1
Q
hyperaldosteronism is caused by increased ___ production
A
aldosterone
2
Q
necrotizing skin and soft tissue infections are surgical ___
A
emergencies
3
Q
primary hyperaldosteronism can be caused by (3)
A
- idiopathic
- adrenal adenoma
- adrenal carcinoma
4
Q
lab values in hyperaldosteronism
A
- uncontrolled hypertension
- hypokalemia
- hypernatremia
5
Q
most common presentation of hyperaldosteronism
A
vision impairment
6
Q
2 tests to dx hyperaldosteronism
A
- plasma aldosterone concentration (PAC); plasma renin concentration (PRA)
- PAC/PRA ratio
7
Q
pharm for hyperaldosteronism
A
Spironolactone
8
Q
imaging for hyperaldosteronism
A
CT scan
9
Q
in hypoaldosteronism, potassium will be
A
high
10
Q
hypoaldosteronism causes metabolic
A
acidosis
11
Q
pharm for hypoaldosteronism
A
Florinef (corticosteroid)
12
Q
Adrenal Insufficiency is also called
A
Addison’s Disease
13
Q
what hormone stimulates coritsol release
A
ACTH
14
Q
4 symptoms of Addison’s Disease
A
- hyperpigmentation of the skin
- weakness
- fatigue
- hypoglycemia
15
Q
Addison’s is differentiated from secondary/tertiary Adrenal Insufficiency by
A
- hyperpigmentation
- hyperkalemia
- dehydration
none of these are seen in secondary/tertiary
16
Q
2 diagnostic tests for Adrenal Insufficiency
A
- simplified cosyntropin test (ACTH stimulation test)
2. 8 am plasma cortisol level + plasma ACTH
17
Q
tx for Addisonian crisis
A
glucocorticoid: high dose 100 mg IV bolus over 24 hours
18
Q
chronic tx for Adrenal Insufficiency
A
mineralocorticoid and glucocorticoid replacement + long acting predinosine/dexamethasone
19
Q
pheochromocytoma triad
A
- HA
- sweating
- tachycardia
20
Q
tests for pheochromocytoma
A
- fractionated metanphrines
- CT or MRI
- if normal –> repeat during spell
21
Q
pheochromocytoma tx
A
in this order:
- alpha blocker
- beta blocker
- liberalize salt intake
- surgical resection
22
Q
MEN 1 involves
A
- parathyroid
- AP
- pancreas
23
Q
MEN 1 pruritis improves with __ and worsens with __
A
sun; stress
24
Q
Men 2 - aka Sipple involves
A
- parathyroid
- pheochromocytoma
- medullary thyroid carcinoma
25
MEN 2b - aka MEN 3 involves
1. marfanoid habitus
2. pheochromocytoma
3. medullary thyroid carcinoma
26
MEN 4 involves
1. parathyroid adenomas
2. pancreatic neuroendocrine tumors
3. gonadal tumors
4. adrenal tumors
5. renal tumors
5. thyroid tumors
27
Congenital Adrenal Hyperplasia is caused by
21-hydroxylase deficiency
28
CAH is characterized by increased __ and accumulation of __ precursors
ACTH; cortisol
29
3 symptoms of CAH
1. skin hyperpigmentation
2. ambiguous genitalia
3. hyponatremia
30
CAH can cause a ___ crisis
salt wasting
31
tx for CAH
1. crisis: hydrocortisone and fluids
| 2. chronic: cortiosteroids + mineralocorticoids for life
32
most common cause of Cushing's Syndrome
iatrogenic --> prolonged steroid use
33
primary Cushing's is caused by
adrenal adenoma or carcinoma
34
most common cause of secondary Cushing's
SCLC
35
work up for Cushing's
```
1. low dose dexamethasone test
(DST)
2. late night salivary cortisol
3. 24 hr urinary free cortisol excretion
4. plasma ACTH
```
36
tx for secondary Cushing's
transsphenoidal resection or irradiation
37
pharm for Cushing's
Mitotane
Metyrapone
Ketoconazole
38
Cushing's Disease (Secondary Cushing's) is specifically caused by
ACTH secreting pituitary tumor
39
T1DM work up
OGTT
| A1C
40
tx for hypoglycemia
15-20 g glucose or simple CHO --> recheck after 15 min
41
BG < 50 tx
glucagon injxn in buttocks, arm, thigh, or nasal spray
42
onset of hypoglycemia occur at what level
60-70
43
cognitive impairment is seen w. hypoglycemia at what level
50
44
