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Differential Dx > Endocrine, Metabolic, Immunologic, Cancer > Flashcards

Endocrine, Metabolic, Immunologic, Cancer Flashcards

1
Q

What system affects many body systems simultaneously due to hormone transport through bloodstream?

A

endocrine system

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2
Q

What endocrine gland can produce Diabetes Insipidus, SIADH, and Acromegaly?

A

pituitary

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3
Q

What endocrine gland can cause Addison’s disease and Cushing’s syndrome?

A

adrenal gland

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4
Q

What endocrine gland can cause Goiter, Thyroiditis, and Neoplasms?

A

thyroid

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5
Q

If the body is producing too much of a hormone, what needs to happen?

A

It needs to be either cut out (leading to supplementation due to resulting in deficiency) or distributed to an area deficient of the hormone(s)

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6
Q

What causes diabetes insipidus?

A

Decreased vasopressin (ADH)

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7
Q

What happens when diabetes insipidus occurs? What are the s/s?

A

a. unabsorbed water will be lost in the urine

b.
- increased urine and thirst –> dehydration
- fatigue
- irritability

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8
Q

What is the primary type of diabetes insipidus?

A

idiopathic

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9
Q

What is the secondary type of diabetes insipidus associated with?

A

trauma, head injury, infection

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10
Q

What gland regulates levels of vasopressin (ADH)?

A

pituitary

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11
Q

What is SIADH?

A

Excess release of vasopressin

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12
Q

What does SIADH result in? What are the s/s?

A
  • decreased water retention –> altering electrolyte levels
  • decreased urine
  • weight gain WITHOUT edema
  • HA
  • confusion and lethargy
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13
Q

What gland regulates the levels of human growth hormone?

A

pituitary

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14
Q

What is acromegaly?

A

Excess secretion of human growth hormone leading to the enlargement of the extremities

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15
Q

What are the s/s of acromegaly?

A
  • CTS
  • back pain (osteophytes in the T-spine)
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16
Q

What bones are most affected by acromegaly in children?

A

long bones (causes gigantism)

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17
Q

What bones are most affected by acromegaly in adults?

A

face, jaw, hands, feet

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18
Q

What endocrine gland regulates levels of cortisol and aldosterone?

A

adrenal gland

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19
Q

What is addison’s disease?

A

Hypofunction of the adrenal cortex leading to decreased cortisol and aldosterone

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20
Q

What is a diagnosis that is described by adrenal insufficiency?

A

Addison’s disease

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21
Q

Symptoms:
- dark pigmentation (only in primary cases)
- hypotension
- progressive fatigue
- GI distrubances
- Tendon calcification
- arthralgia (Secondary only)
- myalgia (secondary only)

A

Addison’s disease

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22
Q

What is considered as the stress hormone?

A

cortisol

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23
Q

What is cushing’s syndrome?

A

Hyperfunction of the adrenal cortex leading to excess cortisol

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24
Q

What are the causes of cushing’s syndrome?

A
  • corticosteroids
  • large doses of cortisol
  • cortisol derivatives
  • iontophoresis
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25
Q

symptoms:
- moon face
- buffalo hump at the neck
- abdominal stretch marks
- masculine traits in women

A

Cushing’s syndrome

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26
Q

What is Goiter? What causes goiter?

A

Enlargement of the thyroid gland due to hypersecretion of TSH and iodine

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27
Q

What are potential s/s of goiter?

A
  • dysphagia
  • hoarseness
  • difficulty breathing
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28
Q

It is common for those with thyroiditis to develop (hyper/hypo) functioning thyroid gland

A

hypo

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29
Q

What is thyroiditis?

A
  • inflammation of the thyroid gland due to infection/autoimmune processes
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30
Q

What is chronic thyroiditis called?

A

Hashimoto’s thyroiditis

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31
Q

What population does hashimoto’s thyroiditis commonly manifest in?

A

females 30-50 y/o

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32
Q

What are s/s of thyroiditis?

