Term
| who should be screened for DM type 2 |
|
Definition
| all individuals >45 years every 3 years and screening individuals at an earlier age if they are overweight [body mass index (BMI) >25 kg/m2] and have one additional risk factor for diabetes |
|
|
Term
| 10 risk factors for DM type 2 |
|
Definition
Family history of diabetes
Obesity (BMI>25)
Physical inactivity
Race/ethnicity
Previously identified with IFG, IGT, or an A1C of 5.7–6.4%
History of GDM or delivery of baby >4 kg (9 lb)
BP>140/90
HDL<35 or TG>250
Polycystic ovary syndrome
cardiovascular disease |
|
|
Term
| what is a clinical feature of type 1 DM who develop insulin deficiency by unknown, nonimmune mechanisms |
|
Definition
| they are prone to ketosis |
|
|
Term
| in type 1 DM what % of beta cells must be destroyed for onset of clinical manifestations |
|
Definition
|
|
Term
| 2 important islet molecules targeted by the autoimmune process in type 1 DM |
|
Definition
| insulin, GAD (precursor to GABA) |
|
|
Term
| in what types of DM are islet cell antibodies present? |
|
Definition
| mostly type 1, but also type 2 and GDM |
|
|
Term
| what % of 1st degree relatives to type 1 DM patients carry islet cell antibodies |
|
Definition
|
|
Term
| 3 types of environmental triggers to type 1 DM |
|
Definition
| viruses (coxsackie, rubella, enteroviruses most prominently), bovine milk proteins, and nitrosourea compounds |
|
|
Term
| what is the MC gene that predisposes to type 2 DM |
|
Definition
| transcription factor 7–like 2 gene |
|
|
Term
| in the skeletal muscle of a type 2 DM, is the resistance to insulin greater in oxidative or non-oxidative utilization pathways of glucose |
|
Definition
| oxidative (glycolysis) more so than non-oxidative (glycogenesis) |
|
|
Term
| 4 genes implicated in the development of permanent neonatal diabetes |
|
Definition
| Kir6.2, ABCC8, glucokinase gene and the insulin gene |
|
|
Term
| is serum sodium lower in DKA or HHS |
|
Definition
|
|
Term
| is serum osmolality higher in DKA or HHS |
|
Definition
|
|
Term
| serum bicarbonate is very low in DKA or HHS |
|
Definition
|
|
Term
| what is the arterial pH in DKA vs. HHS |
|
Definition
|
|
Term
| which enzyme is regulated by the hyperglucagonemia present in DKA, and leads to the increased production of ketones |
|
Definition
| carnithinepalmoyltransferase 1 |
|
|
Term
| which ketone is more abundant in DKA, betahydroxybutirate or acetoacetate |
|
Definition
|
|
Term
| what is the name of the urine keotsis detection reagent? what does it detect? |
|
Definition
| nitroprusside, acetoacetate |
|
|
Term
| what is the best quantitative method of measuring ketones |
|
Definition
| serum beta hydroxybutyrate |
|
|
Term
| in what circumstance in DKA should you wait with insulin |
|
Definition
| potassium<3.3. first fix potassium and only then give insulin |
|
|
Term
| in what circumstance in DKA should potassium be witheld |
|
Definition
|
|
Term
| what is the typical fluid deficit in DKA |
|
Definition
|
|
Term
| how should insulin be administered in DKA |
|
Definition
| bolus of 0.1 units/kg and then IV 0.1 units/kg/hr until acidosis fixed and then 0.05 units/kg/hr until can eat and then switch to SC |
|
|
Term
| when should glucose be added to the treatment of DKA? |
|
Definition
| when glucose levels decline from 200 |
|
|
Term
| why are urine levels of ketones increase as ketoacidosis decreases |
|
Definition
| beta hydroxybutyrate is converted to acetoacetate which is detected by nitroprusside in the urine |
|
|
Term
| what is the adverse effect of bicarbonate treatment in DKA? |
|
Definition
|
|
Term
| when should bicarbonate be supplemented in DKA |
|
Definition
| levels < 6.9 and until levels reach 7.0 |
|
|
Term
| how much fluid should be replenished in HHS |
|
Definition
| 1-3 L in the first 2-3 hrs |
|
|
Term
| what should be done if sodium levels are over 150 |
|
Definition
| fluid resuscitation should start with 0.45 NaCl |
|
|
Term
| in HSS when should fluids be replaced from normal saline to hypotonic saline (0.45% or 5% dextrose) |
|
Definition
| when patient hemdinamically stable in order to replenish free water loss |
|
|
Term
| how much is the free water loss in HSS? how rapid should it be replenished |
|
Definition
| 10 L of free water. over a period of 1-2 days - 200-300 ml/hr hypotonic saline |
|
|
Term
| how is insulin administered in HHS |
|
Definition
|
|
Term
| which provides greater benefit blood pressure control or glycemic control |
|
Definition
| BP control - reduces both macro and microvascular complications |
|
|
Term
| when in the course of diabetes does nonproliferative retinopathy appear |
|
Definition
| late in the 1st decade of disease |
|
|
Term
| nonproliferative retinopathy vs. proliferative lead to blindness by which mechanisms |
|
Definition
| retinal ischemia vs. retinal detachment |
|
|
Term
| what is the incidence of retinopathy in type 1 DM in 5 yrs and in 15 yrs? |
|
Definition
| 25% incidence with 5 years, and 80% incidence with 15 years of type 1 DM |
|
|
Term
| DM patients with micro/macroalbuminuria have an increased risk for... |
|
Definition
|
|
Term
| what % of DM patients with macroalbuminemia will progress to ESRD and at what time? |
|
Definition
|
|
Term
| what % of DM patients develop microalbuminemia and after how long |
|
Definition
|
|
Term
| which renal abnormality occurs in DM besides nephropathy? what drugs may exacerbate it? |
|
Definition
| type 4 renal acidosis (hyporeninemic, hypoaldosteronic) exacerbated by ACEi/ARBs |
|
|
Term
| some diabetics have a decline in GFR w/o the presence of microalbuminuria. how does this effect the screening in these patients of decreased renal function |
|
Definition
| creatinine should be checked as well |
|
|
Term
| the diabetic patient should be controlled at what blood pressure levels |
|
Definition
|
|
Term
| 4 risk factors for neuropathy in DM |
|
Definition
glycemic control
duration of disease
smoking
BMI |
|
|
Term
| 3 pharmacological treatment options for diabetic neuropathy |
|
Definition
| tricyclic antidepressants, SNRIs or anticonvulsants |
|
|
Term
| what are the lipid level recommendations for diabetic patients, over 40, w/o CHD |
|
Definition
| TG<150, LDL<100, HDL>40/50 |
|
|
Term
| which diabetic patients should receive lipid lowering (statin) therapy regardless of their LDL levels? |
|
Definition
| over 40 w/ CHD or w/ CHD risk factors |
|
|
Term
| 2 adverse effects of using Niacin to increase HDL in diabetic patients in doses over 2g/d |
|
Definition
| increased insulin tolerance and worsen glycemic control |
|
|
Term
| what is the LDL goal for diabetics w/ CHD |
|
Definition
|
|
Term
| what is a surgical prophylactic treatment for the need of amputation in diabetic foot |
|
Definition
| peripheral arterial bypass |
|
|
Term
| 4 Abx options for mild diabetic foot |
|
Definition
| cephalosporin, clindamycin, amoxicillin/clavulanate, and fluoroquinolones |
|
|
Term
| 6 Abx options for severe diabetic foot |
|
Definition
| ertapenem, piperacillin/tazobactam, cefotetan, ampicillin/sulbactam, linezolid, or the combination of clindamycin and a fluoroquinolone |
|
|
Term
| what Abx regimen should be added to an IV properly treated diabetic foot after 48 hrs w/o improvement |
|
Definition
|
|
Term
| 3 contributing factors to infection in DM |
|
Definition
| impaired cell mediated immunity, phagocytosis and vascularization |
|
|
Term
| 3 infections which are almost exclusive to diabetic patients |
|
Definition
| rhinocerebral mucormycosis, emphysematous infections of the gall bladder and urinary tract, and "malignant" or invasive otitis externa |
|
|
Term
| which organism MCC invasive otitis externa in diabetics |
|
Definition
|
|
Term
| 2 yeast species which commonly cause UTI in diabetics |
|
Definition
| candida, Torulopsis Glabrata |
|
|
Term
| which dermal manifestation is common amongst type 1 diabetics |
|
Definition
|
|
Term
| how is blurred vision caused acutely in hyperglycemia |
|
Definition
| decreased content of water in the lens |
|
|
Term
| type 1 diabetics are at an increased risk for the following 5 autoimmune diseases |
|
Definition
| autoimmune thyroid disease, adrenal insufficiency, pernicious anemia, celiac disease, and vitiligo |
|
|
Term
| what is the goal range for preprandial plasma glucose in the Tx of DM |
|
Definition
|
|
Term
| what is the goal for postprandial peak plasma glucose (1-2 hrs after meal) |
|
Definition
|
|
Term
| when should a stress test be preformed in a diabetic with unknown CHD |
|
Definition
type 1 - after 15 yrs
type 2 - after 10 yrs
or if any complication present |
|
|
Term
| what is a CI to vigorous exercise in DM |
|
Definition
| proliferative retinopathy |
|
|
Term
| what happens when mixing lispro (short acting) with regular NPH |
|
Definition
| lispro absorption is delayed |
|
|
Term
| what is the general requirement of insulin for patients with type 1 DM |
|
Definition
