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51 Cards in this Set
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Q250. How can Calcium correct for Hypoalbuminemia?
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A250. Adjust Calcium upward by 0.8mg/dL for each 1.0g/dL of albumin below normal
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Q251. Toxins that cause low calcium; (5)*
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A251. Can Produce A Calcium Fall:; Cimetidine;; Phenytoin;; Alcohol;; Citrate;; Fluoride
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Q252. Etiology of Hypercalcemia; (14)*
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A252. CHIMPANZEES:; Calcium supplementation;; Hyperparathyroidism / Hyperthyroidism;; Immobility;; Meds / Multiple Myeloma;; Padget's Dz;; Addison's Dz / Acromegaly;; Neoplasm metastasis;; Zollinger-Ellison syndrome;; Excess Vit-A;; Excess Vit-D;; Sarcoidosis or TB (granulomatous dz)
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Q253. MCC of hypercalcemia; MCC for inpatient?
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A253. Primary Hyperparathyroidism; Inpatient: Malignancy
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Q254. Dx: malaise, HA, diffuse aches, dehydration, N/V, nodules on skin, cornea, conjunctiva and kidneys
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A254. Hypercalcemia; (nodules are calcifications)
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Q255. Drugs that cause Hypercalcemia; (5)*
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A255. C-TALE:; Calcium supplementation;; Thiazides;; Antacid abuse;; Lithium;; Excess Vitamin D
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Q256. Dx: "Stones, bones, groans and psychiatric overtones"
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A256. Hyperparathyroidism
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Q257. Tx for Primary Hyperparathyroidism patient with underlying cardiac failure; (drug and maintenance)
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A257. Lasix to maintain diuresis; and Pulmonary artery pressure monitoring to avoid volume overload
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Q258. Pathophysiology behind Renal Osteodystrophy
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A258. Nephron loss reduces phosphate excretion, causing hyperphosphatemia, which lowers serum calcium and increases PTH secretion; (secondary parahyperthyroidism)
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Q259. (3) Bone lesions assoc with Secondary Hyperparathyroidism
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A259. Osteitis Fibrosa Cystica;; Adynamic Bone Dz;; Osteomalacia
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Q260. Definition: Normal bone is replaced by fibrous tissue, primitive woven bone and cysts
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A260. Osteitis Fibrosa Cystica
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Q261. Dx: bone pain, proximal muscle weakness, pruritis, soft- tissue ulcerations, diffuse soft-tissue calcifications
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A261. Secondary Hyperparathyroidism; (Renal Osteodystrophy)
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Q262. Goal and Tx for Secondary Hyperparathyroidism /; Renal Osteodystrophy; (2 drugs and 2 if drugs dont work)
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A262. Goal:; Normalize calcium-phos balance Tx:; 1. Aluminum-containing antacids: reduce GI absorpt of PO4-; 2. Vit-D with Calcitrol: inc serum Ca++ and reverse bone damage; 3. Subtotal parathyroidectomy; 4. Renal transplant
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Q263. If patient has hypocalemia or hypophosphatemia (or both) what is the next step?
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A263. Check for Hypomagnesemia:; Ca++ and PO4- will not elevate if Magnesium is low
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Q264. Dx: Rapid transfer of Calcium into bones following removal of hyperactive parathyroid; What electolyte disorder can it cause?