A
  • dysphagia
  • difficulty breathing
  • hoarseness

–> the same as goiter

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33
Q

What causes grave’s disease?

A

excessive secretion of thyroid hormone

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34
Q

With grave’s disease, metabolism (increases/decreases)

A

increases

–> leads to a thin stature

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35
Q

What are s/s of those > 70 y/o with grave’s disease?

A
  • tachycardia
  • fatigue
  • weight loss
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36
Q

What are s/s of graves disease in those < 50 y/o?

A
  • tachycardia
  • hyperreflexia
  • increased sweating
  • heat intolerance
  • weight loss
  • tremors
  • bulging eyes
  • painful shoulder motion (periarthritis)
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37
Q

What is the difference between Graves disease and goiter?

A

Graves disease is HYPERthyroidism leading to excessive secretion of the THYROID hormone

Goiter is HYPERsecretion of the THYROID STIMULATING HORMONE

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38
Q

Is hyperthyroidism or hypothyroidism more common?

A

HYPOthyroidism

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39
Q

There is a (decrease/increase) in metabolism when hypothyroidism is present.

A

decreased metabolism

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40
Q

What are s/s of hypothyroidism?

A
  • puffiness
  • CTS
  • anemia
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41
Q

What are risk factors for hypothyroidism?

A
  • women
  • medication
  • radiation –> most common in women with breast cancer due to destroying the thyroid
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42
Q

What is hyperparathyroidism?

A

Excessive secretion of PTH leading to calcium in the blood

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43
Q
  • decreased bone strength
  • pathologic Fx
  • muscle weakness and atrophy
A

hyperparathyroidism

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44
Q

What is hypoparathyroidism?

A

Decreased secretion of PTH causing a decrease of calcium in the blood

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45
Q

What is a result of hypoparathyroidism?

A

NM and cardiac irritability

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46
Q
  • muscle spasms
  • paresthesias
  • Tetany
  • cardiac arrythmias
A

hypoparathyroidism

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47
Q

What is the level of glucose leading to hyperglycemia?

A

> 300

–> severe if more than 350-400

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48
Q

What are s/s of hyperglycemia?

A
  • fruity breath
  • confusion
  • lethargy
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49
Q

What is the ideal range of blood glucose?

A

70-300

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50
Q

(true/false) once you get to a point in hyperglycemia, your body creates MORE (doesn’t know when to stop) –> hard to stop production

A

true

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51
Q

What is the level of glucose leading to hypoglycemia?

A

< 70

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52
Q

What are s/s of hypoglycemia?

A
  • pallor
  • sweating
  • shakiness
  • HA
  • blurred vision
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53
Q

What is the treatment for hypoglycemia?

A

10-15 grams of carbs

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54
Q

Metabolic syndrome is a precursor for ____.

A

DM

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55
Q

Metabolic syndrome is characterized by what? What does this increase the risk of?

A

a. Insulin resistance
–> insulin is working hard but not producing the same effect

b. greater risk to develop diabetes

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56
Q

What are s/s of metabolic syndrome?

A
  • abdominal obesity
  • increased triglycerides, decreased HDL, increased LCL
  • increased BP (130/85)
  • insulin resistance
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57
Q

What is the primary culprit of high glucose?

A

sugary drinks

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58
Q

Gout is characterized by elevated ___.

A

serum uric acid (hyperuricemia)

–> uric acid crystals collected in the joints –> causes an inflammatory response

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59
Q

When is gout most common to manifest in a person’s life?

A

40-50 y/o

–> can be seen from 60-70 y/o as well

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60
Q

What are differential diagnoses to gout?

A
  • turf toe (EXT based) - closer presentation
  • reverse turf toe (FLX based)
  • Bunions (lateral drifting of the hallux)
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61
Q

What is pseudogout?

A

Arthritic condition caused by calcium pyrophosphate dihydrate (CPPD) crystals

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62
Q

Where is the primary location of pseudogout?

A

knee

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63
Q

What is the most common location for gout to occur?

