6️⃣low potassium in the blood (causing frequent urination)

Aldosterone increases urine production

Question 11

Diabetic ulcer next step

Answer 11

Surgical debridement

Question 12

Pt acromegaly ttt with octreotide
future investigation?

Answer 12

Echo

Question 13

DM drugs CI in DM + HF

Answer 13

Thiazolidindiones

Question 14

Charcot foot

Answer 14

A rare but serious complication that can affect persons with peripheral neuropathy, especially those with diabetes mellitus. Charcot affects the bones, joints, and soft tissues of the foot or ankle. The bones become weak and can break and the joints in the foot or ankle can dislocate.

Question 15

Estrogen is abundant in human body

Answer 15

Estradiol

Question 16

BMI

Answer 16

Body mass index
Underweight: <18.5
Normal: 18.5 - 24.9
Overweight: 25 -29.9
Obese: 30 - 34.9
Extremely obese: >35

Question 17

Most active thyroid hormone

Answer 17

Thyroxine, the most abundant thyroid hormone, contains four iodine atoms and is nicknamed T4, while triiodothyronine, the most active form, has three and is referred to as T3.

Question 18

How does DM cause infection?

Answer 18

People who have had diabetes for a long time may have 1️⃣peripheral nerve damage and 2️⃣reduced blood flow to their extremities, which increases the chance for infection. The high sugar levels in your blood and tissues 3️⃣allow bacteria to grow and allow infections to develop more quickly.

Hyperglycemia in diabetes is thought to cause 4️⃣dysfunction of the immune response, which fails to control the spread of invading pathogens in diabetic subjects. Therefore, diabetic subjects are known to more susceptible to infections.

Question 19

Reduce weight standard

Answer 19

1 pound, or approximately 0.45 kg, equates to about 3,500 calories. As such, in order to lose 1 pound per week, it is recommended that 500 calories be shaved off the estimate of calories necessary for weight maintenance per day

Question 20

CAH

Answer 20

Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect the adrenal glands, a pair of walnut-sized organs above the kidneys. The adrenal glands produce important hormones, including: Cortisol, which regulates the body’s response to illness or stress/Most of these disorders involve excessive or deficient production of hormones such as glucocorticoids, mineralocorticoids, or sex steroids

گروهی از بیماری‌های وراثتی اتوزوم مغلوب

تولید بیش از حد آندروژن در مبتلایان باعث ظاهر شدن صفات مردانه و از دست دادن نمک می‌شود. این بیماری به دو نوع معمول و غیرمعمول تقسیم می‌شود. در نوع معمول، نقص آنزیمی شدیدتر است و باعث بروز علائم بیماری مانند مردانه شدن دستگاه تناسلی خارجی در دختران در بدو تولد می‌شود. نوع معمول بیماری را به دو نوع از دست‌دهنده نمک (SW) و بروز صفات مردانه به تنهایی (SV) تقسیم می‌کنند.

نقص آنزیم ۲۱ هیدروکسیلاز در مبتلایان به نوع غیرمعمول خفیف‌تر است و این افراد بعد از تولد با علائم بیماری همچون افزایش فعالیت آندروژن‌ها روبه‌رو می‌شوند. دختران مبتلا به این نوع بیماری در بدو تولد صفات مردانه را نشان نمی‌دهند.

Question 21

What causes hyperplasia of adrenal gland?

Answer 21

ACTH-dependent (secondary) adrenal hyperplasia is most commonly due to an ACTH-secreting pituitary adenoma (Cushing’s disease) and ectopic ACTH from a non-pituitary tumor. Corticotropic releasing hormone (CRH) producing tumors can also cause adrenal hyperplasia

Question 22

Cushing syndrome

Answer 22

Cushing’s syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it (1)helps your body respond to stress. Cortisol also helps (2)maintain blood pressure. (3)regulate blood glucose.

Cushing’s syndrome can be caused by (1)overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), (2)excess production of cortisol from a tumor in the adrenal gland or (3)elsewhere in the body (ectopic Cushing’s syndrome) or (4)a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).

Left untreated, Cushing syndrome can result in exaggerated facial roundness, weight gain around the midsection and upper back, thinning of your arms and legs, easy bruising and stretch marks.

Question 23

which antibiotic contraindicated with diabetes?