| 0.5–1 U/kg per day of insulin divided into multiple doses, with 50% of the insulin given as basal insulin |
|
|
Term
| 3 parameters in determining the preprandial short acting insulin dose in type 1 DM |
|
Definition
| preprandial glucose level, amount of carbohydrates in meal and physical exercise |
|
|
Term
| what is the ratio of insulin to carbohydrates for each meal |
|
Definition
| 1-1.5 insulin units per 10g carbohydrates |
|
|
Term
| 2 methods to calculate supplemental insulin units according to preprandial glucose levels |
|
Definition
1. for each 50mg/dl above preprandial target add 1 unit of insulin
2. (body weight in kg) x (blood glucose – desired glucose in mg/dL)/1700 |
|
|
Term
| what is amylin (Pramlintide)? and how does it treat DM |
|
Definition
| a peptide secreted with insulin from beta cells. given preprandially with insulin. slows gastric emptying and suppresses glucagon |
|
|
Term
| 2 glucose lowering medications that are also effective in type 1 DM |
|
Definition
| amalyn and alpha-glucosidase (acarbose) |
|
|
Term
|
Definition
| Serum creatinine >1.5 mg/dL (men) >1.4 mg/dL (women), CHF, radiographic contrast studies, seriously ill patients, acidosis |
|
|
Term
| what is the major toxicity of metformin |
|
Definition
|
|
Term
| 3 GI side effects of metformin |
|
Definition
| nausea, diarrhea, metallic taste |
|
|
Term
| which glucose lowering medications are contraindicated in renal/hepatic failure |
|
Definition
| the insulin secrategogues including: sulfynylureas, nonsulfynylureas, GLP-1 agonists and Dipeptidyl Peptidase-4 Inhibitors |
|
|
Term
| what is Exenatide? what are its side effects |
|
Definition
|
|
Term
|
Definition
| long-acting GLP-1 agonist, medullary carcinoma |
|
|
Term
| 6 drugs significantly interact with sulfynylurea |
|
Definition
| alcohol, aspirin, ketoconazole, fluconazole, alpha-glucosidase (acarbose), coumadin |
|
|
Term
| 2 drugs that are alpha glycosidase inhibitors |
|
Definition
|
|
Term
| 5 conditions in which alpha glycosidase inhibitors are CI |
|
Definition
| inflammatory bowel disease, gastroparesis, creatinine >2 mg/dL, antiacids, bile acid resins |
|
|
Term
| what do TZDs do to fat tissue |
|
Definition
| distribute it from the center to the periphery |
|
|
Term
| what is a follow up test indicated with the use of TZDs for diabetes |
|
Definition
| initial LFTs and then every 2 months - hepatic failure |
|
|
Term
| 2 CIs for the use of TZDs |
|
Definition
| hepatic failure and CHF class 3-4 |
|
|
Term
| what is the effect of Rosiglitazone (TZD) on serum lipids |
|
Definition
|
|
Term
|
Definition
| decrease hematocrit, increase plasma levels, increase fractures, hepatic failure, cardiovascular risk, weight gain, hyperlipidemia |
|
|
Term
| what role do bile acid resins have in the treatment of DM |
|
Definition
| decrease serum glucose levels via an unknown mechanism |
|
|
Term
| 3 conditions in which insulin should be the initial treatment in type 2 DM |
|
Definition
| lean individuals, severe weight loss, renal or hepatic disease that precludes oral glucose-lowering agents |
|
|
Term
| which 2 glucose lowering drugs are less effective at lowering A1C |
|
Definition
| DPPV-Is and alpha glucosidase inhibitors |
|
|
Term
| 2 glucose lowering drugs which take 3-4 wks to start lowering glucose levels |
|
Definition
|
|
Term
| what is the role of aspirin in DM |
|
Definition
| primary prevention in type 1 or type 2 DM men >50 years or women >60 years with one risk factor CV disease |
|
|
Term
| when should diabetics initially perform an eye examination? how frequent the follow up |
|
Definition
type 1 - within 5 yrs
type 2 - at diagnosis
every 2 yrs if normal |
|
|
Term
| when should screening for microalbuminuria begin in type 1 DM |
|
Definition
|
|
Term
| what are the blood glucose goals in the hospitalized patient? |
|
Definition
critically ill 140-180
non-critically ill <140 preprandial and under 180 at all times |
|
|
Term
| what is the Tx of a hospitalized patient with occasional peaks of hyperglycemia |
|
Definition
| basal insulin + short acting (not SOS short acting) |
|
|
Term
| how does pregnancy impact insulin resistance |
|
Definition
|
|
Term
| 8 malignant conditions that can cause hypopituitarism |
|
Definition
Pituitary adenoma
Parasellar mass (germinoma, ependymoma, glioma)
Rathke's cyst
Craniopharyngioma
Hypothalamic hamartoma, gangliocytoma
Pituitary metastases (breast, lung, colon carcinoma)
Lymphoma and leukemia
Meningioma |
|
|
Term
| 5 inflammatory/infiltrative conditions that can cause hypopituitarism |
|
Definition
Lymphocytic hypophysitis
Hemochromatosis
Sarcoidosis
Histiocytosis X
Granulomatous hypophysitis |
|
|
Term
| 4 organisms that may cause infection of the pituitary and hypopituitarism |
|
Definition
Fungal (histoplasmosis)
Parasitic (toxoplasmosis)
Tuberculosis
Pneumocystis carinii |
|
|
Term
| 4 congenital syndromes associated with hypopituitarism |
|
Definition
septo-optic dysplasia,
Prader-Willi syndrome, Laurence-Moon-Biedl syndrome,
Kallmann syndrome) |
|
|
Term
| 5 tests to check for GH hyposecretion |
|
Definition
| Insulin tolerance test, GHGH test, L-Arginine test, L-dopa test, prolactin |
|
|
Term
| 5 commonly used drugs that cause prolactin hypersecretion |
|
Definition
H2 antagonists
Cimetidine, ranitidine
Serotonin reuptake inhibitors
Fluoxetine
Calcium channel blockers
Verapamil
Estrogens |
|
|
Term
| what are diagnostic levels of prolactinoma and what are 3 conditions that should be considered in lower levels? |
|
Definition
>200, prolactinoma
<100 - microadenomas, other sellar lesions that decrease dopamine inhibition, or nonneoplastic causes of hyperprolactinemia |
|
|
Term
| what is the treatment of an asymptomatic prolactin secreting microadenoma |
|
Definition
| only estrogen replacement, unless fertility wanted |
|
|
Term
| 2 drugs for the treatment of a symptomatic prolactin secreting microadenoma |
|
Definition
| cabergoline, bromocriptine |
|
|
Term
| 6 side effects of cabergolin/bromocriptine for prolactinoma |
|
Definition
| constipation, nasal stuffiness, dry mouth, nightmares, insomnia, and vertigo |
|
|
Term
| 3 indications for surgical debulking of a prolactinoma |
|
Definition
| dopamine resistance or intolerance and the presence of an invasive macroadenoma with compromised vision that fails to improve after drug treatment |
|
|
Term
| what are the recurrence rates of hyperprolactinemia in surgical debulking of macroprolactinomas |
|
Definition
|
|
Term
| 3 CIs to GH treatment in adult growth hormone deficiency |
|
Definition
| active neoplasm, intracranial hypertension, and uncontrolled diabetes and retinopathy |
|
|
Term
| 3 side effects of GH therapy |
|
Definition
| fluid retention, joint pain, and carpal tunnel syndrome |
|
|
Term
| what test confirms the diagnosis of acromegaly |
|
Definition
| failure of GH suppression to <0.4 g/L within 1–2 h of an oral glucose load (75 g). |
|
|
Term
| 3 indications for somatostatin use in acromegaly |
|
Definition
| adjuvant treatment for preoperative shrinkage of large invasive macroadenomas, immediate relief of debilitating symptoms, and reduction of GH hypersecretion |
|
|
Term
| which 2 group of drugs, besides somatostatin, are known to suppress GH |
|
Definition
| dopamine agonists and GH receptor antagonists |
|
|
Term
| the clinical features of ectopic ACTH secretion vs. ACTH-Secreting Pituitary Tumor is prominent for... |
|
Definition
Rapid onset
Pigmentation
Severe myopathy
Serum potassium <3.3 g/dl |
|
|
Term
| 2 test to differentiate btwn adrenal and pituitary hypercortisolism |
|
Definition
24-h urine free cortisol (UFC)
1-mg dexamethasone suppression test |
|
|
Term
| 2 tests to differentiate pituitary from ectopic hypercortisolism |
|
Definition
2-mg dexamethasone suppression test
Inferior petrosal sinus sampling (IPSS) w/ or w/o CRH induction |
|
|
Term
| when would it be sensible to use Inferior Petrosal sinus Sampling |
|
Definition
| when pituitary MRI with gadolinium enhancement is insufficiently sensitive to detect small (<2 mm) pituitary ACTH-secreting adenomas |
|
|
Term
| what do the most common pituitary adenomas secrete |
|
Definition
|
|
Term
| 8 drugs that cause nephrogenic diabetes insipidus |
|
Definition
Lithium
Demeclocycline
Methoxyflurane
Amphotericin B
Aminoglycosides
Cisplatin
Rifampin
Foscarnet |
|
|
Term
| what are Dipsogenic (abnormal thirst) causes of primary polydipsia |
|
Definition
Sarcoidosis
Tuberculous meningitis
head trauma
Multiple sclerosis
Lithium
Carbamazepine |
|
|
Term
| what is a confirmation test for DI |
|
Definition
| urine volume exceeds 50 mL/kg per day and the osmolarity is >300 mosmol/L |
|
|
Term
| after determining the patient is suffering from diabetes insipidus, what is the next step in the workup to minimize the options to either nephrogenic or central DI? |
|
Definition