criteria for T2DM dx
1. FBG < 126
2. A1C greater than or equal to 6.5
3. random plasma BG 200 or higher
confirmation w. at least 2 tests
45
indications for insulin
1. A1C > 10%
2. BC 300 or higher
3. complications (ex CAD)
4. serum BG not met w. oral meds
5. markedly symptomatic
46
ABCs of DM goals
1. A1C
2. blood pressure <140/90; CVD risk 130/80
3. Cholesterol
47
DM insulin regimen
1. stable baseline: basal insulin --> long acting OR short term via pump PLUS pre-meal short acting
2. intermediate insulin at bedtime OR long acting insulin in the AM or at bedtime
48
testing for gestational diabetes should occur
24-48 weeks gestation --> A1C OGTT
49
metabolic syndrome includes (5 things)
1. elevated TG
2. low HDL
3. HTN
4. abdominal obesity
5. insulin resistance
50
what is an insulinoma
tumor of pancreas that produces excess insulin
51
insulinoma presentation
healthy appearing person w. fasting hypoglycemia
52
DKA triad
1. hyperglycemia
2. ketosis
3. metabolic acidosis
53
tx for DKA
IV insulin + glucose
54
Charcot Foot can be a complication of
DM ch
55
acne is caused by (4 things)
1. androgens
2. keratin and sebum plug hair follicle
3. C acnes
4. inflammation
56
tx for acne
1. topical retinoid
2. benzoyl peroxide
3. +/- abx
57
acne morphologies
1. comedomes
2. inflammatory
3. nodulocystic
58
Actinic keratosis can turn into
SCC
59
indurated lesions w. a scale are suggestive of
SCC
60
tx for AK
1. liquid nitrogen cryotherapy
2. Diclofenac
3. Ingenol Mebutate
61
which gene is most altered tumor suppressor gene in SCC and AK
p53
62
SCC originates in
keratinocytes
63
work up for SCC
tangential shave bx
64
tx for SCC
mohs micrographic surgery
65
staging for melanoma
Breslow depth
66
warts are caused by what virus
HPV
67
molluscum contagiousum is caused by what virus
pox virus
68
HPV __ and __ have higher risk for malignancy
16; 18
69
only FDA approved tx for warts
Imiquimod
70
HPV prevention
Ceravix; Gardasil; Gardasil-9
71
endemic goiter is caused by
low iodine diet e
72
most endemic goiters reflect __ thyroid hormone levels
euthyroid
73
pharm for endemic goiter
Levothyroxine
74
primary cause of hypothyroidism
Hashimoto's
75
TSH nl
0.5-5.0
76
is serum T3 used to dx hypothyroidism
no!
77
pharm for hypothyroid
1. Levothyroxine
| 2. Armour thyroid: T3 and T4 from pig
78
most common thyroid d.o in US
Hashimoto's
79
Hashimoto's is an ___ disorder
autoimmune
80
tx for Hashimoto's
1. AI --> abs
2. antithyroperoxidase
3. antithyroglobulin
81
myxedema can be a complication of
untreated hypothyroidism
82
painful subacute thyroiditis (deQuervain's) often a
viral URI
83
tx for deQuairvan's
1. ASA
2. Propranolol
3. Iodinated contrast agent for elevated T3
4. Ipodate sodium/iopanoic acid for elevated T4
84
labs in hypothyroidism
TSH: high
| T3/T4: normal to low
85
Graves Disease is a type of autoimmune
hyperthyroidism
86
3 PE symptoms of hyperthyroidism
1. Afib
2. exophthalmos
3. myxedema
87
```
labs in hyperthyroidism:
TSH:
FT4:
T4:
FT3:
T3:
```
TSH: low
| FT4, T4, FT3, T3: elevated
88
tx for hyperthyroidism
1. Propranolol
2. Thiurea (Methimazole, Propylthiouracil) --> safe in pregnancy
3. Iodinated contrast agents (Iopanoic acid, Ipodate sodium)
4. Radioactive iodine 131 --> NOT save in pregnancy
89
contraindications for Radioactive iodine 131
pregnancy
| exophthalmos
90
__% of thyroid nodules are
benign
91
work up for thyroid nodules
1. thyroid US
| 2. fine needle bx
92
tx for thyroid nodule
1. Propranolol
| 2. Radioactive Iodine 131
93
folliculitis is inflammation of the
hair follicle
94
folliculitis is caused by
staph>strep
95
tx for folliculitis
warm compress
avoid systemic abx!
