7 ⼀ENDOCRINE/OPHTHO Flashcards

Question

How does DKA and HHONKS affect total body K+ levels?

Answer 1

⬇︎**total body** K+ (REGARDLESS OF WHAT SERUM VALUE SAYS) ## Footnote DKA & HHONK causes severe osmotic diuresis --\> ⬇︎total body K+ stores even though serum K+ level may be elevated = [maintain > 5.3*K+* ✳]

Answer 2

_serumK \<3.3 *Remember that ALL DKA and HHONKS pts are Total Body K+ depleted due to osmotic diuresis regardless of what serum values say*

Answer 3

1st: .Determine if pt has ⇪ [Cortisol_GC]^{([Overnight low-dose dexamethasone suppression test] | [late night salivary cortisol assay] | [24 hr urine free cortisol])} 2nd. _If[Cortisol_GC] ⇪ = ⊕Cushing Syndrome 3rd: If ⊕Cushing Syndrome → perform ACTH workup^(image)to determine if Cushing Syndrome [ACTH-*dependent*] or [ACTH-*INdependent*]

Answer 4

3rd: If ⊕Cushing Syndrome → perform ACTH workup^(image)to determine if Cushing Syndrome [ACTH-*dependent*] or [ACTH-*INdependent*]

Answer 5

"**F**at **H**eavy **P**eople **M**ay **HOG** *the Cushing*" 1. **F**at reDistribution (central obesity, Moon face) 2. **H**yperpigmentation (from excess ACTH activating [Melanocyte MC1 R]) 3. **P**urple striae with skin atrophy and bruisability 4. **M**uscle atrophy 5. **H**TN 6. **O**steoporosis 7. **G**lucose intolerance \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Cushing **SYNDROME** is caused by ⇪ [Cortisol_{Glucocorticoid}]^{(which may be ACTH-INdependent or ACTH-dependent)}*

Answer 6

[Addison's Primary Adrenal Insufficiency] disease **Autoimmune** Primary Adrenal Insufficiency (suspect this in pts with other Autoimmune diseases - pernicious anemia, vitiligo, hypothyroid!) *Sx = HYPERKalelmia, hypOnatremia, wt loss, fatigue*

Answer 7

1. TB 2. Autoimmune adrenalitis 3. CA 4. Adrenal Hemorrhage

Answer 8

“*Addison was a* **SNAP FHAG**” 1. [**S**odium ⬇︎ DEC] 2. [**N**AHA (Normal AG Hyperchloremic metabolic acidosis)] 3. **A**norexia_{WT LOSS} 4. [**P**otassium ⇪ INC] 5. **F**atigue 6. [**H**yperpigmentation^{(ACTH and MSH)}] 7. [**A**ndrogen deficiency^{(⬇︎axillary/pubic hair)}] 8. **G**I Sx

Answer 9

ACTH analog ⼀*used for ACTH stimulation test -- when [basal morning plasma cortisol] and [basal morning plasma ACTH] are equivocal* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Addison's Primary Adrenal Insufficiency]

Answer 10

1. **basal morning plasma cortisol ⼀(*****dx = low cortisol*****)** 2. **basal morning plasma ACTH ⼀(*****dx = HIGH ACTH*****)** 3. [Cosyntropin ACTH stimulation test] ⼀(*use if 1 and 2 are equivocal*)

Answer 11

**HEMPI** to *DIL* **H**ydralazine [**E**tanercept (TNFα R Blocker)] **M**inocycline **P**rocainamide [**I**nfliximab (TNFα R Blocker)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ +ANA and **+antiHistone**

Answer 12

CTS changes lens epithelial gene transcription ➜ **CATARACTS**

Answer 13

inhibiting Na+/Glucose transporter ➜ [⇪ urinary glucose] AND [⇪ urinary Na+] and the [⇪ urinary Na+] travels to macula densa where it causes ⬇︎renin secretion ➜ [⬇︎Angiotensin II] ➜ ⬇︎efferent arteriole constriction ➜ ⬇︎GFR = delays DM nephropathy

Answer 14

[eyelid swelling-redness] / fever / conjunctivitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **orbit**al = **orbit** eye pain with movement + proptosis + ophthalmoplegia

Answer 15

IVAbx ➜ [Surgical debridement (if fluid collection/abscess present)]

Answer 16

[OTC Thyroid supplement vs surreptitious prescription thyroid med] ➜ supressess [ANT Pit TSH] ➜ ⬇︎thyroid gland synthesis ( ⬇︎RAIU and ⬇︎thyroglobulin)

Answer 17

**TT** **F**_eels **ARCHED** 1. **T**remor 2. **T**achycardia 3. [**F**atigue^{*(+/- Apathy in Elderly)*}] 4. **A**ppetite ⬆︎ but Wt ⬇︎ 5. **R**eflexes ⬆︎ 6. **C**ardio^{* (Tachycardia, Palpitations,Exertional SOB, ⇪Myocontractility→HTN)*} 7. **H**eat intolerance --\> SWEATING 8. [**E**xophthalmos with lid lag = GRAVES DISEASE] 9. **D**iarrhea +/- dyspepsia *Older pts may only have Fatigue, Cardio, or Apathetic!*

Answer 18

[CTS \> 3 Weeks] = TAPER DOWN *(taper allows for return of adequate endogenous cortisol_{glucocorticoid}*)

Answer 19

MEASURE PTH!

Answer 20

- Primary HyperParathyroidism - Tertiary HyperParathyroidism^{(Intractable Hypercalcemia 2/2 Autonomous Parathyroid)} - [Familial hypOcalciuric Hypercalcemia] - Lithium

Answer 21

1. **MALIGNANCY** 2. [VitD toxicity] 3. [VitA toxicity] 4. Granulomatous disease 5. [*LCD-TV* Rx] 6. Milk-alkali syndrome 7. Thyrotoxicosis^{*(Thyroid hormone causes bone resorption → ⇪ Ca+)*} 8. Immobilization

Answer 22

“**LCD**-**TV** with too much Calcium!” **L**ithium **C**a+carbonate excess **D**^Vitamin **T**hiazides **V**_itamin*A*

Answer 23

**hCAT** [**h**ashimoto **C**hronic **A**utoimmune^*(antiTPO)* **T**hyroiditis] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *hCAT can progresses to Thyroid Lymphoma | [hCAT+ Pemberton = Thyroid Lymphoma]* | *chronic [antiTPO Lymphocyte] infiltrate thyroid targeting TPO*

Answer 24

facial plethora or neck vein distension when arms are raised \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - obstructive **ENLARGED THYROID** - [Thyroid lymphoma (if ⊕ in the setting hCAT)]

Answer 25

1. [thyroid nodule iTSo MEN] 2. [Calcitonin ⇪ (from thyroid gland C cell neoplasia)] * MEN = Multiple Endocrine Neoplasia // iTSo = in The Setting of*

Answer 26

**P**ituitaryMacroAdenoma **P**arathyroid hyperplasia [**P**ancreatic-GI *GLIV* tumors ⼀*G*astrinoma/g*L*ucagonoma/*I*nsulinoma/*V*IPoma]

Answer 27

- Parathyroid Hyperplasia - Medullary Thyroid CA - Pheochromocytoma

Answer 28

Parathyroid hyperplasia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1st: {[Plasma free metanephrines] --(confirm by)-- \> 2nd: - [24h urinary fractionated metanephrines] - catecholamines - abd imaging]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Undiagnosed Pheochromocytoma can cause fatal HDUS peri-thyroidectomy