| fluid deprivation test: positive if fluid deprivation does not result in urine concentration (osmolarity >300 mosmol/L, specific gravity >1.010) before body weight decreases by 5% or plasma osmolarity/sodium rise above the upper limit of normal |
|
|
Term
| while preforming the fluid deprevation test and after minimizing to NDI or CDI, which test is able to distinguish the two? |
|
Definition
| give desmopressin and repeat the urine osmolarity 1–2 hours later. An increase of >50% indicates severe pituitary DI, whereas a smaller or absent response is strongly suggestive of nephrogenic DI |
|
|
Term
| how do you differentiate partial NDI from partial CDI? |
|
Definition
| measure AVP in correlation to urine osmolarity |
|
|
Term
| how to distinguish pituitary/nephrogenic DI from primary polydipsia |
|
Definition
| MRI bright spot in the neurohypophysis- almost always present in patients with primary polydipsia but is invariably absent or abnormally small in patients with pituitary/nephrogenic DI |
|
|
Term
| what is the treatment of nephrogenic DI |
|
Definition
| thiazide diuretic and/or amiloride in conjunction with a low-sodium diet and a prostaglandin synthesis inhibitor (e.g., indomethacin) |
|
|
Term
| 10 neoplasms that may cause inappropriate secretion of AVP |
|
Definition
Lung
Duodenum
Pancreas
Ovary
Bladder, ureter
Thymoma
Mesothelioma
Bronchial adenoma
Carcinoid
Gangliocytoma
Ewing's sarcoma |
|
|
Term
| 11 drugs that may cause inappropriate ADH secretion |
|
Definition
Vasopressin or desmopressin
Chlorpropamide
Oxytocin, high dose
Vincristine
Carbamazepine
Nicotine
Phenothiazines
Cyclophosphamide
Tricyclic antidepressants
Monoamine oxidase inhibitors
Serotonin reuptake inhibitors |
|
|
Term
| how do you treat adipsic hypernatremia? |
|
Definition
| give amount of missing free water in 24-48 hrs: FW = 0.5BW x [(SNa – 140)/140]. |
|
|
Term
| in case of hyponatremia, how can you rule out the possibility of hypervolemic hyponatremia (osmotically driven shift of water from the intracellular space to the extracellular space)? |
|
Definition
| if plasma glucose is not high enough to account for the hyponatremia [serum sodium decreases 1 meq/L for each rise in glucose of 2 mmol/L (36 mg/dL)] and/or plasma osmolarity is reduced in proportion to sodium (each decrease in serum sodium of 1 meq/L should reduce plasma osmolarity by 2 mosmol/L) |
|
|
Term
|
Definition
if it is mild - water restriction: drink 500 ml less than you urinate
If the symptoms or signs of water intoxication are more severe, the hyponatremia can be corrected more rapidly by supplementing the fluid restriction with IV infusion of hypertonic (3%) saline |
|
|
Term
| what is the treatment of chronic SIADH |
|
Definition
| democlocycline or fludrocortisone |
|
|
Term
| 5 drugs that inhibit type 2 deiodinase, hence decreased conversino of T4->T3? |
|
Definition
| PTU, propranolol, amiodarone, glucocorticoids, ipodate |
|
|
Term
| what happens to total T4 and TBG with excess estrogens (pregnancy, oral contraceptives, hormone therapy, tamoxifen, cirrhosis, hepatitis) |
|
Definition
|
|
Term
| drugs that cause hypothyroidism |
|
Definition
| contrast media, amiodarone, lithium, antithyroid drugs, p-aminosalicylic acid, IFNa and other cytokines, aminoglutethimide, sunitinib |
|
|
Term
| after measuring TSH and unbound T4, what is the next step in the workup of hypothyroidism? |
|
Definition
|
|
Term
| TSH elevated, unbound T4 normal, negative anti-TPO - what is the next step |
|
Definition
|
|
Term
| in a patient suspected clinically of having thyrotoxicosis and in the lab - low TSH and normal unbound T4, what is the next step in the workup |
|
Definition
|
|
Term
| in a patient suspected clinically of having thyrotoxicosis and in the lab - low TSH, normal unbound T4 and normal unbound T3, what is the next step in the workup |
|
Definition
| subclinical hyperthyroidism - follow up in 6-12 months |
|
|
Term
| in patient proven to have primary thyrotoxicosis by lab (low TSH, high T4 or T3), what is the next step in the workup? |
|
Definition
evaluate for signs and symptoms of Grave's disease: Diffuse goiter, positive TPO antibodies (TSI, TBII), ophthalmopathy, dermopathy
present - Grave's
absent - toxic adenoma or multinodular goiter |
|
|
Term
| what is another way to distinguish Grave's disease from nodular thyroid disease, destructive thyroiditis, ectopic thyroid tissue, and factitious thyrotoxicosis |
|
Definition
| radionuclide (99mTc, 123I, or 131I) scan |
|
|
Term
| what is an important instruction given to patients on anti-thyroid drugs? and why? |
|
Definition
| stop treatment in case of sore throat, fever, or mouth ulcers and report to you doctor's office for a CBC. risk of agranulocytosis |
|
|
Term
| what are the indications for Radioiodine treatment of Grave's disease |
|
Definition
| initial treatment or for relapses after a trial of antithyroid drugs |
|
|
Term
| what instructions should be given to a patient planned to undergo Radioiodine therapy for Grave's disease |
|
Definition
| must stop Methimazole 2 days before treatment or PTU several weeks before treatment |
|
|
Term
| 2 CIs to Radioiodine therapy of Grave's disease |
|
Definition
| pregnancy and breast feeding |
|
|
Term
| what is the indication for Subtotal or near-total thyroidectomy for Grave's |
|
Definition
| patients who relapse after antithyroid drugs |
|
|
Term
| what is a possible treatment of severe ophthalmopathy in grave's disease |
|
Definition
high dose glucocorticoids and cyclosporine
resistant cases - External beam radiotherapy |
|
|
Term
| 2 treatment options for dermopathy associated with grave's disease |
|
Definition
| octreotide, glucocorticoid ointment |
|
|
Term
| initial therapy of thyroiditis? |
|
Definition
NSAIDs or aspirin
if not helpful - prednisone |
|
|
Term
| what can be said of thyroid function during pregnancy? |
|
Definition
| hCG weakly activates the TSH-R. TSH levels drop. this causes hyperemesis gravidarum |
|
|
Term
|
Definition
| symptoms of faintness with evidence of facial congestion and external jugular venous obstruction when the arms are raised above the head, a maneuver that draws the thyroid into the thoracic inlet |
|
|
Term
| what is the treatment of nontoxic goiter |
|
Definition
| thyroxine, which will reduce the goiter size in 3-6 months |
|
|
Term
| what is the role of US in the workup of multinodular nontoxic goiter |
|
Definition
| identify which nodules should be biopsied: large, dominant nodules or those with sonographic characteristics suggestive of malignancy (e.g., microcalcifications, hypoechogenicity, increased vascularity) |
|
|
Term
| how is the diagnosis of solitary hyperfunctioning nodule (toxic adenoma) made? |
|
Definition
|
|
Term
| what is the treatment of choice for toxic adenoma |
|
Definition
|
|
Term
| what is the most prevalent thyroid malignancy |
|
Definition
|
|
Term
| which has a better prognosis follicular or papillary thyroid carcinoma |
|
Definition
|
|
Term
| what is the therapy of thyroid cancer |
|
Definition
1. near-total thyroidectomy
2. TSH suppression with thyroxine
3. radioiodine ablation - not all |
|
|
Term
| what are the 4 indications for adding radioiodine ablation to the treatment of thyroid cancer |
|
Definition
patients with papillary tumors > 1.5cm
spread to the adjacent lymph nodes
FTC
metastases |
|
|
Term
| what is the first step of follow up after thyroid ablation d/t cancer? |
|
Definition
| An initial whole-body scan should be performed about 6 months after thyroid ablation and thyroglobulin measurement |
|
|
Term
| what is the second step (after whole body scan and Tg measurements) in the follow up after thyroid ablation d/t cancer? |
|
Definition
if no sign of disease on whole body scan and Tg<2, proceed with rhTSH-stimulated Tg levels one year after ablation (and 6-12 months thereafter)
if sign of disease on whole body scan treat with repeat radioiodine ablation
if no sign of residual disease on whole body scan but Tg>2, follow up using T4 withdrawal protocol (Scan and Tg measurements) |
|
|
Term
| how does the T4 withdrawal protocol work? |
|
Definition
| change levothyroxine (T4) to the more rapidly cleared hormone liothyronine (T3), thereby allowing TSH to increase more quickly - perform scan and Tg measurements |
|
|
Term
| 2 indications for repeat radioiodine ablation |
|
Definition
1. residual disease on whole body scan
2. Tg>5-10 |
|
|
Term
| 2 treatment options for anaplastic thyroid carcinoma |
|
Definition
anthracyclines and paclitaxel
radiation therapy |
|
|
Term
| surgery should be avoided in which cancer of the thyroid |
|
Definition
|
|
Term
| what is the first step in the workup of a solitary thyroid nodule? |
|
Definition
|
|
Term
| if TSH is low in the workup of a solitary thyroid nodule, what is the next step? |
|
Definition
| thyroid scan - if the nodule is "hot" - it is not malignant |
|
|
Term
| what is the next step in workup of a solitary thyroid nodule if TSH is low or thyroid scan "cold" |
