UWorld Educational Objectives Flashcards
tx for hyperthyroid induced tachysystolic afib
beta-blockers
Can hyperPTH cause hypertension
Yes, a rarer cause of secondary HTN
HOCM murmur is where
LLSB
Most common cause of constrictive Pericarditis in the third world
TB
Common causes of constrictive pericarditis
Radiation therapy, viral infections, and Cardiac surgery
CHF in young patient
Consider viral myocarditis from coxsackie B
First line medical tx for HOCM
Beta-blocker or non-dihydropyridine CCB like diltiazem
tx for aortic regurg.
decrease afterload, dihydropyridine CCB or ACEi
When does mitral stenosis usually present
in pregnancy
What are reversible risk factors for PACs
tobacco and alcohol
tx in symptomatic PACs
beta-blockers
Tx for cardiac tamponade
Massive volume resuscitation and emergency pericardiocentesis
First line tx for PVCs symptomatic
beta-blockers
First study for AAA
abd. u/s
Mitral prolapse murmur softened with what maneuvers
Softened with increased preload
Diagnostic criteria for ARDS
Acute onset; Bilateral patchy airspace disease on CXR; PCWP<200
First line tx for Cocaine induced cardiac ischemia
Benzos, nitrates, and aspirin. (Nitrates help vasodilate the coronaries)
MItral stenosis patients develop what
They develop afib from the L atrial dilation
HOCM inheritance
Aut. Dom.
When does ventricular free wall rupture occur
3-7 days post-anterior wall MI
What meds to hold before stress testing
Inotropes like digoxin and beta-blockers
What blood vessels supply the different areas of the heart
Inferior wall: R coronary artery >>> L circumflex Anterior Wall: L anterior descending Lateral Wall: LAD and L circumflex Right ventricle: RCA Posterior wall: RCA
Lone afib tx
Aspirin, if they dont have stroke, tia, DM, HTN, HF, Age>75, or valvular heart dz. Hence no one is on aspirin therapy.
CK-MB or troponin for immediate MI recurrence
CK-MB, because it returns to normal in 2 days, troponin is more specific but is present for 10 days
Dresslers syndrome
Improved leaning forward. Tx with NSAIDs. Avoid anticoagulation to prevent hemorrhagic pericardial effusion
Megaesophagus, megacolon, and cardiac dysfunction
Chagas dz
Amiodarone side effects
Pulm fibrosis, thyroid (hypo or hyper), hepatotoxcity, corneal deposits, and skin discoloration
Loop diuretics electrolyte effects
HypoK and HypoMag
Tx WOlf-Parkinson-White patients
Avoid AV nodal blockers like beta-blockers, CCBs, digoxin, and adenosine because of increased conductance through the accessory pathway
One of the most deadly consequences of aortic dissection
Cardiac tamponade
Most common cause of daeth with acute MI
Reentrant ventricular arrhythmia (vetricular fibrillation)
Treating strep viridans endocarditis
IV pencillin G or IV ceftriaxone
Tx congenital long QT syndrome
beta blockers
Post-MI persistent ST elevations
Ventricular Aneurysm
Dipyramidole effect on stress testing
Coronary steal: it diverts blood to the healthy tissues because it dilates all the vessels but the diseased vessels are already maximally dilated so you get less perfusion
Premature atrial beats tx and f/u
they are benign and need nothing
Thiazides bad side effects
Hyperglycemia, hyperTGs, inc. LDL, hypoNa/K and hyperCa
Surgery for AAA
> 5cm, symptomatic, rapid rate of growth
Best way to slow AAA progression
smoking cessation
What lowers preload-meds
nitrate and diuretics
Heat stroke definition
temp >105
Can cocaine cause STEMIs
yes
Pathology of HTN emergency
fibrinoid necrosis of small arterioles
Papilledema on ophthalmoscopy in HTN >200
Confirms the diagnosis
Digitalis toxicity heart effects
A.fib and AV block (from increased ectopy and vagal tone, respectively)
Mobitz type II origin
His Purkinje fucked up
Long term prognosis in STEMI most effected by
time to coronary blood flow restoration
best tx for ventricular tachycardia
Amiodarone or lidocaine
What to avoid in variant (printzmetal’s angina)
beta blockers and aspirin because they promote vasoconstriction
BP >30 mmHg between arms and tearing chest pain
Aortic dissection
