random Flashcards
Causes of hyperandrogenism in women
PCOS CAH Ovarian/adrenal tumors Hyperprolactinemia Cushing Syndrome Acromegaly
*** Added to pt with Metformin failure, SE of weight gain and hypoglycemia
Sulfonylureas
*** DM med with SE of weight gain, edema, CHF, bone fracture, bladder cancer
Pioglitazones
*** DM med that is weight neutral
DPP-IV inhibitors (sitagliptin)
DM med for someone who desire weight LOSS
GLP1receptor agonist
DPP-IV inhibitors (sitagliptin) is weight _____
neutral
Pt has inadequate mgmt of DM on Metformin and desires rx that will help him lose weight
GLP1 receptor agonist
These two non-insulin DM rx achieve the greatest A1C control
Metformin and Sulfonylurea
Two SE of insulin
Risk of hypoglycemia and weight gain
*** How can chronic GI disease affect Ca, Ph, Vit D and Parathyroid hormone
Chronic GI disease can lead to Vit D deficiency, which is needed for Ca and Ph absorption. With low Vit D, Ca and Ph become low and PTH increases.
Stimulation of TSH receptors by thyrotropin-receptor antibodies
Graves disease
Can estrogen in OCP, HRT, and pregnancy increase the level of T4-binding globulin resulting in ELEVATED total thyroid hormone levels but normal TSH?
Yes
*** Other name for a beta cell tumor
Insulinoma - pt with hypoglycemia and high c-peptide
F and ST in pt taking antithyroid medication
STOP rx - agranulocytosis
Infertility, decreased libido, impotence, gynecomastia in men
Prolactinoma
Autonomous production of thyroid hormones
Toxic adenoma
High titers of _____ antibodies are present in Hashimotos and confer increased risk of miscarriage
anti-TPO
*** ______ is an important cause of hypocalcemia, particularly in alcoholics
Hypomagnesemia
Pt comes in with recent virilization and you suspect a tumor. What labs?
Testosterone and DHEAS level
elevated T and normal DHEAS = ovarian
opposite = adrenal source
Pt has a pheochromocytoma. What to give them before beta blockade?
alpha adrenergic block like phenoxybenzamine
Flushing, lethargy, N/V, muscle weakness/cramps, watery diarrhea, low potassium, pancreatic tail tumor
VIPoma
VIPoma + hyperparathyroidism
MEN syndromes
Flushing, diarrhea, bronchospasm, tumor in small intestine
carcinoid tumor
Causes of osteomalacia
VITAMIN D DEFICIENCY: malabsorption bypass celiac sprue chronic liver or kidney disease
Decreased bone density with thinning of cortex, pseudofractures, impaired osteoid matrix mineralization, vitamin D deficiency
Osteomalacia
Old pt with T2DM found altered with BG > 1000.
Hyperosmolar hyperglycemic state - FIRST HYDRATE with NS, then IV INSULIN, supplement with POTASSIUM as needed
2nd step after Metformin, SE of weight gain and hypoglycemia
Sulfonylureas
DM rx with SE of weight gain, edema, CHF, bone fracture, bladder cancer
Pioglitazones
These two non-insulin DM medications acheive the greatest A1C control
Metformin and Sulfonylurea
Two SE of insulin
risk of hypoglycemia and weight gain
how can chronic GI disease affect Ca, Ph, Vit D and Parathyroid hormone
Chronic GI losses can lead to vitamin D deficiency, which is needed for Ca and Ph absorption. With low Vit D, Ca and Ph becomes low and as a result PTH increases.
stimulation of TSH receptors by thyrotropin-receptor antibodies
Graves disease
Can estrogen in OCP, HRT, and pregnancy increase the level of T4-binding globulin resulting in ELEVATED total thyroid hormone levels but normal TSH?
Yes
Tther name for a beta cell tumor
insulinoma - someone with hypoglycemia and high c-peptide
High titers of _____ antibodies are present in Hashimotos and have increased risk of miscarriage
anti-TPO
______ is an important cause of hypocalcemia, particularly in alcoholics
hypomagnesemia
Arthritis, reduced chest expansion and spinal mobility, tenderness at tendon sites, dactylitis, uveitis
AS
< 40 years old, back pain relieved with exercise, elevated ESR and CRP, HLA-B27
AS
What labs and imaging for AS?
XR of SI joint, labs with ESR, CRP, BLA-B27
AS complications
osteoporosis and vertebral fracture
Aortic regurgitation
Cauda equina
Young, oral apthous ulcers, genital ulcers, uveitis, erythema nodosus, thrombosis
Behcet disease
Will biopsy of vessels in Behcet disease show nonspecific vasculitis?
yes
Pathergy in Behcet disease
exaggerated skin response
Reactive arthritis (uveitis, arthritis, oral ulcerations) typically follows these two types of infections
GI or GU illness
Heberden nodes
OA - distal interphalangeal
Bouchard nodes
OA - proximal interphalangeal
*** > 50 yo with stiffnes in the neck, shoulder, and hip muscles
Polymylagia rheumatica