|
Definition
|
|
Term
| what is the next step in follow up if FNA of a solitary thyroid nodule is benign |
|
Definition
follow up with US every once in a while
Many authorities advocate TSH suppression
Repeat FNA is indicated if a nodule enlarges, and a second biopsy should be performed within 2–5 years to confirm the benign status of the nodule |
|
|
Term
| what do you do with an indiagnostic result on FNA of a solitary thyroid nodule |
|
Definition
|
|
Term
| patients with Cushing's syndrome are in a hypercoagulable state, and at an increased risk of DVT |
|
Definition
|
|
Term
| after confirming cushing's syndrome with a midnight plasma cortisol, 24 hr urine cortisol or overnight dexamethasone test, what is the next step in the workup? |
|
Definition
| plasma ACTH test to distinguish ACTH nonresponsive adrenal lesions from ACTH responsive pituitary or ectopic causes to cushing's |
|
|
Term
| after establishing that cushing's syndrome is caused by an adrenal lesion what is the next step in workup? and still 3 options in the DD? |
|
Definition
| adrenal CT: unilateral adenoma or bilateral micronodular or macronodular adrenal hyperplasia |
|
|
Term
| 4 treatment options in recurrent ACTH secreting pituitary adenoma after resection |
|
Definition
| second surgery, radiotherapy, stereotactic radiosurgery, and bilateral adrenalectomy |
|
|
Term
| 2 drugs that help suppress cortisol secretion in cushing's disease |
|
Definition
| metyrapone and ketoconazole |
|
|
Term
| what is the most common cause of Conn's syndrome (primary hyperaldosteronemia) |
|
Definition
| bilateral adrenal hyperplasia (not adrenal adenoma) |
|
|
Term
| who is eligible for screening of mineralocorticoid excess in the setting of hypertension |
|
Definition
| those who exhibit hypertension associated with drug resistance, hypokalemia, an adrenal mass, or hypertension before the age of 40 |
|
|
Term
| what is the accepted screening test for hypertension d/t mineralocorticoid excess |
|
Definition
| concurrent measurement of plasma renin and aldosterone with subsequent calculation of the aldosterone-renin ratio (ARR) |
|
|
Term
| what are 2 preconditions to perform the ARR screening test |
|
Definition
mineralocorticoid receptor antagonists need to be ceased at least 4 weeks prior to ARR measurement
potassium serum levels need to be fixed |
|
|
Term
| Diagnostic confirmation of mineralocorticoid excess in a patient with positive ARR screening result |
|
Definition
saline infusion test: 2 L of saline over a 4-hour period. aldosterone> 140
oral sodium loading test (300 mmol NaCl/d for 3 days)
fludrocortisone suppression test (0.1 mg q6h with 30 mmol NaCl q8h for 4 days |
|
|
Term
| 2 antihypertensive drugs that lower the ARR (increase renin) and 1 that increases the ARR (by increasing aldosterone) |
|
Definition
|
|
Term
| after establishing primary hyperaldosteronism what is the next step in the workup? |
|
Definition
|
|
Term
| what are the indications for preforming adrenal vein sampling (AVS) in the workup of primary hyperaldosteronism |
|
Definition
| only in surgical candidates with either no obvious lesion on CT or evidence of a unilateral lesion in patients older than 40 years, as the latter patients have a high likelihood of harboring a coincidental, endocrine inactive adrenal adenoma |
|
|
Term
| what is the goal of adrenal vein sampling in the workup of primary hyperaldosteronism |
|
Definition
| AVS is used to compare aldosterone levels in the inferior vena cava and between the right and left adrenal veins |
|
|
Term
| how is adrenal vein sampling done? |
|
Definition
| AVS requires concurrent measurement of cortisol to document correct placement of the catheter in the adrenal veins and should demonstrate a cortisol gradient >3 between the vena cava and each adrenal vein. Lateralization is confirmed by an aldosterone/cortisol ratio that is at least twofold higher on one side than the other |
|
|
Term
| 2 drug options for primary hyperaldosteronism |
|
Definition
| eplerenone, spirinolactone |
|
|
Term
| which patients with a new found adrenal incidentiloma need diagnostic workup |
|
Definition
| Patients with an adrenal mass >1 cm |
|
|
Term
| what is the first step in the workup of patients with a new found adrenal incidentiloma? |
|
Definition
| check if it is hormone secreting: metanephrines/catecholamines, cortisol, aldosterone, DHEA/17b-hydroxyprogesterone |
|
|
Term
| how do you determine malignancy/benign nature of adrenal incidentaloma |
|
Definition
CT - 3 findings that suggest benignity:
1. size<4 cm
2. low density<10 HU |
|
|
Term
| what is the follow up strategy of an adrenal incidentiloma found to be benign? |
|
Definition
| repeat screening for hormone excess and CT imaging at 12 months |
|
|
Term
| what is the only indication for FNA in the incidentally found adrenal tumor |
|
Definition
| Fine-needle aspiration (FNA) or CT-guided biopsy of an adrenal mass is almost never indicated. FNA of a pheochromocytoma can cause a life-threatening hypertensive crisis. FNA of an adrenocortical carcinoma violates the tumor capsule. FNA should only be considered in a patient with a history of nonadrenal malignancy |
|
|
Term
| what is the confirmatory histological evidence of malignancy for an excised adrenal tumor |
|
Definition
| the Weiss score, taking into account high nuclear grade; mitotic rate (>5/HPF); atypical mitosis; <25% clear cells; diffuse architecture; and presence of necrosis, venous invasion, and invasion of sinusoidal structures and tumor capsule. The presence of 3 or more elements suggests ACC |
|
|
Term
| 3 determinants of poor prognosis in adrenocortical carcinoma |
|
Definition
| Capsule violation during primary surgery, metastasis at diagnosis, and primary treatment in a nonspecialist center |
|
|
Term
| what is the treatment of ACC that invades adjacent organs? |
|
Definition
| en bloc removal of kidney and spleen should be considered to reduce the risk of recurrence |
|
|
Term
| what is the adjuvant therapy that should be provided to patients after resection of primary ACC |
|
Definition
| mitotane - a derivative of the insecticide o,p'DDD, is an adrenolytic agent that is also effective for reducing cortisol in cushing's syndrome |
|
|
Term
| 4 factors that implicate high rates of recurrence in ACC |
|
Definition
| tumor size >8 cm, histopathologic signs of vascular invasion, capsule invasion or violation, and a Ki67 proliferation index 10% |
|
|
Term
| what is the treatment If the ACC recurs or progresses during mitotane treatment |
|
Definition
| chemotherapy: cisplatin, etoposide, doxorubicin plus continuing mitotane, the so-called Berrutti regimen |
|
|
Term
| what is the MCC of primary adrenal insufficiency |
|
Definition
| autoimmune adrenalitis (APS syndromes and the such) |
|
|
Term
| beside adrenal insufficiency, what other s/s can be found on APS2 syndrome |
|
Definition
| thyroid autoimmune disease, vitiligo, and premature ovarian failure, type 1 diabetes mellitus, pernicious anemia |
|
|
Term
| beside adrenal insufficiency, what other s/s can be found on APS1 syndrome |
|
Definition
| Hypoparathyroidism, chronic mucocutaneous candidiasis, other autoimmune disorders |
|
|
Term
| beside adrenal insufficiency, what other s/s can be found on Kearns-Sayre syndrome |
|
Definition
| Progressive external ophthalmoplegia, pigmentary retinal degeneration, cardiac conduction defects, gonadal failure, hypoparathyroidism, type 1 diabetes |
|
|
Term
| what is the MC presenting sign of primary adrenal insufficiency (adrenal)? |
|
Definition
|
|
Term
| how is The diagnosis of adrenal insufficiency made? |
|
Definition
| cosyntropin test, a safe and reliable tool with excellent positive predictive diagnostic value. The cut-off for failure is usually defined at cortisol levels of <500–550 nmol/L (18–20 g/dL) sampled 30–60 minutes after ACTH stimulation |
|
|
Term
| During the early phase, within 4 weeks of adrenal, patients may still respond to exogenous ACTH stimulation, what is a confirmatory test in this case? |
|
Definition
| the insulin tolerance test |
|
|
Term
| 3 CIs to the insulin tolerance test |
|
Definition
| diabetes mellitus, cardiovascular disease, or history of seizures |
|
|
Term
| after confirming adrenal insufficiency, how do you continue to distinguish primary from secondary dysfunction |
|
Definition
| plasma ACTH, plasma renin, serum aldosterone |
|
|
Term
| what should be done in patients who have been established to have primary adrenal insufficiency? |
|
Definition
| should undergo screening for steroid autoantibodies as a marker of autoimmune adrenalitis |
|
|
Term
| in a patient diagnosed with primary adrenal insufficiency, whom screening for steroid autoantibodies was negative, what is the next step in workup? |
|
Definition
adrenal imaging by CT is indicated to investigate possible hemorrhage, infiltration, or masses.