tests for suspected aortic dissection
TEE!!!!! or CT with contrast
Drug for stable angina and HTN
beta-blockers
Quickest drug to relieve pulm. edema
nitroglycerin
Causes of pulsus paradoxus
Cardiac tamponade, tension pneumothorax, severe asthma
aortic dissection EKG
normal
Before TEE for aortic dissection, do what first
control HTN
what is tilt table testing
used to dx vasovagal syncope: pt strapped in goes from supine to standing position very quickly
TB pleural effusion is notable for what
High adenosine deaminase concentration
Causes of ARDS
sepsis, severe infection, extreme bleeding, toxic ingestions, burns
theophylline toxicity chracaterized heavily by
excess epinephrine: GI upset, headache/insomnia, arrhythmia
Theophylline and erythrmoycin/ciprofloxacin
Those antibiotics increase the plasma concentration by decreasing clearance leading to toxicity
INtermittent hemoptysis with mobile cavitary lesion in lung
Aspergilloma
Inpatient tx for CAP
levofloxacin for antipneumococcus. O/p therapy azithro or doxy
Dx PCP
bronchoalveolar lavage
what do you fear most with bronchiectasis
fatal hemoptysis
Clubbing and sudden-onset joint arthropathy in a chronic smoker
Hypertrophic osteoarthropathy: often associated with lung cancer
Characteristic extrapulmonary manifestation of Mycoplasma pneumonia
erythema multiforme
Mild hemoptysis in pts with smoking history
chronic bronchitis
DLCO in emphysema and chronic bronchitis
low in emphysema and normal in chornic bronchitis
Postpartum woman with pulm. symptoms and multiple nodules on xray
Suspect choriocarcinoma, elevated beta-hCG confirms diagnosis
Second episode of clot tx
Lifetime coagulation
Nonseminomatous GCTs markers
AFP and beta-hCG
WHAT HAPPENS when you lay on side of consolidation
can get arteriovenous shunting and hypoxia
Most common causes of SVC syndrome
small cell lung cancer and non-Hodgkin’s lymphoma
Tube thoracotomy indications
effusion pH <60
When to do embolectomy for PE
if there is a contraindication to fibrinolysis
what decreases mortality in COPD
home oxygen and smoking cessation
sweat chloride test is positive if
Cl>60
muscle side effect of cocaine
rhabdo
What level CPK needed to cause ATN in rhabdo
CPK >20,000 U/L
What can raise the left mainstem bronchus and cause a persistent cough
Enlarged left atrium from mitral stenosis from rheumatic fever
Old person with PNA, abdominal pain, confusion, and hyponatremia
Legionella pneumonia
A1AT deficiency organs affected
lungs and liver
Legionella key
ABDOMINAL PAIN/GI COMPLAINTS and CONFUSION
Anaerobic lung infection tx
Clindamycin
Aspirin allergy
Pseudo-allergic reaction: avoid NSAIDs and use leukotriene receptor antagonists
When to use thrombolytics in PE
When there is hemodynamic instability. R ventricluar strain is a relative indication
Histoplasma environment
Mississippi or Ohio River valleys and Central America where there is lots of bird or bat shit
Sarcoid extrapulmonary manifestations
Skin: erythema nodosum Eyes; uveitis
new clubbing in COPD patients
new lung cancer
PCP CXR findings
bilateral diffuse interstitial infiltrates beginning in the perihilar region is characteristic
A-a gradient in restrictive diseases
Wider due to lower DLCO and V/Q mismatch
difference between neuromuscular diseases and restrictive lung disease
DLCO normal in neuromuscular disease
Blastomycosis geography
Great lakes, mississippi, and ohio river valley
Skin and bone lesions, productive cough from the midwest
Blastomycosis
blastomycosis tx
itraconazole or amphotericin B
Allergic rhinitis tx
H1 receptor antagonists decrease nasal inflammation and post-nasal drip
Hypercalcemia and what GI complaint
Constipation, can be severe
Hypercalcemia presentation
Severe constipation, anorexia, weakness, renal tubular dysfunction, and neurologic symptoms
When to suspect ischemic colitis
Patients with evidence of atherosclerotic vascular disease, presenting with abd. pain followed by bloody diarrhea with minimal abd. exam findings. Splenic flexure most commonly affected.