96
furuncle (aka boil) is caused by what pathogen
staph
97
furuncle is an infevtion of the
hair follicle AND surrounding soft tissue furu
98
tx for furuncle
1. warm compress
| 2. I&D
99
if abx for furuncle
1. Doxycycline
2. 1st gen cephalosporins
3. Tetracyclines
100
a carbuncle is a coalescence of
furuncles
101
carbuncles are caused by which pathogen
staph
102
tx for carbuncle
systemic abx focused on MRSA:
1. Tetracyclines
2. Bactrim
103
cellulitis is caused by what pathogen
staph, strep
104
cellulitis is an infection of the
epidermis AND subcutaneous CT
105
cellulitis is especially concerning for
DM pt
106
cellulitis patients may appear
septic
107
cellulitis tx OP setting
1. Penicillins
2. beta lactam inhibitors
3. cephalosporins
4. sulfa
5. tetracyclines
108
cellulitis tx hospital setting
1. Vancomycin
| 2. Ancef
109
cellulitis tx DM
1. Bactrim PLUS Keflex
110
what drug is contraindicated in CO for cellulitis
Azithromycin
111
erysipelas is caused by what pathogen
group A strep
112
erysipelas is an infection of the
dermis
113
erysipelas is characterized by
very shiny, red, well demarcated erythema
114
erysipelas tx
1. vancomycin
| 2. daptomycin
115
necrotizing fasciitis is characterized by
bullae, crepitus of the skin
116
nectrotizing fascitis is caused by
group A strep (Mprotein)
117
___ progresses quickly, destroys subcutaneous fat, but spares ___
nectrotizing fasciitis; muscle
118
tx for necrotizing fasciitis
urgents surgical consultation
119
Fournier's Gangrene attacks the
penis and scrotum
120
RF for Fournier's Gangrene
DM, etoh, HIV, obesity, malignancy
121
fx for Fournier's Gangrene
1. urgent surgical consultation!
2. Vancomycin immediately post surgery
2. then Piperacillin/Tazo
122
gas gangrene (clostridial myonecrosis) destroys subcutaneous fascia fat, AND
muscle
123
gas gangrene is caused by
clostridium perfingens
| traumatic wounds/perforation of bowel
124
tx for gas gangrene
urgent surgical consultation!
125
MRSA is associated with
previous hospital stay dt infxn
surgical procedures
enteral feeding
prior abx
126
common complaint associated w. MRSA
spider bite
127
tx for MRSA
3rd gen Cephalosporins
Fluoroquinolones
Vancomycin
128
Community Acquired MRSA (CA-MRSA) causes atypical symptoms not usually associated w. s. aureus, including
necrotizing fasciitis
purpura fulminans
necrotizing PNA
community outbreaks
129
nasal MRSA is associated w. 10% increases risk for skin/soft tissue infxn; what is the tx for nasal MRSA
topical intranasal muciporin for 5 days
| daily bathing w. antibacterial agent
130
MRSA has developed resistance to
clindamycin
131
newer tx for MRSA
1. Linezolid
2. Tedizolid
3. Daptomycin
4. Tygecycline
5. Ceftaroline
6. Oritavancin
7. Dalbavancin
132
hot tub folliculitis is caused by
pseudomonas
133
tx for hot tub folliculitis
op: no tx
| if progresses: Cipro
134
dog/cat bite treatment
1. irrigate!
2. Augmentin or Ampicillin
3. rabies/tetanus vaccine
135
Eikenella corrodens is associated with
dog/cat bikes
136
measles prodrome triad
fever, cough, coryza
also: conjunctivitis, malaise
137
Kolik spots (maculopapular rash) are pathopneumonic for
measles
138
Hyperparathyroidism symptoms
stones, bones, abdominal groans, thrones, psychiatric overtones
139
hyperparathyroidism labs will show elevated PTH and elevated
calcium
140
5 symptoms of hypoparathyroidism
1. abdominal cramps
2. muscle cramps
3. tetany
4. numbness/tingling
5. paresthesias
141
Chovstek sign is associated with
hypoparathyroidism
142
what is Chovstek sign
contraction of eye, nose, or mouth muscle by tapping facial nerve anterior to ear
143
Trosseau sign is associated with
hypoparathyroidism
144
what is Trosseau sign
spasm in hand/wrist w. compression to forearm
145
most common cause of hypoparathyroidism
post surgical removal of thyroid or parathyroid
146
1st test for growth hormone deficiency
1. IGF
then:
2. 2 provocative stimulation tests: insulin, deep sleep, glucagon, exercise etc
147
tx for growth hormone deficiency
recombinant HGH SQ daily
| monitor w. IGF and growth response
148
in kids, growth hormone excess is called
gigantism
149
in adults, growth hormone excess is called
acromegaly
150
growth hormone excess is almost always caused by
pituitary adenomas - usually benign macroadenomas
151
testing for growth hormone excess
1. IGF1
2. then fasting BG, prolactin, glucose, LFTs, BUN/CR
OGTT is gold standard: shows failure of GH to suppress
152
growth hormone tx
transphenoidal resection
153
growth hormone excess pharm
Somastatin analogs:
Ocreotide
Lanreotide
Dopamine agonists:
Cabergoline
GH receptor antagonist:
Pegvisomant
Clin Med 1
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