Clin Med Exam 6

Start Studying!

Terms

undefined, object

copy deck

very dry tongue, thirst, polyuria, dec'd BP, tachycardia, inc'd RR, vomitting, abd pain, diaphoresis: DKA
fatigue, weight loss, excessive urination, polyuria, polydipsia, polyphagia: DM
fingerstick, UA, CBC, C7, Ha1c, fasting lipids, EKG: Dx of DM
Malignant Otitis Externa, Emphysematousis pyelonephritis, retinopathy, foot complications, CAD, MI, CVA, PVD: Manifestations of DM
antiestrogens x 3 months or surgery: Tx of gynecomastia
serum LH, FSH, testosterone semen analysis dec'd testosterone dec'd Gonadotropin inc'd FSH dec'd NL sperm: Dx of Testicular Feminization
Phenotypic female fetus- L-S folds don't fuse= short vagina breat enlargement inc'd LH: Testicular Feminization
remains prepubital small testes rubbery testes lack testosterone see endocrinologist: Kallmas Syndrome
XXY gynecomastia small firm testes azoospermia euchnoidal skeletal proportions elevated FSH and LH: Kleinfelter Syndrome
testosterone therapy GnRH surgery: Tx for infertililty
surgical excision alpha blockade by phentolamine beta blockade Epi= alpha and beta: Tx of Pheochromocytoma
24 hr urinary catecholamines or metabolites VMA Plasma catechols inc'd during HTN MRI or CT of adrenals: Dx of Pheochromocytoma
HTN- not controlled by meds flushing anxiety nausea weakness weight loss looks like a thyroid problem: Pheochromocytoma
correct electrolyte abNL spirolactone ACEi Angioplasty in Renal Artery Stenosis: Tx of hyperaldosterone
document HTN and hypokalemia hypoMg EKG changes CT/MRI of adrenals Serum/Urine Aldosterone Level Plasma renin levels Serum ACTH: Dx of hyperaldosteronism
HTN hypokalemia absent or decreased DTR proximal muscle weakness and fatigue parasthesias: Hyperaldosteronism
Exogenous- dec steroid dose Endogenous- surgery for pit or lung Ca, Radiation of Chemo, unilateral adrenalectomy or radiation: Cushing's Syndrome
24 hour UFC- 1st serum cortisol serum ACTH high dose dexamethasone suppression test MRI gadolinium of pituitary MRI of adrenals CXR DEXA: Dx of Cushing's
hyperglycemia inc'd protien and muscle breakdown central obesity poor wound healing virilizing of women HTN osteoporosis: Cushing's Syndrome
prolactin secreting pit tumors drugs effecting CNS OCP and HRT hypo/hyperthyroidism breast stimulation chest wall injury spinal cord injury: Causes of Galactorrhea
Pituitary Surgery: Tx for acromegaly
macroadenomas metalstatic carcinoma germinomas craniopharyngiomas: Causes of Hypopituitarism
h/a bilateral visual fiels effects dec'd GH dec'd GnRH dec'd libido: Mass Effects of Pituitary Tumors
Transsphenoidal surgery or suppressio of prolactin by bromocroptine: Tx for Prolactinoma
most common secretory adenoma commonly amenorrhea and galactorrhea excess PRL men--> dec libido, oligospermia, dec'd testosterone: Prolactinoma
>1cm in diameter endocrine inactive tumor mass effect sellar enlargement deviation of the pituitary stalk displace optic chiasm bitemporal visual fiels cuts: Pituitary Macroadenoma
<1cm does not cause sellar enlargement, structural problems, hypopituitarism: Pituitary Microadenoma
MRI w/ gadolinium: Dx test done for pituitary tumor found before death
Pituitary insufficiency Nonfunctional adenomas incidental finding on autopsy: Pituitary Tumor
address dysrhythmias, seizures IV Mg ID cause: Tx of HypoMg
GI loss malnutrition renal loss Rx: Causes of HypoMg
