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17 Cards in this Set
- Front
- Back
Features of primary hyperaldosteronism?
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HTN, hypokalemia, metabolic alkalosis, suppressed plasma renin activity and elevated plasma aldosterone levels
Hypokalemia: muscle cramps, polyuria, elevated glucose levels |
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Factitious thyrotoxicosis
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results from ingestion of excessive exogenous thyroid hormone due to psychiatric dz or attempted wt loss.
suspect in a person with low BMI and efforts at weight loss --> palpitations, sweating, weight loss, hyperactivitiy and diarrhea - goiter and exophthalmos classically MISSING bx would reveal FOLLICULAR ATROPHY due to suppression of endogenous thyroid hormone production |
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GI manifestations of diabetes
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diabetic autonomic neuropathy - postprandial bloating, early satiety, constipation and diarrhea.
Metoclopramide (drug of choice), bethanechol and erythromycin are useful in the management of gastroparesis |
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Radioiodine therapy is more likely to cause permanent hypothyroidism in what form of hyperthyroidism?
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Graves' disease (since whole thyroid gland is hyperfunctional --> complete uptake results in complete thyroid ablation)
more likely euthryroid in toxic adenoma and multinodular goiter |
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Drugs of choice for diabetic neuropathy
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TCA (worsen urinary sx due to cystopathy and orthostatic hypotension due to CV autonomic neuropathy), alternatively gabapentin
also NSAIDs (though avoided in renal dysfunction) |
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T3/T4 and TSH levels in generalized resistance to thyroid hormones
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high serum T3/T4 with normal or mildly elevated TSH levels
pts typically have features of HYPOTHYROIDISM despite having elevated free thyroid hormones |
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initial important step in the management of non-ketotic hyperglycemic coma
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When hypovolemia is present, NORMAL SALINE should be started initially and then replaced with 0.45% saline.
Because of the large volumes of glucose induced osmotic diuresis, pts may require up to 8-10 liters of normal saline to reach the euvolemic state. |
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Pts with rapid breathing and h/o weight loss, polydipsia, and polyuria
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suspect DKA in stuporous patients
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Features of metabolic syndrome
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- abdominal obesity: Men waist circum > 40 inches; women > 35 inches
- fasting glucose > 100-110 - BP > 130/80 - TriG > 150 mg/dL - HDL cholesterol: Men < 40 mg/dL; Women < 50 mg/dL |
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suspected MENIIa syndrome patient. Next steps?
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Genetic testing
If positive for RET proto-oncogene mutation, total thyroidectomy is indicated (almost 100% will develop invasive medullary thyroid carcinoma |
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Most beneficial therapy in the progression of diabetic nephropathy?
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strict BP control (not glycemic control!)
only intervention that has conclusively been shown to reduce the decline in GFR once azotemia develops. |
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HbA1C: describe test and what it means
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HbA1C is formed by nonenzymatic glycosylation of Hbg - level is independent of plasma glucose level, and is reflective of the avg blood glucose level within the preceding 3 month period.
Generally, every 1% increase in HbA1c corresponds with a 35 mg/dL increase in the mean plasma glucose level |
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Main substrates of gluconeogenesis
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alanine, lactate and glycerol 3 phosphate
PYRUVATE is an intermediate of alanine during the process of gluconeogenesis |
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What should be measured alongside the serum calcium level?
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serum albumin level --> must calculate corrected total serum calcium value.
With every 1 g/dL change in serum albumin from 4 g/dL, serum calcium changes by 0.8 mg/dL |
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glucose readings:
10PM: 100 3AM: 50 7AM: 200 Reason for morning hyperglycemia? |
SOmogyi effect occurs when counterregulatory hormones kick in during period of nocturnal hypoglycemia (likely due to amount of insulin given), thereby resulting in early morning hyperglycemia
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Hirsutism developing in a menopausal woman --> what is the next step in management and what is the likely dx?
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Highly suggestive of androgen-secreting neoplasm of the ovary or adrenal
Serum testosterone and DHEAS levels are helpful in delineating hte site of excess androgen production Elevated testosterone with normal DHEAS: ovarian source Elevated DHEAS with relatively normal testosterone: adrenal source DHEA is secreted from both the ovaries nad adrenals, whereas DHEAS, a sulfated form of DHEA, is speifically secreted from the adrenals. |
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Characteristics of osteomalacia, rickets, paget's dz, osteoporosis, and osteogenesis imperfecta as it relates to the bone
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Osteomalacia: defective mineralization of the bone
Rickets: defective mineralization of the bone and cartilage Paget's dz: disordered skeletal remodeling Osteoporosis: low bone mass with normal mineralization Osteogenesis imperfecta: defective formation of collagen |