Answer 29

1. Calcitonin 2. CEA 3. [Neck US (r/o regional metastasis)] 4. [_Chromo10*RET* protooncogene] germline testing 5. [Coexisting tumor r/o *([Parathyroid hyperplasia], [Medullary Thyroid Hyperplasia], Pheochromocytoma,)*]

Answer 30

**P**ituitaryMacroadenoma/**P**arathyroid hyperplasia/[**P**ancreatic-GI *GLIV* tumors] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [PARATHYROIDECTOMY with autotransplantation to muscle pocket]

Answer 31

[**P**rolactinoma]/[**P**arathyroid hyperplasia]/[**P**ancreatic&GI *GLIV* tumors] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**P**ancreatic *G*astrinoma (Zollinger Ellison)] - normal Ca+ (*⇪ Ca+ ➜ falsely elevated gastrin*) - NO acid-reducing tx (*PPI ➜ falsely elevated gastrin*)

Answer 32

[**T3/T4**^{thyroid hormone]} causes bone resorption **➜ ⇪ serum Ca+/Hypercalcemia**

Answer 33

1. [fundoscopic fluffy yellow-white chorioretinal lesions] 2. [floaters + eye pain and ⬇︎acuity] 3. [hospitalized patients on Parenteral nutrition = RF1] 4. [s/p GI surgery or GI perforation = RF2] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx = [Vorizonazole + Intravitreal antifungal + vitrectomy] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *RF = Risk Factor*

Answer 34

Chronic pancreatitis (RF cystic fibrosis) ➜ islet cell damage ➜ ⬇︎insulin secretion then insulin deficiency ➜ glucose intolerance ➜ DM \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ✔︎ = INSULIN*-replace Insulin pt stopped producing* ❌❌= [GI peptide antiDM (DPP4 inhibitors / GLP1🟢)] - *since these target GI peptides ➜ slows gastric emptying and ⇪ risk for pancreatitis* or ❌= [insulin secretagogues (Glipizide)]*- impaired ability to secrete endogenous insulin from DEC islet beta cell reserve*

Answer 35

insulin secretagogues

Answer 36

Food → intestine [GLP1] secretion naturally ➜ ^GLP1**iLAGG** _{→ GLP1 is then cleaved-inactivated by DPP4} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ⇪ **i**nsulin secretion and insulin sensitivity ⬇︎**L**iver glucose secretion ⬇︎**A**ppetite → wt loss ⬇︎**G**astric emptying^{*(⇪pancreatitis risk)*} ⬇︎**G**lucagon secretion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ so... [GLP1🟢] → ⇪^GLP1**iLAGG** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *liragluTIDE / exenaTIDE / dulagluTIDE*

Answer 37

Targets GI peptides ➜ slows gastric emptying \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote *linaGLIPtin* *sitaGLIPtin* *saxaGLIPtin*

Answer 38

[Pioglitazone thiazolidinedione] ⇪ insulin sensitivity by stimulating [PPAR-γ] on liver/muscle/fat] BUT it also stimulates [PPAR-γ] on renal CD ➜ ⇪ Na+ reabsorption ➜ fluid retention ➜ precipitates CHF

Answer 39

sudden **reversible** transient monocular blindness 2/2 carotid artery atherosclerotic disease

Answer 40

carotid endarterectomy

Answer 41

carotid doppler US

Answer 42

mildly low TSH **but** [normal free T4, normal T3 and normal physiology (*normal HR, bone density*)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RECHECK Thyroid function test in 8WKS (*most TSH normalize on its own*)

Answer 43

HCTZ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HCTZ [⇪ serum Ca+] while [⬇︎ urinary Ca+]*

Answer 44

[hypOthyroidism] ➜ [poor periOperative outcomes] ⼀BUT 911 surgeries are Ok if hypOthyroidism not severe (i.e. no myxedema coma)

Answer 45

[levothyroxine T4] ⇪ myocardial O2 demand which can ➜ Myocardial ischemia ➜ in CAD pts can cause MI or arrhythmia = slow gradual [levothyroxine T4] titration

Answer 46

intermediate-acting ; [basal insulin when injected BID] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ NPH has a pronounced peak which can ➜ hypOglycemia = bad for patients who already have hypOglycemic episodes

Answer 47

*Pump Indicated if T1DM pt (on current manual injection) has…* 1. hypOglycemic episodes 2. [suboptimal glycemic control HbA1C\>7] 3. highly variable BG readings

Answer 48

T1DM require a [(long basal) and (rapid bolusx3)] every day

Answer 49

[Cancer RF = (\> 1cm), fam hx, radiation hx, cervical LAD, compressive sx, thyroid hormone ∆] [Suspicious US = hypOechoic, microcalcifications, internal vascularity]

Answer 50

> \> 1 cm > > \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Cancer RF = (\> 1cm), fam hx, radiation hx, cervical LAD, compressive sx, thyroid hormone ∆] [Suspicious US = hypOechoic, microcalcifications, internal vascularity]

Answer 51

✔︎ long standing DM1 pts overtime develop blunting of their autonomic feedback to [hypOglycemia (tremor, sweating, AMS)] = ⬇︎[*hypOglycemia awareness system (HAS)*] ✔︎ so this means… if _long_-standing DM1 present with hypOglycemia ⼀ it’s likely to be a SEVERE HYPOGLYCEMIA EPISODE (since , in a {blunted *HAS*} pt, only SEVERE HYPOGLYCEMIA can activate a {blunted *HAS*} to induce sx necessary to make pt aware/get help] **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** [Strict avoidance of **any** hypOglycemia x 2-3 weeks] restores patient’s *HAS*

Answer 52

1. [papillary thyroid cancer] 2. [follicular thyroid cancer] * * * DeTC target TSH : [**LR** =^TSH(0.1-0.5)^6mo_→(_Ln)] | [**IR**=^TSH(0.1-0.5)] | [**HR**=^TSH(\<0.1)^{x yrs}]

Answer 53

in [DeTC s/p thyroidectomy] pts, ***elevated*** **TSH** actually **stimulates growth of residual thyroid cancer cells** = goal TSH depends on _Risk of Recurrence_ * * * [**LR** =^*TSH*(0.1-0.5)^6-12mo_{then →}(low nml TSH range)] [**IR**=^*TSH*(0.1-0.5)] [**HR**=^*TSH*(\<0.1)]^{x years} * * * TSH\*=DeTC TSH goal

Answer 54

[initial stage of CA] ; [Risk of Recurrence] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DeTC target TSH : [**LR** =^TSH(0.1-0.5)^6mo_→(_Ln)] | [**IR**=^TSH(0.1-0.5)] | [**HR**=^TSH(\<0.1)^{x yrs}]

Answer 55

DECREASES… 1. [**micro**vascular complications ⼀*nephropathy, retinopathy*] 2. [peripheral neuropathy onset] 3. [peripheral neuropathy progression]

Answer 56

delayed gastric emptying (2/2 DM, drugs, postviral) ; [nuclear gastric emptying study]

Answer 57

- [succussion splash] - [early satiety] - [Abd fullness postprandial] - [dysautonomia ^{*(dizziness, diaphoresis)*}] - [labile glucose control] | *BE SURE TO R/O MECHANICAL OBSTRUCTION*

Answer 58

1. metoclopramide 2. erythromycin

Answer 59

[5y after T1DM dx] and [**AT TIME OF DX for T2DM**] * * * * give Statin if [age ≥40 with DM]*

Answer 60

ACEk2 inhibitor \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *this improves diabetic nephropathy AND INC GFR*