NM irritability hyperreactive DTR muscle cramps muscle fibrillation CNS hyperexcitability irritability and combativeness disorientation psychodid ataxia, vertigo, nystagmus, seizures Cardia Arrhythmias: HypoMg
Stop any exogenous source of Mg IV fluids to dilute Mg diuretics to increase excretion Mg IV Ca: Tx for HyperMg
N/V weakness skin flushing lightheadedness disappearance of DTR hypotn arrhythmia Intraventriculat conduction delay asystole ventilatory failure muscle weakness vasodilation heart block st: HyperMg
large doses of Vit D and Ca: Tx for Hyperparathyroidism
hypernatremia hyperkalemia eosinophilia metabolic acidosis cortisol and aldosterone levels ACTH or corticotropin stim. tests Adrenal Imaging on CT and MRI Adrenal Ab: Dx of Addisons
Vomitting dehydration hypoglycemia hypotension: ACUTE Addisons Dz
Fasting hypoglycemia inc'd pigmentation inability to respond to stress aldosterone lack weight loss fatigue vomitting women- lack axillary and pubic hair and dec'd hair on extremities: Addisons Dz
insufficient PTH produced depressed reabsorption of Ca from bones low serum Ca tetany sxs carpopedal spasm: Hypoparathyroidism
Surgical removal by standard surgery or MIRP: Tx of hyperparathyroidism
inc'd parathyroid hormone inc'd serum Ca: Dx of Hyperparathyroidism
50% asx renal stones emotional disorders renal insufficiency pancreatitis hypercalciuria osteoporosis PUD: Primary hyperparathyroidism
After pt with CRF receives a renal transplant, the parathyoirs remain overactive even though new kidneys are fx well: Tertiary Hyperparathyroidism
compensatory inc in fx due to renal, GI or bone dz: Secondary hyperparathyroidism
unknown cause benign or malignant single or multiglandular involvement: Primary Hyperparathyroidism
lack of cortisol, aldosterone and androgen autoimmune 80-90% of gland has to be destroyed before sx occur: Addison's dz
inc'd ACTH hyperplasia of ZF and ZR lack of cortisol or aldosterone inc'd adrenal androgens shunting to biosynthesis of androgens and 17 ketosteroids: Congenital Adrenal Hyperplasia
dec'd aldosterone dec'd cortisone inc'd 17-hydroxyprogesterone inc'd progesterone check plasma 17 hydroxyprogesterone excess: Congenital Adrenal Hyperplasia
Androgens only- hirsutism and amenorrhea: Virilizing of Adrenocortical or Ovarian Tumors
Androgens + Cortisol secretions: Mixed virilizing of Adrenocortical or Ovarian Tumors
hirsutism infertility amenorrhea obesity enlarged ovaries: Polycystic Ovary Syndrome
Fludrocortisone Lasix: Tx of Hyporeninemic Hypoaldosteronism
dec'd renin dec'd AT I Dec'd ATII dec'd Aldosterone hyperkalemia hyponatremia: Hyporeninemic Hypoaldosteronism
Lifeling replacement of glucose and mineralcorticoids: Tx of Secondary Adrenal Insufficiency
Failure of Standing dehydration test: Dx of Secondary Adrenal Insufficiency
exogenous steroids infiltrative- sarcoidosis tumors- pituitary/ hypothalmic post partum pituitary necrosis head trauma pituitary surgery/ irradiation: Causes of Secondary Adrenal Insufficiency
Autoimmune- Addisons Infectious- TB, HIV Infiltrative Disorders- Sarcoid, Amyloid Hemmorhage. thrombosis Metastasis: Causes of Adrenal Insufficiency
panhypopituitarism or sudden withdrawal of steroids dec'd ACTH NL aldosterone: Secondary Adrenal Insufficiency
inc'd ACTH inc'd renin dec'd cortisol dec'd aldosterone dec'd urinary 17 hydroxycorticosteroids unresponsive adrenals IV infusion does not cause a rise in cortisol: Primary Adrenal Insufficiency
