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*DOOS 2 > Study Guide Info > Flashcards

Study Guide Info Flashcards

1
Q

is gynecomastia normal in pubertal boys?

A

Yes, in 70%

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2
Q

Drugs that can cause gynecomastia

A

alcohol
spironolactone
cimetidine
ketoconazole

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3
Q

Cause of gynecomastia

A

estradiol excess either from decrease in androgen production or increase in estrogen production

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4
Q

What is the genotype XXY called?

A

Klinefelter’s syndrome

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5
Q

what will labs be like with Klinefelter’s syndrome (FSH, LH< testosterone)

A

Elevated FSH and LH

low testosterone

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6
Q

What will be seen w/ Klinefelter’s patients at puberty

A

varying degrees of hypogonadism
gynecomastia
small, firm testes <2 cm, azoospermia
tall and lnaky

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7
Q

are Klinefelter’s patients fertile or infertile

A

often infertile or reduced fertility

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8
Q

What is the absence of 1st menses by age 16?

A

primary amenorrhea

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9
Q

labs to get w/ primary amenorrhea

A 
hCG
FSH
LH
prolactin
TSH
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10
Q

most common cause of primary amenorrhea?

A

ovarian failure (Hypergonadotropic hypogonadism) followed by mullerian agenesis

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11
Q

What is mullerian agenesis

A

congenital absense of femal genital tract

results in primary amenorrhea

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12
Q

Structural causes of primary amenorrhea

A 
vaginal obstruction
cryptomenorrhea
imperforate hymen
mullerian agenesis 
absence of uterus
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13
Q

Gonadal causes of primary amenorrhea

A

17-alpha hydroxylase deficiency
dysgensis
resistant ovary
pregnancy

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14
Q

2 adrenal causes of primary amenorrhea

A

congenital adrenal hyperplasia

PCOS

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15
Q

development in women of androgen-dependent terminal body hair in a male pattern (excessive androgenic effect)

A

Hirsutism

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16
Q

most common disorder w/ hirsutism

A

PCOS (need abdominal US)

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17
Q

Medical tx for hirsutism

A 
OCP
cimetidine
metformin (if PCOS)
spironoolactone or ketoconazole
GNRH agonist
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18
Q

tumors that can cause hirsutism

A 
ovarian tumors (arrhenoblastoma and hilar cell)
adrenal tumors (cushing- adrenocortical carcinoma)
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19
Q

Drugs that can cause hirsutism

A

anabolic steroids (methyltestosterone, oxandrolone)
danazole
some OCPs

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20
Q

most common cause of galactorrhea

A

prolactinoma

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21
Q

how do women w/ a prolactinoma present?

A

amenorrhea and infertility

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22
Q

hypothalamic/ pituitary diseases that cause hyperprolactinemia

A

granulomatous dz (infiltration)
compression of pituitary stalk
acromegaly
primary hypothyroidism

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23
Q

what causes normal prolactin galactorrhea?

A

local breast stimulation/ irritation
OCP
recent pregnancy
stress

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24
Q

cessation of menses for >3 months in woman with previously normal cycle

A

secondary amenorrhea

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25
Q

most common cause of secondary amenorrhea

A

prengnacy

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26
Q

ovarian causes of secondary amenorrhea

A

chronic anvoluation
PCOS
premature menopause
ovarian tumor

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27
Q

what is scarring of the endometrium that can lead to secondary amenorrhea?

A

asherman’s syndrome

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28
Q

adrenal causes of secondary amenorrhea

A

cushing’s
androgen secreting tumor
adrenocortical insufficiency
congenital adrenal hyperplasia

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29
Q

Hypothalamic-pituitary dysfunction causes of secondary amenorrhea

A

exercise (athlete triad)
stress
eating disorders
hyperprolactinemia

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30
Q

consumption of what food suppressed progesterone effects and can lead to secondary amenorrhea?

A

papaya

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31
Q

how can hemochromatosis lead to secondary amenorrhea?