A

1st MTP joint

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64
Q

What is a differential diagnosis to pseudogout?

A

OA

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65
Q

What is hemochromatosis?

A

Lack of regulation in iron absorption/metabolism

–> Intestinal tract absorbs excess iron producing tissue damage

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66
Q

What are risk factors for hemochromatosis?

A

Men > 50 y/o
Women > 60 y/o

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67
Q

What are s/s of hemochromatosis?

A
  • CHF
  • edema
  • DM
  • decreased body hair
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68
Q

Where is iron most absorbed?

A

RBCs (hemoglobin)

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69
Q

What is osteomalacia?

A

Softening of the bones

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70
Q

What is osteomalacia caused by?

A

Vitamin D deficiency

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71
Q

What is the name of osteomalacia in children?

A

Rickets

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72
Q

What are s/s of osteomalacia/rickets?

A

bowing of the long bones

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73
Q

What is Paget’s disease?

A

Focal inflammatory condition of the skeleton characterized by disordered bone remodeling

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74
Q

What is the most common skeletal disease? What is the second most common?

A
  1. osteoporosis
  2. Paget’s Disease
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75
Q

What bones are more affected by Paget’s disease?

A

long bones in the axial skeleton

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76
Q

What is another name for Reiter’s syndrome?

A

Reactive arthritis

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77
Q

What are the 3 common s/s of reiter’s syndrome?

A

Conjunctivitis, arthritis, inflammation of the cervix

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78
Q

(true/false) Family Hx of systemic inflammatory/related disorders may be the only available “Red Flag”

A

true

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79
Q

What diagnoses have a global clinical presentation?

A
  • rheumatic disorders
  • Seronegative Spondyloarthropathies
  • ankylosing spondylitis
  • reactive arthritis (Reiter’s syndrome)
  • psoriatic arthritis
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80
Q
  • SYMMETRICAL soft tissue/joint pain
  • stiffness
  • swelling
  • weakness
  • constitutional s/s
  • Raynaud’s
  • sleep disturbance
A

rheumatic disorders

81
Q

What is Seronegative Spondyloarthropathies?

A

Inflammation of the spine

82
Q

What is the difference between Seronegative Spondyloarthropathies and rheumatic disorders?

A

Seronegative Spondyloarthropathies have ASYMMETRICAL pain

Rheumatic disorders have SYMMETRICAL pain

83
Q
  • asymmetric peripheral arthritis
  • connective tissue disorder
  • inflammatory eye disease
  • MSK and cutaneous features
A

Seronegative spondylarthropathies

84
Q

What is the average amount of time for AIDS to develop after HIV exposure?

A

10 years

85
Q

What type of virus is HIV?

A

Neurotropic virus

86
Q

What are the s/s of HIV?

A
  • decreased concentration/memory
  • personality change
  • HA
  • Sz
  • neuropathy
  • weakness
  • paralysis
  • motor dysfunction
87
Q

What are differential Dx for HIV?

A

Seizures and brain tumors

88
Q

What are the groups at risk for TB?

A
  • 25 to 44 y/o using injectible drugs
  • minorities
  • prison occupants/workers
  • homeless
  • immigrants
89
Q

What is a problem with TB vaccinations?

A

There are now multi-resistant forms of TB

90
Q

When is a standard TB test unreliable?

A

If HIV/AIDS is present

91
Q

(true/false) can’t really Dx fibromyalgia other than exclusion of other possible Dx

A

true

92
Q

What is fibromyalgia?

A

Non-inflammatory condition presenting w/ generalized MSK pain w/ TTP globally

93
Q

Fibromyalgia is more common in (males/females)

A

females

–> preadolescent - early postmenopausal women

94
Q

What syndrome has questionable Dx via 18 tender points in the body? How many are needed for Dx?

A

Fibromyalgia
(must report as actual pain, not tenderness) - 11/18 points

95
Q

(true/false) Fibromyalgia has inflammation that is marked on blood tests

A

FALSE (no inflammation to be marked on blood tests)

96
Q

definition: Chronic, systemic inflammatory disorder predominantly effecting diarthrodial jt synovium

A

rheumatoid arthritis

97
Q

What joints are commonly affected by rheumatoid arthritis?