Answer 61

positive; diffuse * * * 1. propranolol 2. Thyroid Tx ([AntithyroidMed] vs [Radioactive iodine ablation] vs [Thyroidectomy]) ## Footnote _{tx = [**P**ropranolol] --\> [**P**TU ---(1 hr later)]--\> [**P**otassium Iodine _andPrednisone_CTS]}

Answer 62

1. _Cardiacpropranolol 2. _Thyroid([AntithyroidMed^{1st line}] vs [Radioactive iodine ablation] vs [Thyroidectomy_surgery]) * * * a. [*mild* hyperthyroidism] b. [Pregnancy ^{(PTU→ MTZ → MTZ)}] c. Elderly^{(older with limited life expectancy)} d. Prep for [radioactive iodine ablation]

Answer 63

positive; diffuse \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. alternative to **AntiThyroids**^{(if unable to tolerate)} 2. alternative to [**Thyroidectomy_Surgery**]^{(if surgery not preferred)} 3. [*SEVERE* hyperthyroidism +/- ophthalmopathy] 4. [*Moderate* hyperthyroidism +/- ophthalmopathy] 5. [*mild* hyperthyroidism +/- ophthalmopathy]^{(* *PATIENT PREFERENCE* *)} * * * *C❌D(pregnancy, lactation)* *| RAI ablation is useful in Graves/Toxic nodular thyroid since INC uptake concentrates Radioactive isotope in diseased thyroid*

Answer 64

positive; diffuse \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ a.{Pregnant (and can't 1st tolerate [Thionamides_Antithyroid])} [b. GOITER^{(LARGE | Retrosternal_obstructive)}] c. [Thyroid CA (suspicion|confirmed)] d. [1º Hyperparathyroidism superimposed] e. *SEVERE* OPHTHALMOPATHY

Answer 65

- [TSH^{*_nml0.4 - 4*} ^{*(TSH q 4mo if Chronic Amiodarone Rx)*}] - [**FREE** T4 ^{*_nml0.9 - 1.7*}] - [total T3] ## Footnote _{*[Free T4 = 0.9 - 1.7]*}

Answer 66

Seidel Sign ⼀*concentrated fluorescein uptake (indicating corneal epithelial defect) with subsequent clearing in a waterfall pattern (indicating fluorescein is being washed out by inappropriately draining aqueous humor)* *\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* Full Thickness Corneal laceration

Answer 67

a. Full thickness Corneal **LACERATION** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b. ⼀URGENT OPTHO CONSULT!! If laceration extends through the full thickness of cornea ➜ can create [perforated open globe injury] = STAT SURGICAL REPAIR \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Seidel sign= concentrated fluorescein uptake with subsequent clearing (from draining aqueous humor) in waterfall pattern*

Answer 68

**ONLY IF [⊕ WHIPPLE'S TRIAD\*]** = clinical hypOglycemia = workup indicated 1. low BG 2. [*_SADHAT*hypOglycemia s_x] 3. [*_SADHAT*sx] resolve with glucose admin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\*Whipple's Triad is required because many people have low BG without hypOglycemia sx = not clinically significant hypoglycemia*

Answer 69

**[⊕ WHIPPLE'S TRIAD]** = clinical hypOglycemia = workup indicated 1. low BG 2. [*_SADHAT*hypOglycemia s_x] 3. [*_SADHAT*hypOgluc sx] resolve with glucose admin

Answer 70

1) Normally, hypOglycemia ➜ negative feedback ➜ suppression of release of [Insulin/CPeptide/ProInsulin] = [low serum Insulin ✅] 2) If Pt has sx hypOglycemia but [High or normal serum Insulin] there must be an abnormal additional source of Insulin (exogenous vs endogenous) = additional workup

Answer 71

evaluates Pts who only have hypOglycemia sx after eating

Answer 72

Proinsulin

Answer 73

▶([cortical cataracts] ; [AMD]) ▶Elderly Cataracts patients must be thoroughly evaluated for severity of [*^cca*AMD] since they: 1.may require both [Cataract lens extraction Surgery] *AND [^ccaAMD] tx (PO eye vitamin)]* or 2. may not benefit from [Cataract lens extraction Surgery] at all *(since opacified lens prevent* [*^cca*AMD] *progression)* [*^cca*AMD]*: (Cortical Cataract) associated -Age related Macular Degeneration*

Answer 74

([cortical cataracts] ; [*^cca*AMD]) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **[cortical cataracts]**: nonpainful *slow progressive lens opacification* ➜ *blurry vision but fields intact* with **[*****^cca*****AMD]**:*(potentially irreversible)* ***loss of central vision** due to central retina degeneration ➜ poor reading, scotomas, dim vision, [dry AMD with Drusen], [wet AMD with choroidal neovascularization]* [*^cca*AMD]*: (Cortical Cataract) associated -Age related Macular Degeneration*

Answer 75

Retinal Detachment

Answer 76

[Iritis_{Anterior Uveitis}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. photophobia 2. pain 3. redness 4. vision loss 5. [irregular constricted pupil] * 6. [Leukocytes in ANT segment]*

Answer 77

1. **corneal opacity** 2. severe photophobia 3. difficulty keeping affected eye open

Answer 78

Iodine-induced hyperthyroidism; [pts with Nodular thyroid dz or Chronic iodine deficiency] have INC risk for thyrotoxicosis following [**iodine exposure** (*radiocontrast for Coronary angio or imaging /amiodarone)* . \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [DEC TSH], [⊝thyrotropin R Ab], [US: ⇪ vascularity +/- nodules]

Answer 79

Iodine-induced hyperthyroidism; [pts with Nodular thyroid dz or Chronic iodine deficiency] have INC risk for thyrotoxicosis following [**iodine exposure** (*radiocontrast for Coronary angio or imaging /amiodarone)* . \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [BBlocker Propranolol] 2. [Methimazole *(add if Severe hyperthyroidism vs elderly heart disease)*]

Answer 80

(**LARGE LOAD iodiNe**) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 👄 *(Wolff-Chaikoff phenomenon)* = _any_ [**LARGE LOAD iodiNe**] →actually *paradoxically* inhibits TPO ^{(temporarily)} → [⬇︎iodiNe organification and coupling] → [⬇︎thyroid hormone synthesis] 👄[Lugol (**LARGE LOAD iodiNe**) solution] = clinically activates (*Wolff-Chaikoff phenomenon*) → [⬇︎thyroid hormone synthesis] for: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [prethyroidectomy in Graves disease] 2. [^acutethyroid storm tx]

Answer 81

1. [PDSGT-(Painful Dequervain Subacute Granulomatous Thyroiditis)] \* 2. [amiodarone *destructive Type 2* thyroiditis] \* 3. thyroid storm ⼀*DEC conversion of T4 ➜ [active T3]* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *\*used in thyroid when destruction of gland ➜ preformed thyroid hormone being released.*

Answer 82

[*normal* Retina] = _normal**DSLs**= [**D**isc margin defined/**S**mall veins *linear* /**L**arge veins defined]/ [**s**plinter hemorrhage^⊝] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | "*my Retina loves **DSLs***" ## Footnote [*Papilledema* Retina^{*(Retina in the setting of Papilledema)*}] = _{Papilledema⚠️}**DSLs** = [**D**isc margin *OBSCURED* / **S**mall veins *SERPENTINE /* **L**arge veins *OBSCURED*] / [**s**plinter hemorrhage^**⊕**]

Answer 83

0.4 ⼀ 4.0

Answer 84

_{**free** thyroxine T4}**[0.9 ⼀ 1.7]** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote 5-12