A

deposition of iron in the ovary

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32
Q

drugs that cause gyencomastia

A

spironolactone
cimetidine
flutamide

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33
Q

physiologic causes of gynecomastia

A

puberty
recovery from chronic illness/ starvatin
old age

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34
Q

A male with pseudohermphroditism due to absense of androgen receptors. Have cryptorchid testes. Elevation in serum testosterone

A

Testicular feminization

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35
Q

this deficiency causes males be unable to convert testosterone to a dihydrotestosterone resulting in a bifid scrotum, hypospadias. At puberty scrotum, phallus and muscle mass will enlarge though.

A

5 alpha-reductase deficiency

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36
Q

What differs the signs and symptoms of type 1 DM from type 2?

A

No ketosis or ketonuria in Type 2

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37
Q

what is a common initial complaint in men w/ T2DM?

A

erectile dysfunction

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38
Q

recurrent candidal vaginitis can be an early tip off to what?

A

DM

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39
Q

which type of diabetes has a stronger genetic component?

A

Type 2

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40
Q

main risk factor for T2DM?

A

central obesity then sedentary lifestyle

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41
Q

is gestational diabetes usually symptomatic?

A

No, usually asymptomatic

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42
Q

risks for gestational DM

A 
marked obesity
personal hx 
delivery of a previous large baby
glycosuria
PCOS
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43
Q

starting dose for insulin for DMT1

A

0.4-1.0 micrograms/kg per day

44
Q

typical initial Rx for DMT2

A

metformin or sulfonylurea

45
Q

cornerstone of management of T2DM?

A

diet and exercise

46
Q

when is insulin the first therapy of choice w/ T2DM?

A

fasting glucose >240

47
Q

2 makers associated w/ T1DM?

A

HLA-DR3

HLA-DR4

48
Q

what causes destruction of the beta cells w/ T1DM?

A

autoantibodies (cytotoxic T cells)

49
Q

what is the period where there is recovery of some of the beta cell function so exogenous insulin level needs drop w/ T1DM?

A

honeymoon period

50
Q

T1DM is sometimes believed to follow what?

A

infectious or toxic insult (mumps, coxsackie)

51
Q

onset w/ rapid acting insulins (Humalog, Novolog)

A

5-15 minutes

52
Q

peak of rapid acting insulin

A

1-1.5 hours

53
Q

duration of rapid acting insulins

A

3-4 hours

54
Q

onset of regular (Humulin or Novolin R) insulins

A

30-60 minutes

55
Q

peak of regular insulins

A

2 hours

56
Q

duration of regular insulins

A

6-8 hours

57
Q

onset of NPH (humulin or novolin N) insulins

A

2-4 hours

58
Q

peak of NPH insulins

A

6-7 hours

59
Q

Duration of NPH insulins

A

10-20 hours

60
Q

Onset of insulins glargine (lantus)

A

1.5 hours

61
Q

peak w/ insulin glargine (lantus) and insulins determir (levermir)

A

flat

62
Q

duration of insulin glargine (lantus)

A

24 hours

63
Q

duration of insulin determir (lantus)

A

17 hours

64
Q

patients taking excess doses or oral hypoglycemic agents have high levels of what?

A

insulin

C-peptide

65
Q

what does C-peptide tell you?

A

tell the difference between insulin produced by the body and insulin injected into the body.
It is produced if insulin is made by the pancreas

66
Q

what do low values of c-peptide indicate?

A

pancreas is producing little or no insulin

67
Q

what is reactive (postprandial) hypoglycemia?

A

symptoms occur w/i 4 hours of eating a meal

68
Q

what causes low blood sugar w/o any symptoms

A

loss of glucagon and epinephrine responses over time
autonomic dysfunction
delayed counterregulatory responses of GH and cortisol

69
Q

Criteria for DKA

A

Hyperglycemia (plasma glucose level of >250 mg/dL)
Ketosis: moderate to severe ketonemia and moderate ketonuria
Acidosis: pH < or equal to 7.3 or bicarb < or equal to 15 mEq/L

70
Q

physiologic types of cushing’s syndrome

A

stress
last trimester of pregnancy
persons who do strenuous exercise

71
Q

pathologic causes of cushing syndrome

A

exogenous steroids

severe psychiatric states (depression or alcoholism)

72
Q

ACTH dependent causes of Cushings syndrome

A

pituitary sources
ectopic ACTH
rare ectopic sources of CRH-tumors

73
Q

ACTH independent causes of cushings syndrome

A

adrenal adenomas/ carcinomas
micronodular adrenal dz
autonomous macronodular adrenal dz

74
Q

what is used to discern b/w cushing’s disease and syndrome

A

high dose dexamethasone suppression

75
Q

Autoimmune destruction of adrenal glands - most common cause of primary adrenal insufficiency

A

Addison’s Dz

76
Q

causes of addison’s

A 
TB
autimmune adrenalitis
sarcoidosis
histoplasmosis
amyloidosis
hemochromatosis
adrenal hemorrhage
77
Q

thyrotoxicosis in Graves disease is due what?