A

small joints of the wrists, hands, and feet

98
Q

(true/false) rheumatoid arthritis is asymmetrical

A

FALSE (symmetrical)

99
Q

Stiffness in the morning caused by rheumatoid arthritis lasts how long?

A

> 1 hour

100
Q

What relieves pain/stiffness caused by rheumatoid arthritis?

A

activity

–> pain/stiffnessreoccurs when trying to resume an activity (“gel phenomenon”)

101
Q

Some patients look like they’re wearing a low of bulky jewelery which is actually a splint for _____.

A

rheumatoid arthritis

102
Q

What are the s/s of rheumatoid arthritis? What is the mnemonic?

A

SERIOUS

Swelling in 1+ joints
Early morning stiffness
Recurring pain/tenderness in any joint
Inability to move a joint normally
Obvious redness and warmth at a joint
Unexplained weight loss/fever/muscle weakness, joint pain
Symptoms > 2 weeks

103
Q

Polymyalgia Rheumatica is a systemic rheumatic inflammatory disorder w/o known cause ~ linked w/ ________

A

Giant cell arteritis

104
Q

If a patient > 50 y/o has a pounding HA on the temporal side of the head… suspect ____________.

A

polymyalgia rheumatica

105
Q

What population is polymyalgia rheumatica most commonly found in?

A

postmenopausal women (> 55 y/o)

106
Q
  • Severe muscle aches and stiffness
  • neck, shoulder, or pelvic girdle pain that is worse in the morning
  • temporal HA
  • weakness
A

polymyalgia rheumatica

107
Q

definition: Type of lupus that is confined to the skin (rashes)

A

Discoid lupus

108
Q

What type of lupus is more severe?

A

systemic lupus

109
Q

What is the cause of lupus?

A

unknown

110
Q

What can systemic lupus butterfly rash can be mistaken as?

A

acne or dry skin

111
Q

What can Discoid Lupus be mistaken as?

A

ring worm, lymes disease, psoriasis, MRSA

112
Q

What is scleroderma?

A

Inflammation and fibrosis of many body parts

113
Q

What structures are affected by scleroderma?

A
  • skin
  • BV
  • synovium
  • skeletal muscle
  • kidneys
  • lung
  • heart
114
Q

What population is scleroderma commonly found in?

A

25-55 y/o women

115
Q

What is the mild form of scleroderma? Does it have a rapid or gradual onset?

A

Limited scleroderma- gradual onset

116
Q

What is the type of scleroderma that has an acute onset?

A

diffuse scleroderma

117
Q

What is a precursor for limited scleroderma?

A

raynaud’s phenomenon

118
Q

What are s/s of scleroderma?

A
  • waxy appearance (“fountain of youth”)
  • ape hand (atrophy of the first webbed space in the hand)
119
Q

What are the s/s of lyme disease?

A
  • bullseye rash
  • flu-like s/s
  • MSK pain
120
Q

How long does it take a bullseye rash to progress?

A

Expands over days to weeks

121
Q

Why is it common for someone to not realize they have a bullseye rash?

A

May not see rash due to ticks gravitating to warm, wet areas (hair, low back, groin)

122
Q

Ankylosing spondylitis is a chronic progressive inflammatory disorder that predominantly affects what?

A

fibrous tissue

SI joints, spine, large peripheral joints

123
Q

What is the cause of ankylosing spondylitis?

A

unknown

124
Q

What population commonly presents with reiter’s syndrome?

A

males 20-40 y/o

125
Q

When do s/s of reiter’s syndrome present themselves?

A

2-4 weeks after viral infection or GI issues

126
Q

What diagnosis can plantar fasciitis be associated with?

A

reiter’s syndrome

127
Q

What is psoriatic arthritis?