Answer 85

_{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. variant of hCAT^{(dx = [⊕TPO antibody], [low RAIU])} 2. HYPERthyroid *transiently* → hypOthyroid ^{(or sometimes Euthyroid)} → spontaneous recovery 3. Goiter**^Nonpainful**^{, small} 4. includes postpartum thyroiditis (midaged Women postpartum) | *🔎TPO = ThyroPerOxidase* ## Footnote * * * *[NSLP_hCAT] dx =same as hCAT dx:* a. ⊕TPO antibody b. low RAI uptake

Answer 86

_{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * * * - ⊕[Thyroid PerOxidase Ab] - [**_low**RAI uptake]

Answer 87

_{{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]}} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [initial Transient HYPERthyroid^{[damage from ^*AntiTPO*Lymphocytes^{(= Lymphocytes that secrete **AntiTPO Abs**)} → infiltrate thyroid follicles → [*preformed* T4/T3/TG] thyroid reservoir release]} 2. **damage ultimately → hypOthyroid**^{(since damage impairs thyroid function)} 3. Goiter^DIFFUSE 4. daughter condition = [NSLP_hCAT] 5. → CA^{*(hCAT can → Thyroid DLBL)*}

Answer 88

[Lymphocyte infiltration _➜ [Transient HYPERthyroidism] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Postviral inflammatory process 2. self-limited 3. **PAINFUL** **DIFFUSE ENLARGED GOITER** 4. FEVER [from postviral inflammatory process⁽*^{etx: viral antigens provoke [CD8 cytotoxic T-lymphocytes] against Thyroid follicles → follicular injury → ***}*⁾ 5. **_HYPER_**thyroid^{(TT Feels ARCHED)} symptoms ## Footnote _{{PDSGT etx: *(Viral antigen cross rxn) → [**PAINFUL** autoimmune CD8 follicle infiltration^{( = **large painful goiter**, FEVER, ⇪ESR, ⇪CRP)}] → [release of stored T4/T3 = **transient HYPERthyroid**] → DEC TSH → DEC iodine organification → DEC iodine demand = **DEC RAIU****}}

Answer 89

_{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - - ⇪ ESR - ⇪ CRP - [***low*** RadioActive Iodine Uptake]_{thyroid scintigraphy} ## Footnote _{{PDSGT etx: *(Viral antigen cross rxn) → [**PAINFUL** autoimmune CD8 follicle infiltration^{( = **large painful goiter**, FEVER, ⇪ESR, ⇪CRP)}] → [release of stored T4/T3 = **transient HYPERthyroid**] → DEC TSH → DEC iodine organification → DEC iodine demand = **DEC RAIU****}}

Answer 90

_{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _{-[Elevated ESR & CRP]_labs
-[***low*** RadioActive Iodine Uptake]_{thyroid scintigraphy}} * * * {*(Viral antigen cross rxn) → [**PAINFUL** autoimmune CD8 follicle infiltration^{( = **large painful goiter**, FEVER, ⇪ESR, ⇪CRP)}] → [release of stored T4/T3 = **transient HYPERthyroid**] → DEC TSH → DEC iodine organification → DEC iodine demand = **DEC RAIU****}

Answer 91

_{[Lymphocyte infiltration _➜ [Transient HYPERthyroidism]} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [NSAIDs ➜ Prednisone*_(refractory)*] 2. [Propranolol (or Atenolol)] 3. [self limited (_{viral infxn →}[*PDSGT* HYPERthyroid]^3w → hypOthyroid → Euthyroid)] * * * ## Footnote _{{PDSGT etx: *(Viral antigen cross rxn) → [**PAINFUL** autoimmune CD8 follicle infiltration^{( = **large painful goiter**, FEVER, ⇪ESR, ⇪CRP)}] → [release of stored T4/T3 = **transient HYPERthyroid**] → DEC TSH → DEC iodine organification → DEC iodine demand = **DEC RAIU****}}

Answer 92

toxic multinodular goiter * * * 1. {HYPERthyroid_{thyrotoxicosis} ^{**(TT F**_eels**ARCHED)**}} 2. nodular enlargement 3. OLDER patients

Answer 93

[Graves_{*1º HYPERthyroid_{thyrotoxicosis}*}] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [thyrotropin R autoantibodies] stimulate thyroid *diffusely* to [INC iodine uptake] and [INC thyroid hormone synthesis]

Answer 94

★ [1º malignant melanocytes from uvea*^{(choroidal pigmented nevus)}*] ★ [identified *incidentally* frequently] ⼀[gold standard dx = US] ★ {⊝**sx** or [small (diameter\<10mm) (thickness\<3mm) pigmented lesion] = [**observation** (repeat exam in 3 mo, then q6 mo)]} ★ {⊕SX or [LARGE (d ≥10mm)(t ≥3mm)] = XBRT --(*if VERY LARGE or extrascleral extension*)--\> Enucleation | *Enucleation: removal of entire globe and intraocular contents*

Answer 95

DM**1** (*inpatient basal insulin is req'd for ALL hospitalized DM1 patients and most DM2*) ; [hospitalized patients eat _less_ than normal = INC hypOglycemia risk] ; [25-50%] * * * **BNC** [**B**asal^{LA or IA}]= controls glucose between meals*^{ALL DM1 (and most DM2)}* [**N**utritional bolus^SA] = controls postprandial glucose excursions*^{req'd only for patients eating obvi}* [**C**orrectional bolus Sliding Scale^SA] = corrects random hyperglycemic excursions \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *L/I/SA: Long/Intermediate/Short-ACTING*

Answer 96

1. critical illness 2. DKA 3. HHONKS 4. perioperation 5. [(SQ insulin) failure]

Answer 97

central Hyperthyroidism; [TSH] & [T4/T3] * * * * * Although [mass effect (HA, visual ∆ )] = common pituitary adenoma sx…* * 85% [**TSH** pituitary adenoma] tumors secrete [**biologically inactive alpha subunit**] = * elevated [**_(Bi)alpha subunit**]? = likely from ⊕[**TSH** pituitary adenoma] *tx = somatostatin analog vs transsphenoidal surgery*

Answer 98

[NMER]_{*Glucagonoma*} | (necrolytic migratory erythematous rash) ## Footnote ***DAN** had a Glucagonoma!* _{Glucagonoma triad: DM, [NMER (necrolytic migratory erythematous rash)], [Anorexia weight loss]

* * *
*Glucagonoma is a rare but malignant pancreatic tumor of the [islet alpha cell] that secretes VIP, calcitonin, GLP1 / dx = high glucagon level / tx = surgical*}

Answer 99

closes {[pancreatic β islet cell] ^{*ATP-sensitive*}K+ Efflux channel^{*( which typically closes from ⇪ATP)*}} → inner cell membrane depolarization → Ca+ INflux → **endogenous** insulin Efflux secretion = **insulin secretagogue** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. ^2GGlimepir_**ide** 2. ^2GGlybur_**ide** 3. ^2GGliPiz_**ide** _{4._1G*Chlorpropam**ide***
5._1G*Tolbutam**ide***} | G = Generation ## Footnote _{*[Megliti**Nide**s ^{("Repagli**Nide**, "Nategli**Nide**")}] = same MOA as Sulfonylurea*}

Answer 100

**insulin secretagogue**^{= (*same as Sulfonylurea MOA*) stimulates **endogenous** insulin secretion} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Nategli_nide_ 2. Repagli_nide_