usually found after metastasis poor prognosis fatal weeks--> months: Anaplastic Thyroid Carinoma
Complete Thyroid removal PLUS a dissection to remove the lymph nodes of the front and side of the neck: Tx for Medullary Ca
most common and most curable type of thyroid ca: Follicular and Papillary Ca
complete removal of the lobe that harbors the ca PLUS almost all of the other lobe SYNTHROID THERAPY: Tx of Follicaular and Papillary Ca
Small- levothyroxine Large- surgery: Tx of Goiters
single fixed hard associated with lyphadenopathy cold on I123 scan: Criteria that makes a nodule seem Malignant
Synthroid and monitoring: Tx of hypothroidism
dec'd T4 and inc'd TSH: Primary Hypothyroidism
dec'd T4 and dec'd TSH: Secondary Hypothyroidism
fatigue, weakness, course dry hair constipation delayed DTR dry rough pale skin cold intolerance/hypothermia depression bradycardia weight gain myalgias arthralgias irritability lethargy p: Hypothyroidism
poor feeding hypotonia inactivity edema of hands and feet: Hypothyroid in Infants
short stature delayed puberty MR development delays: Hypothyroid in children
hypothermia stupor extreme weakness hypoventilation hypoglycemia: Myxedema coma
most common permanent tx of hyperthyroidism: Radioactive I
PTU/ Methimazole Antithyroid Drugs Radioactive Iodine Surgery Beta Blockers Ablative therapy with RAI: Tx of Hyperthyroidism
dec'd I uptake: Dx of Thyroiditis
TSH receptor Ab inc'd I uptake toxic adenoma: Dx of Graves Dz
inc'd free T4 dec'd TSH: Dx of hyperthyroidism
Ingestion of excessive amounts of thyoxine: thyroxicosis factitia
thyroid swells rapidly and is painful and tender Gland is producing thyroid hormone but quits taking up I resolves over a few weeks NSAIDS and Bed Rest: DeQuervains Thyroiditis
in late stages... inc'd TSH dec'd T4 and T3: Hashimotos Thyroiditis
inflammation of thyrois is always enlarged Thyroid is inefficient in converting I into thyroid hormone and compensates by enlarging: Hashimotos Thyroiditis
cause of hyperthyroid thyrois nodules produce excess amounts of thyroid hormones palpable goiter: Solitary Toxic Nodule
Autoimmune goiter women 8:1 hyperthyroid eye dz thyroid dermopathy check for antithyroglobin and antihyroperoxidase Ab: Graves Dz
Most common cause of hyperthyroid autoAb attach to activating sites on the thyroid which stimulates hormone synthesis: Graves Dz
precipitated by stressor--> surgery acute infection, MI, uncontrolled DM, radioactive iodine therapy: Thyroid Storm
coma marked hyperpyrexia diaphoresis tachycardia a-fib cardiac failure N/V diarrhea agitation delerium: Thyroid Storm
thyrotoxicosis tachycardia muscle weakness hair loss fine tremor diaphoresis staring gaze weight loss tactile temp palpitations a-fib insomnia light or absent menses heat intolerance b: Hyperthyroidism
elevated circulating thyroid hormone not increades thyroid activity source either pit or hypothalmus: Hyperthyroidism
loss of one, all or a combination of AP hormones: Anterior Hypopituitarism
hypogonadism and infertility: LH and FSH deficiency
central diabetes inspidis with polyuria and polydipsia, and hypernatremia: ADH deficiency
painless swelling in region of thyroid TFT NL irradiation to head and neck + thyroid needle aspirations: Thyroid Ca
NL WBC inc'd sed rate + RF- doesn't rule this out Xray: OA