In males, very long chain fatty acids should be measured to exclude X-ALD
17OHP for congenital adrenal hyperplasia |
|
|
Term
| what is the initial treatment of acute adrenal insufficiency |
|
Definition
Acute adrenal insufficiency requires immediate initiation of rehydration, usually carried out by saline infusion at initial rates of 1 L/h
Glucocorticoid replacement |
|
|
Term
| which drugs can trigger a pheochromocytoma attack |
|
Definition
| tricyclic antidepressants, opiates, metoclopramide |
|
|
Term
| malignant pheochromocytoma, seen in 10% of cases, metastasizes where?! |
|
Definition
|
|
Term
| what is Averbuch's chemotherapy protocol for malignant pheochromocytoma |
|
Definition
| dacarbazine (600 mg/m2 days 1 and 2), cyclophosphamide (750 mg/m2 day 1), and vincristine (1.4 mg/m2 day 1), repeated every 21 days for three to six cycles |
|
|
Term
| 5 syndromes associated with pheochromocytoma |
|
Definition
| NF1, MEN2A, MEN2B, VHL, paraganglioma syndromes |
|
|
Term
| what is whipple's triad for convincingly identifying hypoglycemia |
|
Definition
| (1) symptoms consistent with hypoglycemia, (2) a low plasma glucose concentration measured with a precise method (not a glucose monitor), and (3) relief of those symptoms after the plasma glucose level is raised |
|
|
Term
| steroid hormone binding globulins are decreased in what 5 conditions |
|
Definition
| androgens, obesity, diabetes mellitus, insulin, and nephrotic syndrome |
|
|
Term
| 4 conditions associated with increased SHBG and therefore decreased active (unbound + bound to albumin) |
|
Definition
| estrogen administration, hyperthyroidism, many chronic inflammatory illnesses, and aging |
|
|
Term
| 2 Conditions in Which Testosterone Administration is Associated with Very High Risk of Serious Adverse Outcomes |
|
Definition
| prostate and breast cancer |
|
|
Term
| 7 absolute CIs to oral contraceptives |
|
Definition
Previous thromboembolic event or stroke
History of an estrogen-dependent tumor
Active liver disease
Pregnancy
Undiagnosed abnormal uterine bleeding
Hypertriglyceridemia
Women aged >35 years who smoke heavily |
|
|
Term
| 3 relative CIs to oral contraceptives |
|
Definition
Hypertension
Women receiving anticonvulsant drug therapy
Women following bariatric surgery (malapsorptive procedure) |
|
|
Term
| oral contraceptives are associated with risk for which 6 conditions |
|
Definition
Coronary heart disease
Hypertension
Venous thrombosis
Stroke—slight increase;
Cerebral vein thrombosis
Cervical cancer |
|
|
Term
| oral contraceptives are associated with decreased risk of what 2 conditions |
|
Definition
| ovarian and endometrial cancer |
|
|
Term
| The diagnosis of carcinoid syndrome relies on... |
|
Definition
| measurement of urinary or plasma serotonin or its metabolites in the urine. The measurement of 5-HIAA is used most frequently |
|
|
Term
| false positive elevations of serotonin in serum or 5HIAA in the urine is d/t... |
|
Definition
| eating bananas, pineapples, walnuts, pecans, avocados, or hickory nuts or is taking certain medications (cough syrup containing guaifenesin, acetaminophen, salicylates, serotonin reuptake inhibitors, or l-dopa). |
|
|
Term
| 3 drugs (5-HT1 and 5-HT2 receptor antagonists) used in the treatment of carcinoid syndrome |
|
Definition
| methylsergide, cyproheptadine, and ketanserin |
|
|
Term
| 3 drugs (5-HT3 receptor antagonists) used in the treatment of carcinoid syndrome |
|
Definition
| ondansetron, tropisetron, alosetron |
|
|
Term
| the most widely used agents to control the symptoms of patients with carcinoid syndrome |
|
Definition
| Synthetic analogues of somatostatin (octreotide, lanreotide) |
|
|
Term
| Carcinoid heart disease is associated with a decreased mean survival (3.8 years |
|
Definition
|
|
Term
| what surgical treatment is used to control the symptoms of carcinoid syndrome |
|
Definition
| Hepatic artery embolization alone or with chemotherapy (chemoembolization) |
|
|
Term
| what is the surgical treatment for carcinoid tumor >2 cm in the rectum, appendix, or small-intestine |
|
Definition
| full cancer operation should be done. This includes a right hemicolectomy for appendiceal carcinoid, an abdominoperineal resection or low anterior resection for rectal carcinoids, and an en bloc resection of adjacent lymph nodes for small-intestinal carcinoids |
|
|
Term
| The diagnosis of ZES requires... |
|
Definition
| the demonstration of inappropriate fasting hypergastrinemia, usually by demonstrating hypergastrinemia occurring with an increased basal gastric acid output (BAO) (hyperchlorhydria) |
|
|
Term
| how do you treat insulinoma before surgery |
|
Definition
| frequent meals and diazoxide - a benzothiadiazide whose hyperglycemic effect is attributed to inhibition of insulin release |
|
|
Term
| what is the distinct syndrome of glucagonoma |
|
Definition
| dermatitis, glucose intolerance or diabetes, and weight loss |
|
|
Term
| what is the characteristic rash of glucagonoma |
|
Definition
| The characteristic rash usually starts as an annular erythema at intertriginous and periorificial sites, especially in the groin or buttock |
|
|
Term
| A plasma glucagon level >1000 pg/mL is considered diagnostic of glucagonoma. |
|
Definition
|
|
Term
|
Definition
| In 50–80% of patients, hepatic metastases are present, and so curative surgical resection is not possible |
|
|
Term
| what is the distinct syndrome of vipoma? what names was it given? |
|
Definition
large-volume diarrhea, hypokalemia, and dehydration
Verner-Morrison syndrome, pancreatic cholera, and WDHA |
|
|
Term
| how is the diagnosis of VIPoma made? |
|
Definition
| demonstration of an elevated plasma VIP level and the presence of large-volume diarrhea |
|
|
Term
| all men syndromes can manifest with pheochromocytoma |
|
Definition
|
|
Term
| causes of hypophosphatemia |
|
Definition
hospitalized - DKA treatment
increase FGF23 levels
persistent renal tubular phosphate-wasting disorder
PTH/PTHrP-dependent
Alcoholism |
|
|
Term
| clinical manifestations of hypophosphatemia |
|
Definition
| clinical manifestations of severe hypophosphatemia reflect a generalized defect in cellular energy metabolism because of ATP depletion, a shift from oxidative phosphorylation toward glycolysis, and associated tissue or organ dysfunction |
|
|
Term
| whats important to remember in the treatment of hyposphatemia |
|
Definition
| administering glucose concurrently with phosphate |
|
|
Term
| 2 causes of false positive hypercalcemia |
|
Definition
| hemoconcentration during blood collection or elevation in serum proteins such as albumin |
|
|
Term
| 4 criteria to commence medical monitoring in the mild asymptomatic hyperparathyroidism patient. 3 parameters to monitor |
|
Definition
Serum calcium (above normal) >1 mg/dL
Creatinine clearance (calculated) If <60 mL/min
Bone density T score <–2.5
Age <50
parameters: annual bone density, serum calcium and creatinine |
|
|
Term
| 4 criteria to commence medical monitoring in the mild asymptomatic hyperparathyroidism patient. 3 parameters to monitor |
|
Definition
Serum calcium (above normal) >1 mg/dL
Creatinine clearance (calculated) If <60 mL/min
Bone density T score <–2.5
Age <50
parameters: annual bone density, serum calcium and creatinine |
|
|
Term
4 criteria for surgical treatment of symptomatic hyperparathyroidism or to commence medical monitoring in the
asymptomatic hyperparathyroidism patient. 3 parameters to monitor |
|
Definition
Serum calcium (above normal) >1 mg/dL
Creatinine clearance (calculated) If <60 mL/min
Bone density T score <–2.5
Age <50
parameters: annual bone density, serum calcium and creatinine |
|
|
Term
| how is the surgical management of hyperparathyroidism associated with a parathyroid adenoma done? |
|
Definition
| Preoperative 99mTc sestamibi scans with single-photon emission CT (SPECT) are used to predict the location of an abnormal gland and intraoperative sampling of PTH before and at 5-minute intervals after removal of a suspected adenoma to confirm a rapid fall (>50%) to normal levels of PTH |