A

Chronic, recurrent, erosive, inflammatory arthritis assoc w/ the skin disease psoriasis

128
Q

What location(s) are commonly affected by psoriatic arthritis?

A

distal joints of the hands and feet

129
Q

(True/false) psoriatic arthritis is symmetrical

A

false (asymmetrical)

130
Q
  • swelling of the fingers
  • possible RA
A

psoriatic arthritis

131
Q

What type of drift is commonly observed in those with psoriatic arthritis?

A

ulnar drift

132
Q

What is the most common inflammatory demyelinating disease of the CNS?

A

MS

133
Q

Who commonly develops MS?

A

women 20-40 y/o

134
Q

What is the biggest risk factor for MS?

A

family Hx

135
Q
  • unilateral vision impairment (“floaters”)
  • pain in multiple areas
A

MS

136
Q

What are differential Dx for MS and GBS?

A
  • transverse myelitis
  • B12 deficiency
  • brain tumor
137
Q

Guillain-Barre Syndrome is a ____ disease that affects the (CNS/PNS).

A

demyelination

PNS – causes a stocking glove presentation

138
Q

(true/false) Guillain-Barre Syndrome affects all age groups/race/sex.

A

true

139
Q

Guillian-Barre Syndrome becomes more serious if it affects what?

A

respiratory muscles/diaphragm

140
Q

_________ is caused by Antibodies produced by the immune system blocking acetylcholine muscle receptors

A

myasthenia gravis

141
Q

When are the peaks of myasthenia gravis?

A

20-30 y/o and 50+ y/o

142
Q

symptoms:
- muscle fatigue
- resp. failure
- ptosis
- diplopia

A

myasthenia gravis

143
Q

(men/women) are more likely to produce myasthenia gravis

A

women

144
Q

What is a differential Dx for myasthenia gravis?

A

bell’s palsy

145
Q

What percent of males and females will develop cancer in their lifetime?

A

Females: 46%
Males: 38%

146
Q

(true/false) Children have increased cancer survival rates but they are at risk of developing cancer later on

A

true

147
Q

What population has a higher death rate when Dx with cancer?

A

african americans

148
Q

What population has a higher incidence and mortality rate when having cancer w/ an infectious etiology?

A

Hispanics ~ lower incidence & mortality w/ major CAs, but higher w/ infectious etiology

149
Q

Cancer prevalence increases with age and plateaus around ____ y/o

A

mid-80s.

150
Q

What major group of cancer makes up 85% of all cancer cases?

A

carcinoma

151
Q

Where can carcinoma be found?

A

Skin, large intestine, stomach, breast

152
Q

The large intestine, stomach, and breast can produce mets due to what?

A

lymphatics

153
Q

What does sarcoma affect?

A

connective tissue (cartilage and bone)

154
Q

How does sarcoma commonly metastasize?

A

blood

155
Q

How do cancers of the bone and lymph system commonly metastasize?

A

blood

156
Q

What are the general characteristics of cancer?

A
  • fatigue > 2-4 weeks
  • constant night pain
  • PMH
  • > 50 y/o
  • 10% of unexplained weight loss in 4 weeks
157
Q

What organs are commonly affected by cancer? Why?

A

Liver and kidneys commonly are affected by cancer in the blood due to being filtering organs. (ischemia –> necrosis –> infection)

158
Q

What are nonspecific characteristics of CA?

A
  • lumps (lymph node)
  • unexplained bleeding
  • proximal muscle weakness
  • suspicious skin lesions
  • pleural pain/SOB
159
Q

What cancers commonly cause pulmonary problems such as pleural pain and SOB due to metastasizing?

A

METS to the brain and some bone cancer

160
Q

What type of cancer is lung, breast, and melanoma?

A

neurologic cancers

161
Q
  • HA
  • personality changes
  • cord compression
  • altered DTRs
  • peripheral neuropathy
  • traditional CA signs
A

neurologic cancers

162
Q

What can peripheral neuropathy be caused by in a cancer case?

A

chemotherapy

163
Q

What are conditions associated with neurologic cancers?

