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