Tx for asymptomatic diverticulosis
high-fiber diet
First step in mgmt of patients with dyspepsia <45 years with no alarm sxs
Noninvasive tests for H. pylori
dx esophageal spasm
manometry
Zinc deficiency sxs
alopecia, skin lesions, abnormal taste, and impaired wound healing
dx of achalasia
manometry, endoscopy to r/o malignancy
explain d-xylose test
D-xylose is purely absorbed without digestion needed, so it tests the integrity of the gut mucosa. Will have low urine excretion with bacterial overgrowth and celiacs, but overgrowth will normalize with abx
skin finding and celiacs
dermatitis herpetiformis
carcinoid triad
flushing, wheezing, diarrhea
what to supply carcinoid syndrome with
niacin; used up in formation of 5-HT
MEN I associated diseases
Primary hyperPTH, pituitary tumors, enteropancreatic tumors
Suspect crohn’s in….
young patient with chronic diarrhea, abd. pain, and weight loss
what drug causes digoxin toxicity
verapamil
risk factors for polyp developing into malignancy
Villous adenoma, sessile adenoma, and size>2.5 cm
Whipple’s disease histology
PAS-positive material in the lamina propria of the small intestine
Whipple’s disease presentation
arthralgias, weight loss, fever, diarrhea, and abd. pain
UC extraGI manifestations
PSC, uveitis, erythema nodosum, and spondyloarthropathy
Severe complications of UC
toxic megacolon and colon cancer
Which IBD improves with Cigarette smoking (decreased likelihood)
Smoking associated with Crohn’s
Screening for UC
yearly colonoscopies 8-10 yrs after diagnosis
Dx whipple’s
Upper IG endoscopy and biopsy small intestine
LES in diffuse esophageal spasm
Normal relaxation response
When to tx chronic hep B
persistently eelvated ALT, detectable serum HBsAg, HBeAg, and HBV DNA with interferon or lamivudine
recurrent pancreatitis with no known cause w/u
ERCP
non-alcoholic fatty liver disease pathophys
insulin resistance increases rate of lipolysis and elevating the circulating insulin levels
liver metastases
GI tract, lung, breast
chronic liver disease vaccinations
hep A and B
Hydatid cyst cause
Echinococcus granulosus
AST and ALT lels in alcoholic liver disaease
<500 IU/L almost always
Risk factors for cholangiocarcinoma
PSC patients who smoke and have UC
pancreatic cancer risk factors
FH, chronic pancreatitis, smoking, diabetes, obesity, high fat diet. NOT ALCOHOLISM
best test for acute panceatitis
serum amylase and lipase
chronic Hep A infection presentation
DOESN’T EXIST
first step in acute renal failure
foley catherization is a critical first step to r/o post-renal obstructions
RFs for non-alcoholic steatohepatitis
obesity, diabetes, hyperlipidemia, TPN, some meds
tx for asymptomatic esophageal varices
non-selective beta-blockers
30% of hemochromatosis patients die from this
HCC
ADPKD presentation
intermittent flank pain, hematuria, UTIs, and nephrolithiasis
HIV kidney disease
collapsing focal and segmental glomerulosclerosis
FSGS presentation
nephritic range proteinuria, azotemia, normal sized kidneys
tx for dehydration
NSS
most common nephropathy with carcinoma
membranous nephropathy
Hodgkin’s lymphoma kidney disease
Minimal change disease
most common cause of renal vein thrombosis in patient with nephrotic syndrome
membranous glomerulonephritis (it is the most common one)
fibromuscular dysplasia angiogram
string of beads
IgA nephropathy presentation
MCC of glomerulonephritis in adults, recurrent gross hematuria, 1-3 days after upper respiratory infection. Serum complement levels are normal
Major toxicity of azathioprine
dose-related diarrhea, leukopenia, hepatotoxicity
major toxicity of mycophenolate
Bone Marrow suppression. M for marrow and mycophenolate.
