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90 Cards in this Set

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differential diagnosis for increased blood glucose (DM)
pancreatic disease (chronic pancreatitis), glucagonoma, Cushing's disease, iatrogenic (corticosteroids), gestational DM, diabetes insipidus
Describe the honeymoon period in type 1 DM
a remission phase seen in type 1 DM days after initiation of insulin therapy, where they have decreased insulin requirements for several months
pathophysiology of type 1 DM
autoimmune destruction of beta cells
pathophysiology of type 2 DM
insulin resistance and inadequate insulin secretion by pancreas
in which type of DM are classic symptoms more common?
type 1 DM
differential diagnosis for increased blood glucose (DM)
pancreatic disease (chronic pancreatitis), glucagonoma, Cushing's disease, iatrogenic (corticosteroids), gestational DM, diabetes insipidus
genetic predisposition of type 1 DM
weak, polygenic in type 1, with association to HLA DR3 and DR4; strong polygenic in type 2 with no HLA association
Describe the honeymoon period in type 1 DM
a remission phase seen in type 1 DM days after initiation of insulin therapy, where they have decreased insulin requirements for several months
common regimen of type 1 DM
MDI regimen (premeal HR and bedtime glargine)
pathophysiology of type 1 DM
autoimmune destruction of beta cells
short-acting insulin
Lispro or Aspart
pathophysiology of type 2 DM
insulin resistance and inadequate insulin secretion by pancreas
frequency of HbA1c checkups
every 3 months
in which type of DM are classic symptoms more common?
type 1 DM
HbA1C goal
<7
genetic predisposition of type 1 DM
weak, polygenic in type 1, with association to HLA DR3 and DR4; strong polygenic in type 2 with no HLA association
common regimen of type 1 DM
MDI regimen (premeal HR and bedtime glargine)
short-acting insulin
Lispro or Aspart
frequency of HbA1c checkups
every 3 months
HbA1C goal
<7
when to obtain baseline ECG in type 1 DM patients?
if with heart disease or is <35 y/o
typical stepwise pharmacologic management of type 2 DM
metformin, a glitazone, and a sulfonylurea (glyburide); if inadequate on 3 drugs, replace glyburide with NPH or glargine insulin at bedtime; if more intense therapy needed, split/mixed regimen of HR and NPH
symptoms and diagnostic findigns in DKA
fruity breath odor, Kussmaul hyperpnea, DHN, abdominal pain, increased AG, hyperkalemia, hyperglycemia, ketones in blood and urine
criteria for HHNK
glu >600; pH <7.3; bicarb >15, AG < 14, osmolality >310
types of DM retinopathy
nonproliferative and proliferative
describe nonproliferative DM retinopathy
retinal vascular microaneurysms, blot hemorrhages, cotton wool spots, macular edema
describe proliferative retinopathy
neovascularization in response to retinal hypoxia
diagnostic findings in kidney biopsy in DM
Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)
treatment of nephropathy
patients with microalbuminuria or proteinuria should be started on ACEi to achieve BP of <125/75
treatment of neurpopathy
stict glycemic control improves nerve conduction; TCAs and carbamazepine for sensory dysfunction
describe myxedema coma
a form of severe hypothyroidism characterized by AMS and hypothermia
describe thyroid storm
a form of severe hyperthyroidism characterized by high fever, DHN, tachycardia, coma and high-output cardiac failure
diagnostic tests for patients with decreased TSH
order RAIU scan, TG antibody and thyroid-stimulating Ig assays
diagnostic tests for patients with increased TSH
order anti-thyroid peroxidase antibody assay
symptomatic treatment of hyperthyroidism
propranolol, hydration, rest, adequate nutrition, cooling measures if severe hyperthermia
pharmacologic treatment of hyperthyroidism
PTU or methimazole; severe cases require RAI thyroid ablation; thyroidectomy
indications for thyroidectomy
large goiters, pregnanat patients, obstruction of trachea
pharmacologic treatment of hypothyroidism
levothyroxine; IV levothyroxine and IV hydrocortisone for myxedema coma patients
most common cause of primary hyperparathyroidism
parathyroid adenoma
common fractures seen in osteoporotic patients
hip fractures, vertebral compression fractures, distal radius fractures following minimal trauma
who should be screened for osteoporosis?