Answer 101

inhibits α-glucosidease ➜ inhibits intestinal carb digestion → ⬇︎postprandial HYPERglycemia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. Acarbose 2. Miglitol

Answer 102

inhibits [DPP-4 GLP1 peptidase] --\> ⬆︎GLP1--\> ⬆︎Glucose-induced insulin release \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. SitaGliptin 2. SaxaGliptin

Answer 103

1. ExenaTIDE 2. LiragluTIDE *These require Injections* | ⬆︎Glucose-induced insulin release ## Footnote "GLP1a says... "**iLAGG** behind food" [⇪**i**nsulin *secretion* & *sensitivity*^{⇪*[Glucose-induced Insulin Secretion]*} [⬇︎**L**iver Glucose secretion] [⬇︎ **A**ppetite^{*(secreted after food intake)*}] [⬇︎**G**astric emptying^{*(⚠️Pancreatitis risk)*}] [⬇︎ **G**lucagon secretion]

Answer 104

[hypothalamic estrogen🟥]_***SERM***; PCOS Infertility

Answer 105

[GnRH🟢] ; endometriosis

Answer 106

Tachypnea causes ⬇︎CO2 acid --\> H+ ions dissociate from albumin so they can help maintain pH --\> ⬆︎free albumin which bind to free ionized Ca+ --\> overall ⬇︎ in ionized unbound calcium

Answer 107

1. vitD deficiency 2. Chronic Kidney Disease 3. Pancreatitis 4. Sepsis 5. Tumor lysis syndrome 6. pseudohypOparathyroidism

Answer 108

1. a. Parathyroidectomy 2. b. Thyroidectomy 3. c. radical neck surgery 4. d. [Polyglandular autoimmune syndrome] 5. e. Metastatic CA 6. f. Wilson disease 7. g. hemochromatosis 8. h. [(*PTH R*) gene mutation] 9. i. [(*Calcium-sensing R*) gene mutation]

Answer 109

***DAN** had a Glucagonoma!* 1. **D**M 2. **A**norexia weight loss 3. **N**ecrotic Migratory Erythema (perioral, extremities, perineum)

Answer 110

Glucagon \>500 ## Footnote Look for **N**ecrotic Migratory Erythema!

Answer 111

★ [Celiac_{malabsorption}] is common with autoimmune thyroid disease = frequent cause of levothyroxine malabsorption ★ Pt now with iatrogenic hypOthyroidism needs Levothyroxine replacement , but potential [Celiac_{malabsorption}] will → [**constant escalating dose requirements of Levothyroxine**] ★ Celiac dx = (elevated serum anti-**TED** → endoscopy). If ⊕Celiac → gluten-free diet → restores nml Levothyroxine absorption * * * * Take Levothyroxine [on empty stomach^{30-60m ac}] _and[4h before other drugs]*

Answer 112

1. [Malabsorption\_Disease (Celiac)] 2. [Malabsorption\_Rx (iron, Ca+)] 3. [catabolic Thyroxine-T4\_Rx (*INC Thyroxine metabolism:* phenytoin, carbamazepine, Rifampin)] 4. Obesity 5. Pregnancy 6. overt prOteinuria * * * *Take Levothyroxine [on empty stomach^{30-60m ac}] _and[4h before other drugs]*

Answer 113

Take Levothyroxine [on empty stomach^{30-60m ac}] *_{--and ---}* Take Levothyroxine [4h before other drugs]

Answer 114

**IBM** **I**: { **^I**^nitial[75-125_mcg/day]*^{(or 25-50 for elderly | CVD)}*} ⬇ **B**:{ [**B**oost/INC Dose q6w until TSH nml^0.4-4 } ⬇ **M**: {**M**aintain & Monitor TSH q6-12months] * * * * note: elevated TSH despite constant escalating levothyroxine doses = levothyroxine malabsorption (c/s Celiac)*

Answer 115

[Struma Ovarii ovarian teratoma] = *rare* ovary tumor that ectopically secretes thyroid hormone → [*rare* _ectopicHYPERthyroidism with low TSH]

Answer 116

[Nonpainful Subacute Lymphocytic Postpartum Thyroiditis]_hCAT = [(_transienthyper*T*) → ( _transienthypO*T* ) → normal*T*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **within ≤1 year postpartum** {[TPO Ab inflammation] → [release of preformed T4 + preformed Thyroglobulin] → [nonpainful goiter + _transienthyper*T*] } 2. {[_transienthyper*T*] → [_transienthypO*T* *with ⬇︎RAIU*^{due to positive feedback's_⬇︎TSH]} ) → normal*T*] (PDSGT also)} 3. [variant of *hCAT*] (PDSGT also) 4. [⊕TPO Ab] ⼀(PDSGT also) 5. [⇪T4, ⇪Thyroglobulin, ⬇︎TSH, ⬇︎RAIU]

Answer 117

used to build thyroid hormone in thyroid follicle, and then **co-secreted with endogenous thyroid hormone secretion** ## Footnote * * * = *in* *pts exogenously taking thyroid hormone → [⇪ T4 but ⬇︎Thyroglobulin]* * = Graves disease → [⇪ T4, ⇪ Thyroglobulin]* * =hCAT (PST, PT) → [⇪ T4, ⇪ Thyroglobulin] (2/2 inflammatory release of preformed T4 and preformed Thyroglobulin)*

Answer 118

1. macula edema 2. proliferative diabetic retinopathy [→ vitreous bleeding → retinal detachment = blindness] 3. lens edema * * * improve glycemic control

Answer 119

Amiodarone's ## Footnote hypOT1: ^{nml pt}[**LARGE LOAD IODINE]***^{= Wolff-Chaikoff Effect: [large load iOdine] DEC thyroid hormone synthesis = hypOT)}* hypOT2. **[intrinsic inhibition (Thyroid hormone synthesis)***^{= hypOT}***]^{TX: LEVOTHYROXINE}** hypOT3. **[intrinsic inhibition (T4 → T3 conversion)***^{= hypOT}* **]^{TX: NONE}** * * * HyperT1. ^{Nodular/Graves}[**LARGE LOAD IODINE**]*^{= AIT1: large iOdine load INC thyroid hormone synthesis = HyperT)}*]**^{TX: Antithyroids}** HyperT2. [[**AIT2**]*^{=destructive thyroiditis: ( → preformed T hormone release→ INC thyroid hormone = HyperT )}*]**^{TX: Prednisone CTS-GC}**^]

Answer 120

FALSE | *chronic Amiodarone pts require TSH **every 4 months***

Answer 121

on empty stomach; 30-60m PREVENT; 4h ; *otherwise Ca+/Fe may possibly cause worsening hypOT in pts taking Levothyroxine*

Answer 122

T2DM does not involve absolute insulin deficiency (like T1DM) and glucose metabolism is sufficient to prevent ketosis

Answer 123

**MDM** [(**M**onogenic **D**M (**M**aturity Onset DM of Young)]: 1. **AUTO DOM EARLY ONSET DM = 2-3 GEN FAM HX** 2. defective glucose sensing and defective insulin secretion 3. Young/normal wt but early DM

Answer 124

“**H**aving **T**reats **F**eels **R**isky” ## Footnote *note: Asymptomatic patients with Abnml screening require a repeat of the same test on a different day for confirmation*

Answer 125

*_Vision Loss_ that's…* 1. monocular 2. [Severe BUT nonpainful 3. …with **temporal sparing**] 4. [_{hx of}amaurosis fugax]

Answer 126

1. optho consult 2. intraarterial thrombolytics 3. ocular massage 4. IOP reduction (ANT chamber paracentesis)