RHabdo signs
Disproportionate elevation in creatinine as compared with BUN, positive blood on dipstick but no RBCs
tx for rhabdo
aggressive IV hydration, alkalinize urine, forced mannitol diuresis may be required
MC presentation of cryoglobulinemia
palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia. Most patients also have Hep C
classic findings in amyloidosis histology
renal amyloid deposits that show apple-green birefringence under polarized light after staining with congo red
acute post-strep glomerulonephritis presentation
10-20 days after strep throat or skin infection. Hematuria, HTN, red cell casts, and mild proteinuria
Goodpasture’s tx
emergent plasmapheresis
wegener’s tx
cyclophosphamide and steroids in combo
when to image pyelo
if it doesnt respond after 48-72 hrs of abx
most common drug cause of priapism
prazosin
MCC of abnormal hemostasis in CRF patients and tx
platelet dysfunction, tx with DDAVP (release VIII and vWF multimers). Do not use PLATELETS!
EPO side effects
HTN worsening, HA, flu like symptoms
tx for hepatorenal syndrome
liver txp
woman with chronic headaches with painless jaundice
analgesic nephropathy (papillary necrosis)
MCC of drug induced CRF
analgesic nephropathy (papillary necrosis and chronic tubulointerstial nephritis)
Analgesic abuse causes
premature aging, atherosclerosis, and urinary tact cancer
Alport’s presentation
recurrent hematuria, sensorineural deafness, FH of renal failure
hep B ifxn and nephrotic syndrome
membranous glomerulonephritis
acute tx of hypercalcemia
IV NSS followed by loop diuretic, then bisphosphonates, then calcitonin, then dialysis
primary hyperTH urine presentation
normal or eleavated urinary calcium excretion
succinylcholine bad side effect
life-threatening hyperK
severe hyperNa
0.9% Na
mild hyperNa
D51/2NS
vomitizing leads to what disturbance
hypochloremic metabolic alkalosis with hypoK
most common drug causes of hyperK
ACEIs, spironolactone, trimethoprim!
lithium and what kidney dysfunction
nephropgenic DI, tx with salt restriction and cease lithium
hypocalcemia common presentation
Hypeactive deep tendon reflexes in patients undergoing major surgery and requiring lots of transfusions
lactic acidsosi in patients with atherosclerosis or afib
unrecognized bowel ischemia
type 4 RTA presentation
diabetic patient with non-anion gap metabolic acidosis, persistent hyperK and renal insufficiency
aspirin intoxication presentation
triad of fever, tinnitus, and tachypnea
common acid-base disorder after a GTC seizure
postictal lactic acidosis that resolves in 60-90 minutes
AVN of femoral head presentation
progressive hip/groin pain without restriction of motion and normal radiographs early on. MRI is gold standard dx.
RA with septic arthritis cause
Staph aureus
subacromial bursitis presentation
pain with active range of shoulder motion, passive itnernal rotation and forward flexion elicits tenderness. caused by repeititive overhead motions.