all patients >65 y/o; patients 40-60 y/o with at least 1 RF for osteoporotic fractures after menopause
screening test for osteoporosis
DEXA scan of spine and hip
interpretation of Dexa scan
take the lowest T-score between spine and hip; if -1 to -2.5 diagnosis is osteopenia; if </= 2.5 diagnosis is osteoporosis
secondary causes of osteoporosis
smoking, alcoholism, renal failure, hyperthyroidism, MM, primary hyperparathyroidism, vitamin D deficiency, hypercortisolism, heparin use, chronic steroid use
when to start treatment in osteoporosis
if T-score is <-2; of <-1.5 with RF for fractures
DOC for osteoporosis, in order of efficacy
bisphosphonates, teriparatide, SERMs, intranasal calcitonin
bisphosphonates
alendronate, etidronate, ibandronate
SERMs
selective estrogen receptor modulators (raloxifene)
how often should DEXA scans be repeated
every 1-2 years after initiation of drug therapy; if worsened T-scores, start combination therapy or change drug
what is Cushing's disease
Cushing's syndrome caused by hypersecretion of ACTH from pituitary adenoma
etiologies of hypercortisolism
adrenal (adenoma, carcinoma),"", pituitary adenoma, ectopic (lung CA), exogenous (CS administration)
symptoms of Cushing's disease
truncal obesity, moon facies, buffalo hump; psych disturbances, HTN, impotence, oligomenorrhea, growth retardation, hirsutism, easy bruisability, purple stria
diagnostic for Cushing's syndrome
increased 24-hour urine cortisol
algorithm for Cushing's syndrome (increased 24 h urine cortisol)
check AM serum ACTH; if <5, give exogenous steroids or obtain adrenal CT or MRI; if >5, give high-dose dexa suppression test
interpretation of high-dose dexamathasone suppression test
suppressed = cushing's disease (confirm with pituitary MRI); nonsuppressed = ectopic ACTH producing tumor (carcinoid tumors, small cell lung CA)
What is Addison's diseas
primary adrenal insufficiency
when is DHEA most elevated
adrenal carcinoma
etiologies of primary adrenal insufficiency
autoimmune, metastatic tumor, hemorrhagic infarction, adrenalectomy, granulomatous disease (TB, sarcoid)
etiologies of secondary adrenal insufficiency
withdrawal of steroids, hypothalamic or pituitary pathology (tumor, infarct, trauma, infection, iatrogenic)
symptoms of adrenal insuff
weakness, anorexia, weight loss, N/V, postural hypotension, diarrhea, abdominal pain, myalgias, arthralgias
symptoms of addisonian crisis
symptomatic adrenal insufficiency, confusion, vasodilatory shock
diagnostic of adrenal insuff
AM serum cortisol <5 or <20 after ACTH stimulation test or <9 increase after same test
nonspecific lab findings for adrenal insufficiency
hyponatremia, hyperkalemia, eosinophilia
how to differnetiate primary from secondary adrenal insufficiency based on diagnostic tests
ACTH increased in primary and decreased in secondary; cortisol after ACTH challenge decreases in primary and increases in secondary
treatment of adrenal insufficiency
glucocorticoids and mineralocorticoids
DOC for adrenal insufficiency
hydrocortisone
treatment of OH/hyponatremia, hyperkalemia in adrenal insufficiency
fludrocortisone
most common functional pituitary tumor
prolactinoma
lab findings in prolactinoma
increased prolactin, decreased LH and FSH; MRI to confirm tumor
traetment of prolactinoma
dopamin agonist (bromocriptine or cabergoline); transsphenoidal surgery ffd by irradiation if tumor is large or medical therapy not tolerated
MEN type 1
Wermer's syndrome; pituitary adenoma; parathyroid hyperplasia; pancreatic islet cell tumor
MEN Type 2a
Sipple's syndrome; parathyroid hyperplasia; thryoid medullary cancer, pheochromocytoma
MEN Type 2b
thyroid medullary cancer, pheochromocytoma, mucocutaneous neuromas, ganglioneuromatosis of colon, Marfan-like habitus
symptoms of hyperparathyroidism
fatigue, constipation, polyuria, polydipsia, bone pain, nausea
diagnostic findings in primary hyperparathyroidism
increased calcium and PTH, low PO4
diagnostic findings in hypercalcemia not due to primary hyperparathyroidism
increased calcium, low or normal PTH, sometimes increased PO4
treatment of primary hyperparathyroidism
surgical removal or parathyroid glands; hydrate, furosemide after deficit corrected, bisphophonates for severe hypercalcemia
complications of primary hyperparathyroidism
nephrolithiasis, nephrocalcinosis, osteopenia, osteoporosis, pancreatitis, cardiac valve calcifications
pathophysiology of Grave's disease
Ab to TSH receptor
pathophysiology of subacute thyroiditis
viral infection (mumps or coxsackievirus)
pathophysiology of Hashimoto's thyroiditis
autoimmune
diagnostic findings in Grave's disease
decreased RAIU scan, (+) Thyroid-stim Ig; (+) Thyroglobulin Ab
diagnostic findings in subacute thyroiditis
increased RAIU scan; (+) Thyroglobulin Ab, high ESR
diagnostic findings in Hashimoto's thyroiditis
(+) anti-TPO Ab
treatment of Grave's
PTU, methimazole, thyroid ablation
treatment of subacute thyroiditis
NSAIds, steroids for severe pain; self-limited
treatment of Hashimoto's thyroiditis
levothyroxine
painless thyroid enlargement
Hashimoto's thyroiditis
hyperthyroidism --> hypothyroidism; tender thyroid
subacute thyroiditis
diffuse painless goiter with eye signs, pretibial myxedema and hyperthyroidism
Grave's disease