Answer 127

- [Pale fundus*^{(2/2 diffuse ischemia)}*] - [cherry red macula]

Answer 128

blurred-to-severe nonpainful vision loss

Answer 129

**Blood & Thunder** (Fundus w retinal hemorrhages & optic disc edema)

Answer 130

[Observation] [+/- intravitreal injection of VEGF inhibitors]

Answer 131

1. **F**loaters 2. [**F**lashing lights_(Photopsia)] 3. {[**F**ield of periphery nonpainful vision *loss 1st*]→ [central nonpainful vision *loss 2nd*]}^{*= “Descending Visual Curtain” progressive vision loss*}

Answer 132

1. marked elevation of retina 2. Vitreous hemorrhage

Answer 133

Surgical correction (retinopexy, vitrectomy)

Answer 134

1. [Hazy vision +/- red hue] 2. nonpainful vision loss 3. Floaters 4. Shadows

Answer 135

1. [red reflex^{absent or DEC}] 2. floating debris/RBC in Vitreous 3. obscured fundus view

Answer 136

1. Bed rest with 30-45° Head-Of-Bed elevation 2. photocoagulation 3. vitrectomy (some cases)

Answer 137

***CCTV** is a nonpainful way to _look_😏 ✅* 1. **C**entral Retinal occlusion⼀artery_{pale fundus + cherry red spot/amaurosis fugax hx} 2. **C**entral Retinal occlusion⼀Vein_{Blood & Thunder fundoscopy} 3. **T**orn (Detached) RETINA_{[flashing lights Photopsia]} 4. **V**itreous hemorrhage_{hazy vision/red hue/absent red reflex/floating debris}

Answer 138

**CAROTID ARTERY ATHEROSCLEROSIS** \> cardiogenic embolism, clotting DO, [giant cell arteritis (vasculitis)] ## Footnote * * * * Central Retinal artery occlusion*

Answer 139

- [subacute (hours to days)] monocular **PAINFUL** vision loss ⼀ pain worse with eye movement. - Fundoscopic optic disc edema - (+/- afferent pupillary defect)

Answer 140

Functional Pituitary Adenoma= **Lactotrope** **\> Somatotrope \>** Corticotrope * * * [**NON**functional pituitary adenomas] arise from [LH/FSH Gonatrope cells of the PITUITARY GLAND ➜ *unique* [isolated ⇪ ^{(nonfunctional)}αlpha subunit] ➜ [⊕feedback on hypothalamus_Gonatrope] → [decreased low LH/FSH gonadotropin levels] ➜ hypOgonadism + mass effect if tumor large enough * * * Tx = Trans-Sphenoidal Surgery

Answer 141

**Estrogen** stimulates liver to make ⇪ [thyroxine binding globulin] ➜ ⇪ binding sites to saturate➜ DEC free T3/T4 Normal thyroid ⇪ [free T3/T4] to saturate the additional TBG binding sites BUT hypOthyroid patients are unable to INC thyroid hormone synthesis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ get TSH weeks after starting Estrogen-OCP and titrate to normal thyroid function

Answer 142

[Cardiovascular disease (REVERSIBLE)] ; Colon CA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cardiovascular Disease is reversible with tx

Answer 143

hypOgonadism ; endogenous testosterone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ recovers weeks/months after d/c but will be permanently suppressed if chronic abuse

Answer 144

**MEATHEAd** 1. [**M**uscle mass ⇪] 2. ****_E_**RYTHROCYTOSIS** 3. **A**ggression 4. [(**T**estosterone/LH/FSH DEC )→ (Testicular size DEC) + (spermatogenesis DEC)] 5. [**H**LD^{( ⇪ LDL|⬇︎HDL)}] 6. [**E**rection & Libido^{[(normal during use) / (DECREASED DURING WITHDRAWAL)]} 7. **A**cne 8. ***d**oubleD-*Gynecomastia

Answer 145

Basal + [3 prn meal] ## Footnote * basal = [NPH BID] or [GluLargine QD]* * \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_* * 3 prn meal = [3 reg insulin c meals]*

Answer 146

- [⬇︎*basal* insulin (NPH BID vs GluLargine QD)] - eat before exercise - avoid insulin injection into "exercise" limbs

Answer 147

**CAPE** ⼀ **CAD ⼀MAD** 1. **_B**_-[***C**ontactLens* → Fluoroquinolone_drops] 2. **_B**_-[**A**zithromycin_drops] 3. **_B**_-[**P**olymyxin-trimethoprim_drops] 4. **_B**_-[**E**rythromycin_ointment] * * * 1. **_V**_-[**C**ompress^Warm/Cold] 2. **_V**_-[**A**ntihistamine_drops] 3. **_V**_-[**D**econgestant_drops] * * * 1. **_A**_-[**M**ast cell stabilizer]*^{freq episodes}* 2. **_A**_-[**A**ntihistamine_drops]ⁱ*^{ntermittent/freq episodes}* 3. **_A**_-[**D**econgestant_drops]*^{freq episodes}*

Answer 148

Keratitis (inflammation of cornea) ; **URGENT OPHTHALMOLOGY CONSULT FOR TX** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [**foreign body sensation**] / photophobia / vision impairment

Answer 149

bacterial infection of [eyelid sebaceous gland]

Answer 150

Keratitis can cause corneal scarring which ➜ blindness if untreated by optho \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ slit-lamp

Answer 151

EYE DISCHARGE directly Contaminated Surfaces

Answer 152

FALSE (only EYE DISCHARGE and contaminated surfaces transmit viral conjunctivitis)

Answer 153

1. Radioactive Iodine 2. Thyroidectomy

Answer 154

1. PreOp tx for Thyroidectomy in Graves 2. Thyroid Storm

Answer 155

Thyroglobulin is the base needed to make thyroid hormone. If thyroid hormone is elevated...and Thyroglobulin is also elevated then Thyroid is naturally producing a lot of thyroid hormone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ If thyroid hormone is elevated ...but Thyroglobulin is low then that means thyroid hormone must had been exogenousouly given

Answer 156

***HHH*** needs ***PPP*** tx = [**P**ropranolol] --\> [**P**TU ---(1 hr later)]--\> [**P**otassium Iodine _andPrednisone_CTS]

Answer 157

***HHH*** needs ***PPP*** Hot, Head and Heart 1. **H**ot = Fever 2. **H**ead = CNS dysfunction with tremor 3. **H**eart = Tachycardia, palpitations, HTN, HF \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = [**P**ropranolol] --\> [**P**TU ---(1 hr later)]--\> [**P**otassium Iodine _andPrednisone_CTS]

Answer 158

Acute Sinusitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *dx: Orbital Cellulitis*

Answer 159

[PreTx (Methimazole)] ➜ [DefinitiveTX (RADIOACTIVE IODINE ABLATION OR SURGERY)]

Answer 160

SYMPTOMATIC HyperThyroid + [Radioiodine uptake in nodule] with suppressed uptake in remainder of gland]

Answer 161

AGE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *less RF: fam hx / smoking / EtOH*

Answer 162

[X-linked **recessive** 1° immunodeficiency] ; recurrent infections ; [catalase positive organisms (**Aspergillus** = MAJOR COD / **Staph A**=liver/skin abscess/adenitis)] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [Loss of NADPH oxidase] impairs intracell killing of [phagocytosed bacteria and fungi] ➜ recurrent infections