Page disease (osteitis deformans) blood work
normal serum calcium and phosphate levels and increased alk phos and urinary hydroxyproline levels
tx for lupus nephritis
immunosuppressants
test for temporal arteritis
elevated ESR and temporal artery biopsy
dermatomyositis presentation
violaceous rashes on face with periorbital edema and proximal muscle weakness, ovarian cancer as well.
viral arthritis presentation
symmetric small joint inflammatory arthritis, resolves within 2 months. ANA and RF positive possibly.
disseminated gonoccocemia
high fever, chills, tenosynovitis, migratory polyarhtrlagias and asmall number of hemorrhagic pustular lesions ont he extremities
bone metastases prez.
progressive pain worsened at rest
dx of polymyositis or dermatomyositis
muscle biopsy
polycythemia vera and what rheum disease
gout
AVN of bone risk factors
chronic steroids and chronic alcohol abuse
hyperthyroid myopathy
progressive proximal muscle weakness
OA presentation
age>50, crepitus, bony enlargement, bony tenderness, lack of warmth/morning stiffness
ankylosing spondylitis presentation
seronegative spondyloarhtorpathy in men<40 yrs, low back pain worst in morning improving over the day
ankylosing spondylitis extraspinal manifestation
anterior uveitis
prosthetic joint septic arthritis
staph aureus
hydroxychloroquine side effect
retinopathy
osteomylelitis risk groups
IV drug users and diabetics
fibromyalgia tx
amitryptyline and cyclobenzaprine to restore phase 4 sleep
OA affects what joints
DIP joints
reactive arthritis presentation
seronegative from enteric or GU infection, may include urethritis, conjunctivis, mucocutaneous lesions, ethesitis, and asymmetric oligoarthritis, NSAIDs are first line
RA spine problem
cervical spine C1-C2 instability subaxial subluxation
De Quervain tenosynovitis prez
new mothers who hold babes with thumb outstretched
methotrexate SEs
stomatitis, nausea, anemia, and hepatotoxicity. tx with folate
systemic sclerosis antibodies
ANA and anti-topoisomerase-I
sjogren antibodies
anti-RO and LA (SSA and SSB, respectively)
Hyperparathyroidism and rheum
pseudogout
disseminated gonococcus infexion prez
triad of polyarthralgias, tenosynovitis, and vesiculopustular skin lesions
serum sickness-like from drugs presntation
1-2 weeks after penicillin, amoxicillin in setting of viral illness. Fever, urticarial rash, polyarthralgia, and LAD
serum sickness preesntation
non-human proteins lead to immune compelx mediated hypersensitivity, resolves with withdarwal of ofending agent, not a true drug allergy
erythema nodosum presentation
painful, subQ, pretibial nodules. seen in sarcoid, TB, histo, recent strep, IBD
distinguish the leg claudications
both worse pain with walking, neurogenic remains painful standing still, and neurogenic has normal ABI and arterial pulses
ruptured baker’s cyst
can look like DVT
methotrexate blood effect
macrocytic anemia
behcet’s syndrome presentation
recurrent oral and genital ulcers, skin lesions, most common in turkish, asian, and arabs
artery complications of giant cell or temporal arteritis
aortic aneurysms
psoriatic arthritis presentation
DIPs, morning stiffness, deformity, dactylitis, nail infolvement. tx with NSAIDs, anti-TNF agents, and methotrexate, NO STEROIDS
Cyclophosphamide side effects
long term leads to acute hemorrhagic cystitis and bladder carcinoma
HLA-B27
PAIR: Psoriatic arthritis, ankylosing spondylitis, IBD, reitiers?.
IBD and ankylosing can have what antibody in common
p-ANCA espite no vasculitis
most common causes of cellulitis
group A strep and staph aureus
parvovirus presentation
MCP, PIP, wrist, and ankle arthritis.
Anti-B19 IgM
Parvovirus. diagnostic
CREST syndrome presentation
Calcinosis cutis (Ca in skin), raynaud, esophageal dysmotility, sclerodactyly, and telangiectasis
Exercise and fibromyalgia pain
WoRSENS IT!