APAP NSAIDS Capsaicin cream (Zostrix) Oral Chondroitin sulfate or glucosamine Intraarticular steroid injection Intraarticular Hyaluronic acid derrivatives Surgery: Tx of OA
BC + dec'd glu inc'd protein and lactate WBC count>10K: Septic Arthritis
Treat empirically w/ abx against gonoccal, staph, pneumococcai and GN orgs Rochephin Naphcillin + Gent: Tx of Septic Arthritis
no viable organisms inc'd sed rate and CRP turbid fluid WBC count >5K low viscosity glu not greatly reduced: Reiter's Syndrome (Reactive Arthritis)
NSAIDS and exercise DMARDS: Tx of Reiter's Syndrome
rare inc'd chylomicrons extremely increased TG NL VLDL and LDL risk of pancreatitis: Type 1 Lipoprotein Disorder
xanthomas in homozygous marked inc LDL NL VLDL Total Cholesterol >500 Vascular Dz in Children: Type 2a Lipoprotein Disorder
Inc'd VLDL inc'd LDL mixed hyperlipidemia inc'd TG TC 250-500: Type 2b Lipoprotein Disorder
dysbetalipoproteinemia inc'd VLDL NL LDL inc'd TG inc'd TC: Type 3 Lipoprotein Disorders
inc'd VLDL inc'd TG familial hypertriglyceridemia NL LDL inc'd risk of CAD: Type 4 Lipoprotein Disorders
inc'd TC NL LDL Inc'd VLDL TG>1000: Type 5 Lipoprotein Disorders
lifestyle change smoking cessation inc fiber dec saturated fats statings bile acid sequest. fibrates niacin: Tx of Lipoprotein Disorders
hyponatremia hypotoxicity euvolemia NL renal, thyrois and adrenal fx Uosm <100 inc'd Una: SIADH
confusion coma N/V h/a weakness psychosis pitting edema peripheral edema absent: SIADH
Na>135 NL BG Sosm <280 CXR CBC C7 Lytes Amy Lip UA CT-head: Dx of SIADH
mild- mod--> HOH restriction and good workup ABCs first consider glu, narcan and thiamine thypotension or hypovolemia--> NSS bolus watch rate of Na--> pontine myelinosis: Tx of SIADH
can't concentrate urine dilute urine dec'd Uosm NL--> high plasma osm: Diabetes Inspidis
HOH depletion test--> continue to make dilute urine: Dx of DI
Psychogenic--> tx psych dz central or neuro--> synthetic ADH (DDAVP) Nephrogenic--> tx renal dz: tx of DI
malaise weakness polyuria polydipsia dehydration nephrolithiasis HTN muscle weakness hyporeflexia EKG changes hypotn tremor lethargy confusion stupor coma: Hypercalcemia
weight loss loss of appetite weakness pain easily fx bones KIDS- deformities ar epi plates ADULTS- softening- bending on long bones: Primary Osteoporosis
inc'd alk phos: Dx of Primary Osteoporosis
Vit D x 6 weeks: Tx of Primary Osteoporosis
dec'd height curved upper back back pain vertebral fx wrist, tibial, hip and humoral fx: Secondary Osteoporosis
XR- prominent vertebral end plates: Dx of Secondary Osteoporosis
Ca/Vit D supplements Calcitonin Weight bearing exercise: Tx of Osteroporosis
dull ache pain, 1+ jts, worse w/ activity, AM, cold, improves with rest, stiffness: OA
PIP, DIP of hand and feet, crepitus, warm, red, effusion, swell, Heberden's DIP, Bouchard: OA
WBC 2000 no infx ESR NL CT/MRI- disc stenosis: Dx of OA
Low exercise, weight loss, steroids, brace: OA
ulner deviation, hammer finger, boutonneire deformity, swam neck, vasculitis, sjogrens nodules, bakers cyst, CTS, symmetrical swelling: RA
wrist, hands, AM stiffness, 3+ jts (at least one jt: wrist, MCP, PIP, Boutonniere's, swan neck): RA
RF+: Dx of RA
NSAIDS ASA methrotrexate antimalarial PCN low dose steroids: Tx of RA
inflammation of sacroilitis, sponylitis jts, adn uveitis, pencil in cup deformity, acro-osteolysis, Joint space loss: Psoriatic Arthritis