Answer 163

central * -[straight lines appearing curvy (wet/exudative-neovascular= aggressive and uL] while* * -[dry/atrophic=gradual and BL)]* * “Of course Mac is the Center!"* * * * peripheral [Glaucoma --\> Gradual tunnel vision ^{(from gradual loss of peripheral vision)}]

Answer 164

teardrop pupil and [DEC visual acuity] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [small sharp objects penetrating globe at high velocity] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [IV abx / eye shielding / eye CT / Optho consult]

Answer 165

**METASTASIS** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [*metastatic* medullary thyroid CA dx] ➜ [CT neck/chest (look for metastasis)] ➜ Surgical Resection

Answer 166

multiNodular \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Surgery

Answer 167

[low TSH] with [normal free T4] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \* **ONLY** Treat^{(Antithyroid v RAI ablation)} **IF** 1. [TSH \< 0.1] 2. or [≥65 yo] 3. or [⊕comorbidities ^{(heart disease, osteoporosis)}]

Answer 168

easy, inexpensive screen that assess for loss of 2TVP (usually of the BL feet) in DM *2TVP = 2-point/Touch/Vibration/Proprioreception*

Answer 169

[AGGRESSIVE GLYCEMIC CONTROL] + [Neuronal transmission adjusters (Duloxetine|Gabapentin-Pregablin|TCA)]

Answer 170

a. normally, [stress (sepsis, surgery)] ➜ adrenal gland ⇪ [*endogenous* Cortisol_{Glucocorticoid CTS}] ➜ [⇪ adrenergic receptor sensitivity to catacholamines] ➜ [⇪ peripheral vasconstriction and ⇪ cardiac contractility] = **MAINTAINS BLOOD PRESSURE DURING STRESS** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ## Footnote b. pts chronically immunosuppressed (RA on prednisone^{*for > 3 weeks*}) have hypofunction of adrenal glands (due to iatrogenic Cushing syndrome) = [relative cortisol deficiency during [stress/sepsis/surgery]➜ require [exogenous corticosteroid] = [stress dose steroids] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c. [Hydrocortisone IV 200 mg/day]^{*to prevent/treat septic shock*}

Answer 171

In patients with elevated ACTH, differentiates source of ACTH ( [Corticotrope Functional Pitutiary Adenoma] vs [Ectopic (SOLC)] )

Answer 172

\>200 ## Footnote Prolactin inhibits LH release

Answer 173

(***C**_a**LEB***) **C**onstricted pupil / *ANTERIOR UVEITIS* / **L**imbus erythema / **E**ye pain / **B**lurred vision

Answer 174

*systemic inflammatory DO* 1. sarcoidosis 2. RA 3. JIA 4. HLA-B27 ## Footnote (***C**_a**LEB***)_sx

Answer 175

orbital septal injury \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **post**septal structures (Extraocular Muscles + eyelid retractors)

Answer 176

NPH | *NPH Peak effect MORE likely to → hypOglycemia*

Answer 177

1. DM 2. HTN 3. PSGN Urine [**A**lbumin-**C**reatinine **R**atio]; 30-300 normal = \< 30 micro = 30-300 MACRO = 300+

Answer 178

1. Edema (pulmonary & peripheral) 2. warm extremities 3. [systolic flow murmur with laterally displaced PMI]

Answer 179

(INC TSH) but (normal [T4 Thyroxine])

Answer 180

hCAT ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *[hashimoto Chronic Autoimmune Thyroiditis]*

Answer 181

[INC anti-TPO (antiThyroid PerOxidase)]

Answer 182

PREGNANCY ## Footnote *(spontaneous abortion/preeclampsia, abruptio placenta)*

Answer 183

FLAT PiG 1. FSH/LH ⬇︎ --\> **Amenorrhea, testicular atrophy** 2. ACTH ⬇︎ --\> **⬇︎Cortisol BUT NOT ALDOSTERONE --\>** hypotension from ⬇︎arterial resistance 3. TSH⬇︎ --\> **Fatigue/hypOthyroidism** 4. Prolactin⬇︎ --\> **LACTATION FAILURE (1ST SIGN OF SHEEHAN!)** 5. GH⬇︎ --\> **Anorexia**

Answer 184

Anti**T**hyroid**P**er**O**xidase ## Footnote *AntiTPO is also a/w miscarriage!!*

Answer 185

*low blood glucose gives you* **SADHAT** ## Footnote 1. **S**eizure 2. **A**MS 3. **D**iaphoresis 4. **H**A 5. **A**nxiety 6. **T**remor

Answer 186

serum : ***I C**onceal **G**lucose* 1. 🔝 insulin 2. ⬇️ cPeptide 3. ⬇️ glucose

Answer 187

gastrin producing tumor in pancreas or duodenum --\> [⬆︎⬆︎gastric acid \> 1000] --\> 1. multiple duodenal/jejunal ulcers **REFRACTORY** to PPI 2. steatorrhea from pancreatic enzyme inactivation *Be sure to screen Zollinger Ellison pts for MEN1 using PTH, Ca+ and Prolactin studies*

Answer 188

1. Retinopathy (from ⬆︎VEGF --\> abnormal angiogenesis) 2. Glaucoma (⬆︎ Sorbitol eye pressure) 3. Cataracts (Glycation of Ocular lens

Answer 189

[free hormone displacement] ➜ [Thyroid production ⬇︎] --\> ⬇︎TOTAL thyroid levels but normal free hormone levels 1. ASA 2. Furosemide 3. Heparin

Answer 190

[G\<8], [B\<9]

Answer 191

**IDIOPATHIC** \> Pituitary tumor *ALL PTS WITH THIS SHOULD UNDERGO CONTRAST BRAIN MRI REGARDLESS OF +/- HA/VISION SX. Precocious Puberty may be the first sign before the tumor*

Answer 192

testosterone derivative with progestin effects \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ endometriosis

Answer 193

**YOU DONT!** - Pubertal gynecomastia is seen in up to 66% of teenage boys mid-late puberty. It can be uL, BL and/or painful Tx = self-limited to ≤2 years

Answer 194

1-4 mo \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RAI eventually --\> hypothyroidism --\>⬆︎ thyroid stimulating autoantibodies --\> stimulate [orbital fibroblast] → expands [orbital tissue]

Answer 195

progressive **fibrosis** of thyroid gland and surrounding tissue (that looks like CA)

Answer 196

Painful **Bones**^{*([brown tumor], [VR osteitis fibrosa cystica], fx, pseudogout)*} **Renal Stones** ^{*(Nephrolithiasis, Polyuria)*} **Abdominal Groans**^{*(constipation, pancreatitis, peptic ulcer, cholelithiasis)*} **Psychic Moans**^{*(Depression, Seizure)*}

Answer 197

*etx: GH stimulates IGF1 secretion most of day --\> acromegaly sx*

Answer 198

*etx: GH stimulates IGF1 secretion most of day --\> acromegaly*

Answer 199

GH stimulates IGF1 secretion most of day --\> Acromegaly ## Footnote ⊝*GH secretion is ⬇︎ by glucose and somatostatin* ⊕*GH secretion is ⇪ by EXERCISE and SLEEP*

Answer 200

**INCREASES** Immobilization --\> ⬆︎osteoclast activity --\> ⬆︎serum Ca+

Answer 201

DECREASE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ release of Ca+ and Phosphorous from damaged muscles --\> CaPhosphate precipitation --\> drops free serum Ca+ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HYPERcalcemia and HYPERphosphatemia can occur later during the **re**mobilization phase during recovery*