|
|
Term
| what is the surgical management of hyperparathyroidism d/t multiple gland hyperplasia, as predicted by a familial history? |
|
Definition
| total parathyroidectomy with immediate transplantation of a portion of a removed, minced parathyroid gland into the muscles of the forearm, with the view that surgical excision is easier from the ectopic site in the arm if there is recurrent hyperfunction |
|
|
Term
| what is the most common type of hyperparathyroidism |
|
Definition
|
|
Term
| after surgery for hyperparathyroidism, what should raise the possibility that surgery has caused hypoparathyroidism |
|
Definition
| If the serum calcium falls to <2 mmol/L (8 mg/dL), and if the phosphate level rises simultaneously |
|
|
Term
| how should calcium levels be instituted in the case of post surgical symptomatic hypocalcemia |
|
Definition
|
|
Term
| what is the mgmt if symptomatic hypocalcemia endures post surgically despite parenteral calcium repletion |
|
Definition
| parenteral vit D (calcitriol) |
|
|
Term
| 2 differences in hypercalcemia causes by primary hyperparathyroidism and PTHrp cancer related |
|
Definition
| calcitriol and PTH are low in PTHrp related hypercalcemia |
|
|
Term
| which 4 malignancies are MC associated with hypercalcemia |
|
Definition
| SCC of the lung, kidney, head and neck, and urogenital tract |
|
|
Term
| in which congenital syndrome is hypercalcemia cause by increased secretion of 1,25(OH)2D ? |
|
Definition
|
|
Term
| what chronic amounts of vit D ingestion is usually required to produce significant hypercalcemia in normal individuals |
|
Definition
| amounts >40,000–100,000 U/d |
|
|
Term
| what is the mgmt of hypercalcemia d/t sarcoidosis |
|
Definition
avoiding excessive sunlight exposure and limiting vitamin D and calcium intake
or glucocorticoids (hydrocortisone) |
|
|
Term
| 4 conditions responsible for Hypercalcemia Associated with High Bone Turnover |
|
Definition
hyperthryoidism
immobilization
Vit A intoxication
Thiazides |
|
|
Term
| secondary hyperparathyroidism is associated with hypercalcemia and what phosphate levels |
|
Definition
|
|
Term
| what are the most important measures in the mgmt of acute hypercalcemia |
|
Definition
| hydration and forced diuresis (loop diuretics) |
|
|
Term
| what treatment do you add in the acute settings of severe hypercalcemia |
|
Definition
|
|
Term
| what is the range of time it takes for bisphosphonates to have a therapeutical affect in hypercalcemia |
|
Definition
| intermediate - but you administer them immediately upon diagnosis |
|
|
Term
| what is the role of oral phosphate in the treatment of hypercalcemia |
|
Definition
|
|
Term
| what is the treatment of life-threatening hypercalcemia |
|
Definition
|
|
Term
| what is the role of glucocorticoids in hypercalcemia |
|
Definition
| they are especially effective in malignancies |
|
|
Term
| what is the treatment of chronic acquired or genetic hypoparathyroidism |
|
Definition
| replenishment of calcium and calcitriol and treatment with thiazide to avoid excess losses of calcium in urine |
|
|
Term
| severe hypomagnesemia associated with hypocalcemia where as mild hypomagnesemia is associated with hypercalcemia |
|
Definition
|
|
Term
| what is the abnormality in the serum electrolytes in hypoparathyroidism caused by severe hypomagnesemia |
|
Definition
| hypophosphatemia - since it usually goes together with hypomagnesemia |
|
|
Term
| 3 clinical findings in pseudohypoparathyroidism type 1a and 1b |
|
Definition
| short stature, round face, brachydactily- The typical findings are short fourth and fifth metacarpals and metatarsals |
|
|
Term
| important note on the inheritance of PHP 1a and 1b |
|
Definition
| endocrine abnormalities become apparent only if the disease-causing mutation is inherited maternally |
|
|
Term
| what is the difference btwn PHP 1a and 1b and PHPII |
|
Definition
| all have hypocalcemia, hyperphosphatemia but PHPII has normal urinary cyclic AMP |
|
|
Term
| what is the treatment of acute severe PTH overwhelmed |
|
Definition
| lowering of blood phosphate by the administration of phosphate-binding antacids or dialysis |
|
|
Term
| what are the nonmodifiable risk factors of osteporosis |
|
Definition
Personal history of fracture as an adult
History of fracture in first-degree
Female sex
Advanced age
White race
Dementia |
|
|
Term
| 5 hypogonadal states associated with osteporosis |
|
Definition
Turner's syndrome
Klinefelter's syndrome
Anorexia nervosa
Hypothalamic amenorrhea
Hyperprolactinemia |
|
|
Term
| 6 endocrine abnormalities associated with osteporosis |
|
Definition
Cushing's syndrome
Hyperparathyroidism
Thyrotoxicosis
Type 1 diabetes mellitus
Acromegaly
Adrenal insufficiency |
|
|
Term
| hematologic disorders associated with osteoporosis |
|
Definition
Multiple myeloma
Lymphoma and leukemia
Malignancy-associated parathyroid hormone (PTHrP) production
Mastocytosis
Hemophilia
Thalassemia |
|
|
Term
| 11 substances associated with osteoporosis |
|
Definition
Glucocorticoids
Excessive thyroxine
Cyclosporine
Aluminum
Cytotoxic drugs
Gonadotropin-releasing hormone agonists
Anticonvulsants
Heparin
Excessive alcohol
Lithium
Aromatase inhibitors |
|
|
Term
| 6 indications to perform bone densitometry |
|
Definition
Estrogen-deficient women at clinical risk of osteoporosis
Vertebral abnormalities on x-ray suggestive of osteoporosis (osteopenia, vertebral fracture)
Glucocorticoid treatment equivalent to 7.5 mg of prednisone or duration of therapy >3 months
Primary hyperparathyroidism
Monitoring response to an FDA-approved medication for osteoporosis
Repeat BMD evaluations at >23-month intervals or more frequently if medically justified |
|
|
Term
| 2 indications for treatment in osteoporosis |
|
Definition
when BMD is >2.5 SD below the mean value for young adults (T-score ≤–2.5), a level consistent with the diagnosis of osteoporosis
postmenopausal women with fracture risk factors even if BMD is not in the osteoporosis range |
|
|
Term
| 2 uses of bone remodelling markers |
|
Definition
1. monitoring the response to treatment - faster than BMD
2. deciding on treatment in postmenopausal women who don't fulfil the BMD criteria for treatment |
|
|
Term
| 5 treatments i did not know of for osteoporosis |
|
Definition
Denosumab - human monoclonal antibody to RANKL
PTH - first bone remodelling then bone resorption
fluoride
Calcitonin
Tamoxifen/raloxifene |
|
|
Term
| definition of paget's disease |
|
Definition
| overactive osteoclastic bone resorption followed by a compensatory increase in osteoblastic new bone formation, resulting in a structurally disorganized mosaic of woven and lamellar bone. |
|
|
Term
| what is part of the pathophysiology of paget's disease |
|
Definition
|
|
Term
| what is the radiographic finding of initial bone resorption and hypervascularization in paget's disease |
|
Definition
| an advancing lytic wedge, or "blade of grass" lesion |
|
|
Term
| what is the usual presentation of paget's disease |
|
Definition
| elevated ALP levels on routine blood chemistry testing or an abnormality on a skeletal radiograph obtained for another indication |
|
|
Term
| what is the MC presenting symptom in paget's disease |
|
Definition
|
|
Term
| what are common sites of fractures in paget's disease |
|
Definition
| femoral shaft and subtrochanteric regions |
|
|
Term
| what is a common physical finding in the skulls of paget disease |
|
Definition
|
|
Term
| what are the cardiovascular complications of paget's disease |
|
Definition
| high-output state and cardiac enlargement d/t the hypervascularity seen in the disease |
|
|
Term
| what are the signs suggesting paget's disease |
|
Definition
| enlarged skull with frontal bossing, bowing of an extremity, or short stature with simian posturing |
|
|
Term
| the diagnosis of paget's disease lies on radiographic and biochemical finding. some of the radiographic findings |
|
Definition
"cotton wool," skull
"picture frame" vertebra
"ivory vertebra."