A
  • lambert eaton
  • polymyositis
164
Q

What is lambert Eaton?

A

Autoimmune disease that causes the immune cells to attack tissues at the NMJ

165
Q

Does lambert eaton syndrome commonly affect the UEs or LEs more?

A

LEs

166
Q

What condition is commonly associated with lung cancer?

A

Lambert Eaton (50%)

167
Q

What is polymyositis?

A

inflammation of multiple muscle groups

168
Q

(true/false) polymyositis can occur before a tumor is detected

A

true

169
Q

How long does it take for polymyositis to occur?

A

weeks to months

170
Q

symptoms:
- proximal muscle weakness
- joint pain
- pulmonary involvement
- unexplained fevers
- anorexia

A

polymyositis

171
Q

Bone cancers are commonly caused by what?

A

METs

172
Q

What portion of the spine is commonly affected by bone cancers?

A

thoracic spine

173
Q

What increases pain with bone cancers?

A

WB and heel strike

174
Q

What can cause lethargy and/or HTN with bone cancers?

A

increased calcium

175
Q

What population is commonly affected by Ewing Sarcoma?

A

5-16 y/o boys

176
Q

What locations does Ewing’s sarcoma commonly affect?

A

pelvis and femur

–> can involve any bone

177
Q

What are the 2 peaks for osteosarcoma?

A

10-25 y/o and adulthood

178
Q

What locations are commonly affected with osteosarcoma?

A

thigh and knee

179
Q

Leukemia is caused by what?

A

increase in abnormal WBCs which leads to inhibiting other cells

180
Q

What are the peaks of leukemia?

A

2-4 y/o and 65+ y/o

181
Q

Symptoms:
- infections
- fatigue
- bleeding
- enlarged lymph nodes (may be painless)
- joint pain (looks like RA)

A

leukemia

182
Q

What are the risk factors for leukemia?

A

chemotherapy, radiation, chemicals

183
Q

What causes multiple myeloma?

A

uncontrolled cell growth from bone marrow

184
Q

What is the common population for multiple myeloma?

A

50-70 y/o

185
Q

Symptoms:
- bone/joint pain and/or destruction
- renal involvement
- neurologic (CTS and LBP with radicular sxs)

A

Multiple myeloma

186
Q

Where is bone/join pain and/or destruction found with multiple myeloma?

A

pelvis, spine, ribs

187
Q

What is the most common cancer that affects the T-spine?

A

multiple myeloma

188
Q

What can hodgkin’s lymphoma look like?

A

flu

189
Q

What are the peaks for Hodgkin’s lymphoma?

A

15-34 y/o
> 50 y/o

190
Q

symptoms:
- enlarged PAINLESS lymph nodes (> 1 cm)
- pruritis
- cyclical, unexplained fevers
- non-productive cough

A

hodgkin’s lymphoma

191
Q

What virus is often present with hodgkin’s lymphoma?

A

Epstein-barr

192
Q

What age group can get non-hodgkin’s lymphoma?

A

All ages (esp. 40-60 y/o)

193
Q

symptoms:
- enlarged PAINLESS lymph nodes
- extranodal manifestations in the CNS, GI, and bone

A

non-hodgkin’s lymphoma

194
Q

What are the risk factors for non-hodkin’s lymphoma?

A
  • immuno-compromised (HIV)
  • radiation
  • increased age
  • immunosuppressed
195
Q

Non-hodgkin’s lymphoma leads to 3% of all ____ diagnoses.

A

AIDS

196
Q

What is the prognosis of non-hodgkin’s lymphoma dependent on?

A

Initial immune system status

197
Q

If a person is severely compromised and has non-hodgkin’s lymphoma, what is their prognosis?

A

4-7 months

198
Q

If a person has non-hodgkin’s lymphoma in addition to a diagnosis of HIV-related brain lymphomas, what is their prognosis?

A

very poor

199
Q

What will happen to muscle if a person has too much radiation exposure?

A

The muscles lose their elasticity

Differential Dx (13 decks)

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