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A264. Hungry Bone syndrome; can cause: Hypomagnesemia
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Q265. parasellar sx
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A265. headache; changes in vision
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Q266. do men or women have a higher rate of parasellar sx associated w prolactinomas
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A266. men
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Q267. tx of prolactinoma
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A267. bromocriptine x 2yrs; or cabergoline (both are DA agonists); surgery if no response to medication
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Q268. dx of acromegaly
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A268. incresaed igf 1; the do glucose suppresion test (glucose normally supresses gh)
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Q269. how should random gh level testing be done
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A269. it shouldn't be done... it's not useful
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Q270. associated sx (aside from teh obvious) of acromegaly
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A270. increased glucose, tg, po4, and prl levels
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Q271. causes of central DI
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A271. sarcoid; TB; syphilis; encephalopathy
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Q272. causes of nephrogenic DI
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A272. lithium; hypokalemia; hypercalcemia
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Q273. tx of central DI
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A273. DDAVP; chlopromide (increases ADH secretion and enhances ADH effects)
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Q274. tx of nephrogenic DI
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A274. HCTZ (works by depleting body of Na --> reabsorption of Na and water in proximal tubules)
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Q275. why is there no edema in SIADH
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A275. natriuresis also occurs b/c the body senses increased blood volume, and secretes ANP, causing natriuresis; decreased proximal tubule reabsorption of Na b/c of increased volume; RAAS is inhibited
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Q276. tx of SIADH
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A276. if no sx: water restriction or ns + loop diuretic; if sx: water restriction + isotonic saline
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Q277. difference between cushing syndrome and cushing dz
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A277. syndrome = increased gc; dz = increased acth from pit
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Q278. effect of hypocalcemia on reflexes
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A278. increased
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Q279. pseudohypoparathyroid
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A279. end organ doesn't respond to pth
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Q280. T3 functions
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A280. 4 B's; brain maturation,; bone growth,; b-adrenergic,; BMR; also diabetogenic and lipolytic
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Q281. Cortisol functions
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A281. diabetogenic; liplolytic; proteolytic; osteolytic; anti-inflammatory; maintains bp
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Q282. How is cortisol anti-inflammatory?
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A282. induces lipocortin, which inhibits phospholipase A2; inhibits IL2; inhibits histamine, 5ht release
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Q283. Sympathetic effect on Insulin release?
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A283. B-adrenergic causes increased release; a2 stimulation inhibits insulin release
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Q284. Steroid Receptors
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A284. PET CAT; progesteron; estrogen; testosterone; cortiol; aldosterone; thyroid hormone; also Vit D
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Q285. IP3 receptors
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A285. TO GAG; TRH; Oxytocin; GnRH; ADH (V1); GHRH
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Q286. Conn's Syndrome
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A286. primary hyperaldosteronism (tumor) (low renin)
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Q287. Addison's Disease
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A287. primary adrenocortical insufficiency
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Q288. Waterhouse-Friderichsen Syndrome
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A288. acute adrenocortical insufficiency; adrenal hemorrhage syndrome assoc with meningococcal septicemia
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Q289. MEN syndromes: inheritance, gene assoc, symptoms
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A289. MenI=pancreas, pituitary, parathyroid; MenII=parathyroid, pheochromocytoma, medullary ca of thyroid; MenIII=pheochromocytoma, medullary ca of thyroid; all auto-dominant, and II and III associated with ret gene
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Q290. MEN syndromes
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A290. Men I=pancreas, pituitary, parathyroid; Men II=parathyroid, pheochromocytoma, medullary ca of thyroid; Men III=pheochromocytoma, medullary ca of thyroid, and mucosal neuromas (oral and intestinal); all auto-dominant, and II and III associated with ret gene
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Q291. Myxedema
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A291. glycosaminoglycan deposition in dermis; related to both hypothyroidism and grave's hypertyroidism; pretibial only in graves
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Q292. Subacute Thyroiditis (de Quervain)
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A292. self limited hypothyroidism (can be hyper early on) following flulike illness; elevated ESR, tender thyroid gland; granulomatous inflammation
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Q293. Thyroid Cancers
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A293. Papillary=groundglass, orphan annie, psammoNa bodies, most common, excellent prognosis; Follicular=good prognosis, uniform cells; Medullary=parafollicular C cells, calcitonin, sheets of cells in amyloid stroma (calcitonin becomes amyloid); lymphoma assoc with Hashimoto's
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Q294. Test for acromegaly?
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A294. oral glucose tolerance test (GH excess causes insulin resistance)
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Q295. Osteitis Fibrosa Cystica
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A295. cystic bone spaces filled with brown fibrous tissue; bone pain; associated with primary hyperparathyroidism
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Q296. Primary Hyperparathyroidism
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A296. stones, bones, groans; stones=renal stones due to hypercalciuria; bones=osteitis fibrosa cystica. often see subperiosteal resorbtion with cystic degeneration, salt/pepper calcarium; groans=weakness/constipation
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Q297. Secondary Hyperparathyroidism
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A297. due to low Ca, usually due to chronic renal disease (renal osteodystrophy); high phosphate!
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Q298. acid/base and calcium relationship
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A298. with alkalosis, there is less free ionized Ca2+ so you can get tetany
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Q299. HLA assoc with Hashimotos
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A299. B5, DR5
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Q300. HLA assoc with DM
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A300. type 1 = DR3, DR4; none for type 2; although type has a stonger genetic predisposition
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