brim sign
bowing deformity of long bones |
|
|
Term
| the diagnosis of paget's disease lies on radiographic and biochemical finding. the biochemical markers should present.... |
|
Definition
| increased ALP and/or parallel rise in markers of bone formation and resorption confirms the coupling of bone formation and resorption in Paget's disease |
|
|
Term
| what are the levels of calcium and phosphate in paget's disease |
|
Definition
|
|
Term
| 2 treatment options for paget's disease |
|
Definition
| bisphosphonates and calcinurin |
|
|
Term
| complication of osteopetrosis |
|
Definition
| loss of vision, deafness, psychomotor delay, mandibular osteomyelitis |
|
|
Term
| what do you see on radiography of osteopetrosis |
|
Definition
| symmetric increases in bone mass with thickening of both cortical and trabecular bone. The cranium is usually thickened, particularly at the base of the skull, and the paranasal and mastoid sinuses are underpneumatized |
|
|
Term
| what is the only significant laboratory abnormality in osteopetrosis |
|
Definition
| elevated serum levels of osteoclast-derived tartrate-resistant acid phosphatase (TRAP) and the brain isoenzyme of creatine kinase |
|
|
Term
| what are the treatment options of osteopetrosis |
|
Definition
Allogeneic HLA-identical bone marrow transplantation
Surgical intervention is indicated to decompress optic or auditory nerve compression |
|
|
Term
|
Definition
| present but malfunctioning osteoclasts. short-limb dwarfism,kyphoscoliosis, blue sclerae |
|
|
Term
| what is included in MCCune-Albright Syndrome |
|
Definition
| endocrine abnormalities, cafe-au-lait spots, skeletal deformities |
|
|
Term
| 5 Primary Hyperlipoproteinemias associated with elevations of Chylomicrons |
|
Definition
Lipoprotein lipase deficiency
Familial apolipoprotein C-II deficiency
ApoA-V deficiency
GPIHBP1 deficiency
Familial dysbetalipoproteinemia |
|
|
Term
| 5 Primary Hyperlipoproteinemias associated with elevations of LDL |
|
Definition
Sitosterolemia
Autosomal recessive hypercholesterolemia
Autosomal dominant hypercholesterolemia
Familial defective apoB-100
Familial hypercholesterolemia |
|
|
Term
| 3 Primary Hyperlipoproteinemias associated with elevations of VLDL |
|
Definition
Familial hepatic lipase deficiency
Familial dysbetalipoproteinemia
ApoA-V deficiency |
|
|
Term
| what are the 2 mechanisms implicated in acquired iron overload (hemochromatosis) |
|
Definition
| iron overload conditions and chronic liver failure |
|
|
Term
| 5 conditions that are deemed to be complicated by iron overload hemochromatosis |
|
Definition
Thalassemia major
Sideroblastic anemia
Chronic hemolytic anemias
Transfusional and parenteraliron overload
Dietary iron overload |
|
|
Term
| 6 conditions of chronic liver failure that cause iron overload (acquired hemochromatosis) |
|
Definition
Hepatitis C
Alcoholic cirrhosis, especially when advanced
Nonalcoholic steatohepatitis
Porphyria cutanea tarda
Dysmetabolic iron overload syndrome
Post-portacaval shunting |
|
|
Term
| what is the first organ to be affected by hemochromatosis |
|
Definition
| the liver - hepatosplenomegaly is present in 95% of symptomatic patients |
|
|
Term
| skin discoloration in hemochromatosis |
|
Definition
| metallic or slate-gray hue (bronzing ) |
|
|
Term
| what is the MC cardiac manifestation of hemochromatosis |
|
Definition
|
|
Term
| why is there hypogonadism in hemochromatosis |
|
Definition
| decreased production of gonadotropins due to impairment of hypothalamic-pituitary function by iron deposition |
|
|
Term
| what are 6 of the MC clinical manifestations of hemochromatosis |
|
Definition
| (1) hepatomegaly, (2) skin pigmentation, (3) diabetes mellitus, (4) heart disease, (5) arthritis, and (6) hypogonadism |
|
|
Term
| 4 ways to assess the degree of iron overload in a patient with hemochromatosis |
|
Definition
| (1) serum iron and the percent saturation of transferrin (2) serum ferritin (3) liver biopsy with measurement of the iron concentration and calculation of the hepatic iron index (Table 357-2), and (4) MRI of the liver |
|
|
Term
| what are 2 good screening tests in family members of patients with hemochromatosis |
|
Definition
| increased saturation of transferrin and an increased serum-ferritin concentration |
|
|
Term
| what is the treatment of hemochromatosis |
|
Definition
weekly or twice weekly phlebotomy
alternative: deferoxamine |
|
|
Term
| why is it important that Alcohol consumption be severely curtailed or eliminated in patients with hemochromatosis |
|
Definition
| it is associated with a 10 fold risk of cirrhosis |
|
|
Term
| 4 Useful Tests for Wilson's Disease |
|
Definition
| KF rings, serum ceruloplasmin, liver biopsy, 24 hr urine collection for copper |
|
|
Term
| what is the treatment of choice for wilson's disease with associated Hepatitis or cirrhosis without decompensation |
|
Definition
|
|
Term
| what drug do you add to zinc in the treatment of mild to moderate hepatic decompensation in wilson's disease |
|
Definition
|
|
Term
| what is the treatment of severe liver decompensation in wilson's disease |
|
Definition
|
|
Term
| what is the treatment added to zinc in neurologic manifestation of wilson's disease |
|
Definition
|
|
Term
| what is the method used to determine severity in wilson's disease |
|
Definition
prognostic index of nazer: bilirubin, AST, PT
helps decide if medical or surgical intervention is indicated |
|
|
Term
| what is the effect of metformin on weight |
|
Definition
|
|
Term
| which releasing hormone induces the secretion of prolactin |
|
Definition
|
|
Term
| what is the last line of medical therapy in UC |
|
Definition
| cyclosporine or infliximab |
|
|
Term
| which treatment is not effective for fistulizing CD |
|
Definition
|
|
Term
| in which vessels does atherosclerosis start in patients homozygous to familial hypercholesterolemia |
|
Definition
| the aortic root, where it can cause aortic valvular or supravalvular stenosis, and typically extends into the coronary ostia, which become stenotic |
|
|
Term
| what is the treatment of choice for homozygotes to familial hypercholesterolemia |
|
Definition
HMG-CoA reductase inhibitor and a second drug (cholesterol absorption inhibitor or bile acid sequestrant)
and APHERESIS - a process by which the LDL particles are selectively removed from the circulation |
|
|
Term
| what is the treatment of patients treated with GCS but w/o DM, with abnormal FPG? |
|
Definition
FPG>200 - insulin
FPG<200 - oral diabetes agents |
|
|
Term
| when do you give phosphate in DKA |
|
Definition
|
|
Term
| 4 non metabolic complications of DKA |
|
Definition
| cerebral edema, Venous thrombosis, upper gastrointestinal bleeding, and acute respiratory distress syndrome |
|
|
Term
| which drug in conjunction to statins raises the risk of myopathy |
|
Definition
|
|
Term
| which drug for DM can cause diarrhea |
|
Definition
|
|
Term
| what would be the cause of hypocalcemia if phosphate is also low |
|
Definition
|
|
Term
| what is the first step in the mgmt of a patient with suspected hypoglycemia |
|
Definition
| draw blood to document glucose levels and check Cpeptide and insulin levels |
|
|
Term
| what to do in patients developing high TSH and low T4, asymptomatic, on amiodarone? |
|
Definition
| continue amiodarone, start levothyroxine |
|
|
Term
| 2 types of amiodarone induced thyrotoxicosis |
|
Definition
type 1 - underlying grave's disease - excessive hormone production d/t excessive iodine
type 2 - destructive thyroiditis |
|
|
Term
| 2 ways to distinguish type 1 from type 2 amiodarone induced thyrotoxicosis? |
|
Definition
1. thyroid doppler - increased flow in type 1
2. thyroid scan - increased uptake in type 1 |
|
|
Term
| what is the treatment of type 1 AIT |
|
Definition
|
|
Term
| what is the treatment of type 2 AIT |
|
Definition
|
|
Term
|
Definition
1. fasting glucose
2. random > 200 + clinical findings
3. A1C>6.5
4. oral glucose tolerance test > 200 |
|
|
Term
| disease associated with subchondral osteopenia |
|
Definition
| turner's syndrome, elderly obese women and renal transplant patients |
|
|
Term
| what do you do with a non-diagnostic result on FNA of a thyroid nodule |
|
Definition
| monitor by US. Repeat FNA is indicated if a nodule enlarges, and a second biopsy should be performed within 2–5 years to confirm the benign status of the nodule |
|
|
Term
| hypercalcemia, elevated PTH, no lytic bone lesions, unresponsive to parathyroid surgery |
|
Definition
| familial hypocalciuric hypercalcemia - insensitivity of recpetors to calcium |
|
|
Term
| adverse effects of lithium |
|
Definition
| ataxia, encephalopathy, hyperreflexia, myoclonus, nystagmus, nephrogenic DI, pseudohyperchloremia, arrhythmia |
|
|
Term
| what is the TSH goal in the treatment with eltroxin of total thyroidectomy d/t follicular carcinoma? |
|
Definition
|
|
Term
| primary aldosteronism can cause both polyuria and through glomerular hyperfiltration, albuminuria |
|
Definition
|
|
Term
| which lab finding may precede the onset of DM, HTN, gout in a patient with metabolic syndrome |
|
Definition
| hyperuricemia - part of the metabolic syndrome |
|
|
Term
| how do you distinguish Acute Uric Acid Nephropathy from acute renal failure d/t dehydration? |
|
Definition
| if the ratio of urinary UA/creatinine > 1 it's Acute Uric Acid Nephropathy |
|
|
Term
| what are the indications to start oral glucose lowering monotherapy in a patient diagnosed with DM2? |
|
Definition
|
|
Term
| what are the indications to start either combination glucose lowering therapy consisting of metformin and another agent or insulin in a patient diagnosed with DM2 |
|
Definition
|
|
Term
| what are the indications to start treatment for DM2 with insulin |
|
Definition
| lean individuals or those with severe weight loss, high FPG > 250 or in individuals with underlying renal or hepatic disease that precludes oral glucose-lowering agents |
|
|
Term
| agranulocytosis is an adverse effect of radioactive iodine |
|
Definition
|
|
Term
| treatment of choice for thyrotoxic crisis |
|
Definition
|
|
Term
| MCC of cushing's syndrome |
|
Definition
| ACTH secreting pituitary adenoma |
|
|
Term
| s/s of hyperparathyroidism |
|
Definition
osteoporosis, pancreatitis, cardiac (LVH), neurological, fractures, pseudogout, recurrent pyelonephritis
diarrhea is not a feature of primary hyperparathyroidism |
|
|
Term
|
Definition
| פאנציטופניה), מחלות דה-מיאליניזציה, החמרה של אס"ק לב, הופעה של נוגדנים ומאפיינים של לופוס, רגישות באיזור ההזרקה ומחלת כבד קשה |
|
|
Term
| 1st and 2nd MC sites involved in amyloidosis |
|
Definition
|
|
Term
| treatment of AL amyloidosis |
|
Definition
| autologous BMT or melphanan and prednisone |
|
|
Term
| side effects of azathioprine |
|
Definition
| פנקריאטיטיס (3-4%), בחילות, חום, פריחה והפטיטיס. ייתכן דיכוי מח עצם (בעיקר לויקופניה) ולכן צריך לעקוב עם ספירת דם. חולי IBD שמטופלים בתרופה זו נמצאים בסיכון מוגבר (*4) ללימפומה |
|
|
Term
| in DKA when will you first correct kalium and only then start insulin |
|
Definition
|
|
Term
| התמונה הטיפוסית של הורמוני התירואיד בפגיעה של אמיודרון שגורמת לתירוטוקסיקוזיס - JED BASEDOW |
|
Definition
| עליה בT4 ירידה בT3 עליה בrT3 . עליה זמנית בTSH שמתנרמלת תוך 3 חודשים |
|
|
Term
|
Definition
• מפחית יצור הורמוני תירואיד
• מעכב את התפקוד של TPO ומפחיתה את החימצון והאורגניפיקציה של היוד
• במננון לא ברור מפחית את רמות נוגדני התירואיד
• מעכב גם את הדיאיונודיזציה שמאפשר את המעבר מT4 לT3
• זמן מחצית חיים של 90 דקות לעומת MMI שהוא של 6 שעות לכן ניתן כל 6-8 שעות
• כ3-4 שבועות לאחר תחילת טיפול יש לבדוק רמות T4 למעקב
• לרוב לוקח 6-8 שבועות עד שמגיעים לאאותירואידיזם
• רמות TSH הרבה פעמים נותרות מדוכאות למשך כמה חודשים ולכן הן לא מספקות אינדקס רגיש לתגובה לטיפול,רק כשהדיכוי נגמר, ניתן להשתמש ברמות שלו על מנת לנטר את הטיפול
• PTU זו תרופת הבחירה בהריון |
|
|
Term
| מה כוללת תסמונתPOLYGLANDULAR AUTOIMMUNE TYPE 1 |
|
Definition
קנדידה מוקוקוטנאית
היפופאראתירואיד
אי ספיקת אדרנל |
|
|
Term
| מה כוללת התסמונת POLYGLANDULAR AUTOIMMUNE TYPE 2 במבוגרים |
|
Definition
אי ספיקת אדרנל
תירואידיטיס
סכרת סוג 1 |
|
|
Term
|
Definition
• אם אי ספיקה ראשונית – יש גם חסר MC
• אם אי ספיקה שניונית –אין חסר של MC
• הסיבה הכי נפוצה לאי ספיקה היא יטרוגנית-דיכוי הציר עקב סטרואידים חיצונים
• אי ספיקה שניונית מעט יותר שכיחה- למעט היתרוגני, הסיבה הכי נפוצה היא גידולים בהיפותלמוס או היפופיזה או תוצאה של ניתוח או הקרנות לטיפול בגידולים הללו.