Fibromyalgia presentation
fatigue, IBS, depression w/o any joint swelling or muscle weakness
anserine bursitis presentation
sharply localized pain over the anteromedial part of the tibial plateau just below the joint line of the knee. Valus stress test fails to reproduce the pain, ruling out damage to the medial collateral ligament, radiographs are classically normal.
viral arthritis vs RA
acute onset, lack of elevated inflammatory markers, and resolution w/i two months
ankylosing spondylitis and fractures
increaed risk for dz >2 decades.
secondary amyloidosis cause
chronic systemic inflammation as may occur in autoimmune disorders, chronic infections, IVDA
amyloidosis presentation
nephrotic syndrome, hepatomegaly, cardiomyopathy, pseudohypertrophy of muscles, and peripheral neuropathy
Paget’s disease pathophys
osteoclast dysfunction leading to mosaic pattern of lamellar bone, incr. alk phos, and characteristic xray findings like femoral bowing. bone and joint pain, skeletal deformities, and hearing loss are common sxs
SIAD presentaiton
hypotonic hyponatremia with euvolemia. Low plasma osmolality (100-150 mOsm/kg) is diagnostic in suspected patients
dx of acromegaly
GH levels following oral glucose load, no suppression of GH levels following oral glucose load
tx hyperthyrodism
propranolol genreally used for sx relief until underlying cuase is identified and definitively treated
most important causes of thyrotoxicosis with low radioactive iodine uptake
subacute painless thyroiditis; subacute granulomatous thyroiditis; iodine-induced thyroid toxicosis; levothyroxine overdose; struma ovarii (thyroid tissue in ovaries)
osteomalacia electrolytes
low or low-normal serum calcium, low serum phosphate, and increased serum PTH
adrenal insufficiency and calcifications in adrenal glands is…
adrenal TB
primary adrenal insufficiency MCC in developed countries
autoimmune adrenalitis
factitious thyrotoxicosis presentation
hyperthyroid sxs, but no goiter or exophthalmos, low TSH and elevated T3 and T4. decreased diffusely iodine uptake by thyroid. biopsy shows follicular atrophy.
most thyroid nodules are
benign colloid nodules
hypophoshatemic rickets presentation
normal serum ca, normal alk phos, normal vit.d, low phospahte
preferred tx for graves’ disease
radioactive iodine therapy
contraindications to radioactive iodine tx
pregnancy and very severe ophthalmopathy
what ratio for primary hyperaldo plasma aldo:plasma renin activity
ratio >30 suggests primary aldo. can’t suppress it with NSS or oral salt solution also supports priamry. then use CT to look for adrenal adenoma
early side effect of radioactive iodine tx
initial worsening of hyperthryoid sxs
pH effect affecting calcium
alkalosis leads to increased albumin binding of Ca leading to decreased ionized calcium.
hashimoto’s antibodies
Anti-TPO
rapidly developing hyperandrogenism
androgen-secreting neoplasm of ovary or adrenal. testosterone for ovarian source and DHEAS for adrenal source.
toxic nodule presentation
radioactive iodine uptake in nodule with suppression of uptake in the rest of the gland. NO INFILTRATIVE OPHTHALMOPATHY.
MEN type 1
The 3 P’s: pituitary adenoma, pancreatic islet cell tumor, and hyperPTH. Tumor suppressor gene Menin.
MEN type 2 inheritance
aut. dom.
MEN type 2a and 2b both share
Medullary carcinoma of the thyroid and pheochromocytoma
MEN type 2a unique
Primary hyperPTH (hyperplasia)
MEN type 2b unique
mucosal neuromas and marfanoid habitus
MEN type 2
2a: medullary thyroid cancer; pheo; primary PTH hyperplasia
2b: medullary thyroid cancer; pheo; mucosal neuromas and marfarnoid habitus
bones and hyperthryoid patients
rapid bone loss from increased osteoclastic activity
vit D toxicity
hyperCa, constipation, abd. pain, weight loss, polyuria, polydipsia. (ALL SIGNS OF HYPERCALCEMIA)
cause of graves ophthalmopathy
proptosis 2/2 autoimmune lymphocytic infiltration of the extraocular muscles resulting in fibroblast proliferation, hyaluronic acid deposition, edema, and fibrosis
most common thyroid malignancy
papillary carcinoma of the thyroid
when to suspect TSH adenoma
high T3/T4 with normal or high TSH
fever and sore throat in patient taking antithyroid drugs
agranulocytosis, stop drugs and check WBCs
CRF and calcium metabolism
hypocalcemia, hyperphosphatemia, and increased PTH are characteristic of secondary hyperPTH
tx DM gastroparesis
Reglan, bethanechol, and erythromycin
MEN IIa syndrome cause
RET proto-oncogene mutation, total thyroidectomy indicated
high estrogen production in young males with secondary inhibition of LH and FSH
leydig cell tumor
best screening test for suspected adrenal insufficiency
cosyntropin (analog ACTH) stimulation test
what is elevated in medullary thyroid cancer
serum calcitonin
hypoPTH presentation
low ca and elevated phos with normal renal function.