A

the overproduction of an antibody that binds the TSH receptor.

78
Q

Occurs in older patients with long-standing multinodular goiter, especially in patients from iodine-deficient regions who are exposed to increased dietary iodine or receive iodine-containing radiocontrast dyes.

A

toxic multinodular goiter

79
Q

T3 and T4 levels are normal with a suppressed TSH.

A

subclinical hyperthyroidism

80
Q

classified as acute, subacute, and chronic. Initial presentation is due to acute release of T4 and T3.

A

thyroiditis

81
Q

from the destruction of normal thyroidal architecture by lymphocytic infiltration results in hypothyroidism and goiter.

A

Hashimoto or lymphocytic thyroiditis

82
Q

results from ingestion of excessive amounts of thyroxine often in an attempt to lose weight.

A

Thryotoxicosis Factitia

83
Q

T4 and T3 levels are normal or low with mildly elevated TSH

A

Subclinical hypothyroidism

84
Q

weight gain with cushings

A

obesity is centripetal, with a wasting of the arms and legs
buffalo hump
moon face

85
Q

common sx of cushings in younger adults

A

thinning of the skin on the top of the hands

86
Q

lab findings in cushing’s

A

elevated plasma alkaline phosphtase levels , glucose intolerance,

87
Q

most common form of thyroid cancer

A

papillary carcinoma

88
Q

presentation of thyroid cancer

A

painless neck swelling and single, palpable non-tender firm mass
often feels stony and hard

89
Q

what type thyroid cancer presents w/ flushing, diarrhea, fatigue and cushing’s syndrome

A

medullary carcinoma

90
Q

most common cause of hyperthyroidism

A

Grave’s disease

91
Q

what is MEN IIA (sipple)?

A

medullary carcinoma of the thyroid
hyperparathyroidism
pheochromoctyoma

92
Q

What is MEN IIB?

A 
medullary carcinoma of the thyroid
mucosal neuromas
intestinal ganglioneuromas
marfanoid habitus
pheochromoctyoma
93
Q

presents w/ HTN, hypervolemia, hypokalemia, hypernatremia, muscle wekaness, fatigue, HA

A

hyperaldosteronism

94
Q

more common presentations in females w/ pituitary prolactinoma

A

anovulation
oligomenorrhea or amenorrhea
infertility
galactorrhea

95
Q

male presentation w/ pituitary prolactinoma

A 
erectile dysfunction
infertiliy
decrease muscle mass
galactorrhea
gynecomastia
96
Q

what do patients w/ Addison’s Dz need before undergoing surgery

A

150-300 mg hydrocortisone

97
Q

Adverse rxns following a thyroidectomy

A

hypoparathyroidism

recurrent laryngeal nerve severed (hoarseness)

98
Q

typical approach for a pituitary resection

A

transsphenoidal surgery

99
Q

what can reduce risk of nodule growth and decrease size, but is controversial

A

levothyroxine

100
Q

how to manage a benign thyroid nodule

A

observe nodule for 1 year after inital bx
recheck seize by US (q 6-12 months)
perform another bx if enlarging

101
Q

Manifestatiosn of peripherals vascular dz

A

ischemic skin ulcers
claudication
limb loss

102
Q

first line for distal sensory neuropathy

A

TCAs (have anticholinergic ADRs)

103
Q

S/S of autonomic insufficiency with DM neuropathy

A

postural HPOTN
impotence
urinary retention

104
Q

Drug that can tx gastroparesis

A

metoclopramide

105
Q

Tx for diarrhea w/ DM?

A

broad spectrum (neomycin or tetracycline)

*DOOS 2 (11 decks)

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