Chlamydial infx: Psoriatic Arthritis
HLA B27 allele XR- sacrilitis osteophytes bamboo spine: Psoriatic Arthritis
very local spasm, neck, shoulder, intercapsular muscle, lower back, butt reproducable on palpation: Mypcascial Trigger Points
ACAP, ASA, NSAID, lidocaine/steroid injection: Tx of Mypcascial Trigger Points
low dose amitrip muscle relaxer, low exercise, SSRI, antidepressants: Ts of a fake dz
pain, siff, cervical , 10-20% temporal arteritis: Poly Rheumatica
inc'd ESR anemia inc'd LFT: Dx of Poly Rheumatica
low dose steroids: Tx of Poly Rheumatica
ice, rest, remove agent, antiinflammatory, steroids: Tx of -itises
trauma, inflammation, pain, limited motion of biceps or supraspinatous tendon: Capulitis, bursitis of shoulder
pain over wrist extensor inserts on lateral epicondyle, tennis elbow: epicondylitis
extensor/abd tendon sheaths in wrist, inflamm disease or repetitive trauma: Tenosynovitis
pain in PM in wrist/hand--> numbness in thumb/index: CTS
ice, rest, remove agent, antiinflamm, steroids: Tx of CTS, Dupuytren's contracture, IT band, Trochanteric bursitis, plantar fascitis
fibrosis/shortening of 1+ flexor tendons of hand--> deformity: Dupuytren's contracture
fascial strain over extensor hip--> pain down side of leg: IT Band
Local Pain over great trochanter--> diff to walk: Trochanteric bursitis
S. Aureus, suspect cellulitis, erythema, fever, leukocytosis, crystal deposits in bursa: Septic Bursitis
Aspirate bursa fluid, cell count, cx, crystal exam: Dx of Septic Bursitis
drai, ABX: Tx of Septic Bursitis
overuse injury, subacromial shoulder, trochant: Nonseptic bursitis
rest, ice, NSAIDS, steroids, don't aspirate iliopsoas bursa: Tx of Nonseptic Bursitis
Low Back pain,: Spinal Dz
rapid, PM pain, podagra, skin inflamm, warm, hot jts, pain w. movement, hurts to put clothes on,: GOUT
Negative Birefringent needle shapped crystals: GOUT
knee, wrist, pubic sym.: psuedogout
positive birefringent rhomboid shaped crystals, athrocentesis: Dx of pseudogout
Colchicine, methyl/prednisone, intercrit, alopurinol: Tx of Gout
NSAIDS, Roids: intracrticular and oral: Tx of Psuedogout
h/a, scalp tenderness, visual disturbances, monocular blindness: Giant cell arteritis
inc'd ESR anemia fever: Dx of Giant cell arteritis
hight dose steroids: Tx for giant cell arteritis
pulseless disease, claudication, leads to MI Tx. Roids: Takayasu Arteritis
associated with hep b/c, involves medium vessels, segmental nec lesion: Polyarteritis Nodusa
Biopsy/ Angiography of vessel: Dx of Polyarteritis Nodusa
asthma, pulm infiltrates, eosinophilia, skin, peripheral nerves, GI, allergic granulomatos adn angitis: Churg- Straus
fuliment alveolar hemm, rapid GN, tissue Bx, lung, kidney, sinuses: Wegner Granulomatosis
small children, young adults, palpable purpuram arthalgia, abd pain, fever, GN: Henoch-Schonlein Purpura
100% mortal w/o tx: Weg. Gran.
Roids and immunosuppressant: Tx of Weg Gran
Roids and NSAIDS: Tx. of H-S Pupura
inc'd serum CPK-MM inc'd aldolase inc'd ALT and AST inc'd LDH inc'd sed rate urine + for hemoglobin: Polymyositis
Steroids and DMARDS: Tx of Polymyositis
45 XO, short stature, hypogonadism, webbed neck, hypertension, reanl abNL,: Turner's Syndrome
daily injections of GH: Tx of Turners
surgery, parathyrois resection, bisphosphantes: Tx of MEN 1 wermer's Syndrome

Start Studying!

Deck Info

Number of cards 174