using viagra and an alpha-blocker
keep them 4 hrs apart due to risk of hypotension
tx of paget’s
asymptomatic: no tx. Symptomatic: oral or IV bisphosphonates
PTH in most patients with hyperCa of malignancy
mostly suppressed
Serum calcium in primary hyperPTH vs. hyperCa of malignancy
higher in Malignancy
primary hyperaldo presentation
young patient with HTN, muscle weakness, and numbness with high aldo/renin ratio
differentiating folicular cancer from adenomas
invasion of the capsule and blood vessels
which thyroid cancer metastasizes often
follicular thyroid cancer because it invades the blood vessels
Alanine turns into what in gluconeogenesis
pyruvate
Sheehan’s syndrome typical presentation
Failure to lactate and other features of pituitary hormal deficiency. overt DI is uncommon.
HLD, unexplained hypoNa and elevated serum muscle enzymes means you should do…
thyroid function tests (hypothyroid)
androgen producing adrenal tumors test
elevated serum DHEA-S levels
Hashimoto’s and cancer
Increased risk of thyroid lymphoma
Antithyroid drug therapy serious side effect
Agranulocytosis
MCC of congenital adrenal hyperplasia
21-hydroxylase deficiency
When to do parathyroidectomy in asymptomatic patients with primary hyperPTH
serum ca >1 mg/dL above upper limit of normal; high urinary calcium 24 hr >400 mg, young age <50, BMD less than T-2.5 at any site; reduced renal function
tx for prolactinoma
bromocriptine or cabergoline
tx for central DI
desmopressin which is administered intranasally
genrealized resistance to thyroid hormones presentation
high serum T4 and T3 with normal/mildly elevated TSH evels with hypothyroid sxs
sick euthyroid syndrome
Pt with acute, severe illness with fall in T3 but normal T4 and TSH
MCC of death in acromegaly
cardiovascular
bartter’s syndrome presentation
hypoK, urine chloride >20 mEq/L, met. alkalosis, normal BP
screening for microalbuminuria
spot urine collection for microalbumin/creatinine ratio
rickets is characterized by
defective mineralization of both bone and growth plate cartilage
aldosterone secretion in central adrenal insufficiency
It is relatively preserved, does not rely on ACTH as much. Angiotensin II is a main driver. absence of ACTH does not lead to zona glomerulosa atrophy
tenosynovitis presentation
swelling over involved tendon, linked to gonococcus, pain swelling and decreased range of motion, can treat with NSAIDs,
Kussmaul’s sign
Paradoxical rise in JVP on inspiration due to decreased R ventricular filling. Can be seen in constrictive pericarditis, restrictive cardiomyopathy, cardiac tamponade
ABPA leads to what
bronchiectasis
Treatment for Toxoplasmosis
Prevention: Bactrim. Active disease: Pyrimethamine
Normal human serum osmolality
285-295 mOsm/L
Preventing Pneumocystis
Pentamidine…or Bactrim….???
Buerger’s disease
Also known as Thromboangiitis obliterans. Recurring inflammation and thrombosis of small and medium arteries and veins of the hands a nd feet strongly associated with smoking tobacco.