Answer 23

Health and Drug Alerts: People with diabetes should avoid antibiotic gatifloxacin

Question 24

Gilbert’s synd

Answer 24

Gilbert’s syndrome is an inherited (genetic) liver disorder that affects the body’s ability to process bilirubin. Bilirubin is yellow liquid waste that occurs naturally as the body breaks down old red blood cells. People with Gilbert’s syndrome don’t produce enough liver enzymes to keep bilirubin at a normal level

The main symptom of Gilbert’s syndrome is short episodes of jaundice, where the skin and whites of the eyes turn yellow.
There’s no treatment for Gilbert’s syndrome. But avoiding things that trigger your symptoms can help.

Gilbert’s syndrome is caused by a faulty gene that runs in families. It’s not related to lifestyle or serious liver problems like cirrhosis

Diagnosing Gilbert’s syndrome can be done by a blood test that detects elevated bilirubin levels. Most often the total level of bilirubin is less than 2 mg/dL, and the conjugated bilrubin level is normal.

در مبتلایان به سندرم ژیلبرت بیلی روبی غیر کونژوگه در خون بالاتر است، اما بیلی روبین کونژوگه در محدوده نرمال است و ۲۰ درصد کل را تشکیل می‌دهد

علت افزایش بیلی روبین غیرکونژوگه در خون، کاهش فعالیت آنزیم گلوکورونیل ترانسفراز است که کار این آنزیم کونژوگه کردن بیلی روبین و برخی مولکول‌های چربی‌دوست دیگر است.

Question 25

Hasimoti’s thyroiditis

Answer 25

Hashimoto’s thyroiditis can cause your thyroid to not make enough thyroid hormone. It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid. Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness

Hashimoto’s thyroiditis patients have a higher risk of thyroid cancer and colorectal cancer. The thyroid cancer prevention effort should start soon after HT is diagnosed, while being cautious of colorectal cancer increases with time

The association of HT with papillary thyroid carcinoma (PTC) has been described. PTC is the most common form of malignancy associated with HT

Question 26

What is the LDL goal for diabetics?

Answer 26

Current guidelines recommend lowering LDL-C as the primary target. Guidelines propose a target of LDL-C <100 mg/dl for patients at high risk, including those with diabetes free of cardiovascular disease. An optional target of LDL-C <70 mg/dl is suggested for patients with diabetes at very high risk.

Question 27

Addison’s disease

Answer 27

also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn’t produce enough of certain hormones. In Addison’s disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone

Tuberculosis (TB) is the most common cause of Addison’s disease worldwide

Symp:

fatigue (lack of energy or motivation)
lethargy (abnormal drowsiness or tiredness)
muscle weakness.
low mood (mild depression) or irritability.
loss of appetite and unintentional weight loss.
the need to urinate frequently.
increased thirst.
craving for salty foods.

Question 28

Aldosteron

Answer 28

Aldosterone is the main mineralocorticoid steroid hormone produced by the zona glomerulosa of the adrenal cortex in the adrenal gland. It is essential for sodium conservation in the kidney, salivary glands, sweat glands, and colon. It plays a central role in the homeostatic regulation of blood pressure, plasma sodium (Na+) and potassium (K+) levels. It does so primarily by acting on the mineralocorticoid receptors in the distal tubules and collecting ducts of the nephron. It influences the reabsorption of sodium and excretion of potassium of the kidney, thereby indirectly influencing water retention or loss, blood pressure and blood volume.

When dysregulated, aldosterone is pathogenic and contributes to the development and progression of cardiovascular and kidney disease.Aldosterone has exactly the opposite function of the atrial natriuretic hormone secreted by the heart.

Aldosterone is part of the renin–angiotensin–aldosterone system. It has a plasma half-life of less than 20 minutes.Drugs that interfere with the secretion or action of aldosterone are in use as antihypertensives, like lisinopril, which lowers blood pressure by blocking the angiotensin-converting enzyme (ACE), leading to lower aldosterone secretion. The net effect of these drugs is to reduce sodium and water retention but increase retention of potassium. In other words, these drugs stimulate the excretion of sodium and water in urine, while they block the excretion of potassium.

Another example is spironolactone, a potassium-sparing diuretic of the steroidal spirolactone group, which interferes with the aldosterone receptor (among others) leading to lower blood pressure by the mechanism described above.

Question 29

Which cells secrets melatonin?

Answer 29

Corticotroph

Corticotrophs are the cells in the anterior pituitary that release adrenocorticotropic hormone (ACTH), melanocyte-stimulating hormone (MSH), and lipotropin. They constitute about 20% of the anterior pituitary cells