• אי ספיקה ראשונית-חצי מהם נרכשים, לרוב עקב הרס אוטואימוני (מתוכם שליש הרס אוטואימוני מבודד והיתר כחלק מתסמונת פולי גלנדולרית), היתר עקב מחלה גנטית
• אבחנה – מתן ACTH ומדידת רמת קורטיזול לאחר 30-60 דק (מבחן סינקטן). אם אין עליה מספקת יש אי ספיקה. כעת להבדיל אם ראשוני או שניוני ניקח רמות ACTH, רנין ואלדסטרון |
|
|
Term
| הפרשה אקטופית של ACTH - מקורות ובירור |
|
Definition
| הכי שכיח זה עקב קרצינואיד בריאה, אך ייתכן גם בלבלב או בטימוס. כמו כן, סרטן SCLC מתקדם, ובמקרים נדירים פאוכרומוציטומה וקרצינומה מדולרית של התירואיד. דבר ראשון נעשה CT של בטן וחזה ברזולוציה גבוהה, אחכ MRI T2 ואם לא אז מיפוי אוקטראוטיד |
|
|
Term
| מהיא התבנית ההורמונלית הטיפוסית בSICK EUTHYROID SYNDROME - שמופיעה במחלה אקוטית |
|
Definition
| ירידה בT3 - גם טוטל וגם חופשי עם רמות נורמליות של T4 ו TSH. LOW T3 SYNDROME, • עליה בrT3- |
|
|
Term
| הניהול של SICK EUTHYROID SYNDROME |
|
Definition
| ניטור תפקודי הבלוטה אך לא לתת טיפול אלא אם יש עדות קלינית להיפו או היסטוריה של היפו |
|
|
Term
| מתי לעשות בדיקת צפיפות עצם |
|
Definition
• לשקול בכל אשה מעל גיל 65
• נשים עם חסר אסטרוגן ועם סיכון קליני לאוסאופורוזיס
• שינויים בחוליות בצילום רנטגן אשר מחשידים באוסטיאופורוזיס
• סטרואידים-מעל 7.5 מ"ג פרדניזון ליותר מ3 חודשים
• היפרפארתירואיד ראשוני
• מעקב אחרי טיפול –כל שנתיים או יותר אם נדרש |
|
|
Term
| 4 ממצאים עם משמעות קלינית חשובה באקרומגליה |
|
Definition
o מחלת לב ב30 אחוז
o חסימתURT עם OSA
o סכרת ברבע מהחולים
o סיכון מוגבר לCRC או פוליפים |
|
|
Term
| תת פעילות סאב-קלינית של בלוטת התריס |
|
Definition
• עדות מעבדתית של חוסר בהורמוני תירואיד, ללא מאפיינים קלינים
• יש לוודא שהעליה ברמות TSH היא קבועה במשך 3 חודשים
• אם TSH מעל 10 ניתן לתת טיפול אך במינון נמוך, במיוחד עם יש נוגדנים
• אם לא מטפלים יש להעריך תפקוד בלוטה פעם בשנה |
|
|
Term
| screening for hypothyroidism in patients with laboratory or radiologic abnormalities that could be caused by hypothyroidism |
|
Definition
Hypercholesterolaemia
Hyponatraemia
Hyperprolactinaemia
Hyperhomocysteinaemia
Anemia
Creatine phosphokinase elevation |
|
|
Term
| If free T4 and T3 are high, but TSH is normal or high, a pituitary MRI should be done to look for a pituitary mass |
|
Definition
|
|
Term
| If serum TSH is low, and free T4 and T3 are high, the diagnosis of hyperthyroidism is confirmed. If the diagnosis of Graves’ disease is not clinically apparent (eg, the presence of ophthalmopathy and a diffuse goiter), a 24-hour thyroid radioiodine uptake and scan should be done to differentiate Graves' hyperthyroidism from other causes (table 1). If radionuclide imaging is contraindicated (pregnancy, breastfeeding), and the diagnosis of Graves’ is uncertain, thyrotropin (TSH) receptor antibodies (TRAb), using a second-generation thyrotropin-binding inhibitory immunoglobulin (TBII) assay, should be measured |
|
Definition
|
|
Term
| fluid management in DKA and HSS |
|
Definition
| We begin with isotonic (0.9 percent) saline infused at a rate of 15 to 20 mL/kg per hour, in the absence of cardiac compromise, for the first few hours. This is followed by one-half isotonic (0.45 percent) saline at 4 to 14 mL/kg per hour if the serum sodium is normal or elevated; isotonic saline is continued if hyponatremia is present. We add dextrose to the saline solution when the serum glucose reaches 200 mg/dL (11.1 mmol/L) in DKA or 250 to 300 mg/dL (13.9 to 16.7 mmol/L) in HHS |
|
|
Term
| in the mgmt of DKA and HSS, The dose of insulin is doubled if the glucose does not fall by 50 to 70 mg/dL (2.8 to 3.9 mmol/L) in the first hour |
|
Definition
|
|
Term
| in DKA and HSS replacement with intravenous potassium chloride (Grade 1A) be initiated when the serum potassium concentration is ≤5.3 meq/L and K and fluids alone should be given if K levels lower than 3.3 |
|
Definition
|
|
Term
| indications for phosphate repletion in DKA and HHS |
|
Definition
| severe hypophosphatemia (<1.0 mg/dL [0.32 mmol/L]), respiratory or cardiac failure, or severe anemia |
|
|
Term
| Serum amylase and lipase levels are elevated in 15 to 25 percent of patients with DKA and, in most cases, do not reflect acute pancreatitis. The diagnosis of pancreatitis should be based upon clinical findings and confirmed by CT scan |
|
Definition
|
|
Term
| initial therapy for DM2 with insulin |
|
Definition
| A1C >10%, fasting plasma glucose >250 mg/dL (13.9 mmol/L), random glucose consistently >300 mg/dL (16.7 mmol/L), or ketonuria |
|
|
Term
| initial treatment for DM2 with metformin, or if CIed sulfanylurea or repaglinide |
|
Definition
|
|
Term
| Most newly diagnosed patients with type 1 diabetes can be started on a total daily dose of 0.2 to 0.4 units of insulin per kg per day, although most will ultimately require 0.6 to 0.7 units per kg per day |
|
Definition
| one-half of the total dose should be given as a basal insulin |
|
|
Term
| major differences in primary vs. secondary adrenal insufficiency |
|
Definition
Hyperpigmentation is not present because ACTH secretion is not increased.
Dehydration is not present, and hypotension is less prominent.
Hyponatremia and volume expansion may be present, but hyperkalemia is not (reflecting the presence of aldosterone).
Gastrointestinal symptoms are less common, suggesting that electrolyte disturbances may be involved in their etiology.
Hypoglycemia is more common in secondary adrenal insufficiency |
|
|