Answer 202

IT DOESNT! ## Footnote [*serum *albumin] does NOT affect iCal+ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ when _*BOUND*albumin^{*which is neutral*} ⬇︎(*i.e. liver dz)* → ⬇︎[ Ca^⊕ normally bound to *[albumin]*] → ⬇︎[**TOTAL** Ca+]. \_\_ \_\_ \_\_ {{ ⬇︎_boundAlb 1.0 = ⬇︎_TOTALCa+ 0.8}} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ when [_*FREE*albumin^{*(which is ⊝)*}] ⇪ → likely *knocks off* Ca^⊕ from *[anions]* → ⬇︎[**TOTAL** Ca+]. [**TOTAL** Ca+]. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 203

[Wt loss--\> **SOCK**] ## Footnote **S****OCK**:**S**pironolactone,**O**CP (1st line after wt loss),**C**lomiphene for infertility,**K**etoconazole \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *etx: DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> Sx*

Answer 204

[*Medullary* Thyroid Carcinoma] ## Footnote also produces ACTH and VIP *associated with MEN2A and 2B*

Answer 205

Screen them for Pheochromocytoma ## Footnote *MTC and Pheochromocytoma are associated with MEN2A and 2B*

Answer 206

Surgical Resection --\> +/- radioiodine ablation and suppressive doses of thyroid hormone (in pts with risk of recurrence)

Answer 207

low Mg+ (especially in alcoholics) --\> ⬇︎PTH hormone release and PTH resistance ---\> ⬇︎serum Ca+ **AND low serum K+** ## Footnote serum Phosphorous levels are NOT affected by this phenomena!

Answer 208

1. **Tea colored** watery secretory diarrhea 2. hypOkalemia 3. hypOchlorhydria (from ⬇︎gastric acid) 4. HYPERcalcemia from ⬆︎bone resorption 5. Facial flushing ## Footnote *tx = octreotide for diarrhea*

Answer 209

1. Bone loss from ⬆︎osteoclast activity 2. cardiac tachyarrhythmias ## Footnote Hyperthyroidism = Graves \> toxic adenoma \> multinodular goiter

Answer 210

agranulocytosis * * * * Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!* * Radioactive Iodine tx can --\> worsening ophthalmopathy*

Answer 211

⬆︎Myocontractility and HR

Answer 212

pRBC and whole blood **CONTAIN CITRATE** and citrate chelates **Ca+** and chelates **Mg** → DEC Ca+ and DEC Mg --\> paresthesias, Chvostek, Trousseau, Hyperreflexia | *Leukoreduction ⬇︎[Febrile Nonhemolytic Rxn] risk from transfusion*

Answer 213

BP control \< 130/80 ## Footnote *do not push HbA1C \< 7%*

Answer 214

agranulocytosis * * * D/C the drug! * Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!* * Radioactive Iodine tx can --\> worsening ophthalmopathy*

Answer 215

DHEA and Testosterone ## Footnote Hyperandrogenism suggest androgen secreting CA of ovary or adrenal glands so these test will help to determine that

Answer 216

- **ISOLATED low T3** - can occur anytime the body is "sick" | *[Euthyroid Sick (low T3) Syndrome]*

Answer 217

Psammoma bodies (large lamellated calcifications with ground glass cytoplasm)

Answer 218

FTC involves **invasion of the tumor capsule** and/or blood vessels which can only be examined via surgical excision This is also the reason FTC has the tendency to hematogenously spread

Answer 219

1. Cabergoline dopamine R agonist OR 2. Bromocriptine dopamine R agonist 3. Transsphenoidal resection if refractory

Answer 220

Transsphenoidal resection surgery | {[Prolactinoma 1-3cm] or Sx⊕}= Cabergoline|Bromocriptine|*Sgry prn*

Answer 221

Activated T cells and **Thyrotropin Autoantibodies** both stimulate retroorbital fibroblast --\> orbital tissue expansion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Smoking, Female

Answer 222

[LARGE *e**N**ormous* nerves] --\> **N**EGATIVE SX = [**N**O 2TVP] [**N**O ankle reflexes] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [small ***p**etit* nerves] --\> **p**ositive sx = **p**ain, **p**aresthesias

Answer 223

1. small phallus 2. [hypOgonads (small testes)] 3. hypOspadia 4. gynecomastia 5. Cryptochidism 6. Eunuchoid body

Answer 224

Estrogen --\> ⬇︎clearance of Thyroid Binding Globulin --\> additional TBG binds up all the free T4 --\> ⬇︎free T4

Answer 225

autonomous production of thyroid hormones from hyperplastic thyroid follicular cells ## Footnote *if multiple uptake present, consider multinodular goiter*

Answer 226

Thyroglobulin is the base needed to make thyroid hormone. If thyroid hormone is elevated...and Thyroglobulin is also elevated then Thyroid is naturally producing a lot of thyroid hormone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ If thyroid hormone is elevated ...but Thyroglobulin is low then that means thyroid hormone must had been exogenousouly given

Answer 227

Primary Hyperaldosteronism

Answer 228

1. microhemorrhages 2. retinal edema 3. exudates Argon laser photocoagulation

Answer 229

*Don't **GAS** a Pheochromocytoma* 1. **G**eneral Beta Blockers (allows unopposed [α] stimulation) 2. **A**nesthesia 3. **S**urgery Phenoxybenzamine (irreversible general alpha blocker)

Answer 230

PTH ⬆︎ conversion of [25VitaminD] to [1-25VitaminD] *PTHrP comes from [SQC, breast, renal, bladder, ovarian]*

Answer 231

1. **[iodiNe contrast]** 2. **infxn** 3. {**pregnancy**^{[gestational transient thyrotoxicosis | childbirth]}} 4. **surgery** 5. **trauma**

Answer 232

1. Serum Anion Gap 2. Beta Hydroxybutyrate levels

Answer 233

HIGH FHH = [urine calcium : creatinine ratio \< 0.01] *Primary Hyperparathyroidism = uccr\>0.02*

Answer 234

NONinflammatory swelling of the salivary glands caused by liver disease or malnutrition (DM, bulimia)

Answer 235

inhibits ADH-mediated renal cortical collecting duct aquaporin insertion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SIADH

Answer 236

Tol**V**aptan = [**V**2 vasopressin ADH R blocker] ; 1. [severe HF Hypervolemia] 2. [refractory SIADH]

Answer 237

Water Deprivation Test ## Footnote give Demopressin AVP after water deprivation and if urine becomes more concentrated = Central DI. If no change = nephrogenic DI. This is ALSO helpful for r/o Primary Polydipsia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_x\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *DI* = inability to concentrate urine 2/2 [^{*(central DI)*}⬇︎ADH] vs [^{*(nephrogenic DI)*}renal *ADH R*⼀resistance]

Answer 238

Asymptomatic Hypercalcemia ## Footnote *Hypercalcemia sx: Painful Bones, Renal Stones, Abd Groans and Psychic Moans*

Answer 239

[GLP1 agonist⁽*^{exenatide, liraglutide}*⁾]

Answer 240

HBA1c \> 8.5%

Answer 241

**I**nsulin [**T**hiazolidinediones (pioglitazone)] **S**ulfonylurea | *"**I**nsulin **T**ops **S**cales"*

Answer 242

_{*"short, **P**hat & retarded"*} **PATERNAL** deletion of chromo15q11 thru 13 ; 1. Hyper**P**hagia --\> **P**hat (Obesity), Gastric rupture, DM2 2. hypOtonia 3. short stature 4. Mentally retarded

Answer 243

_{*"short, s**M**iling & retarded"*} **maternal** deletion of chromo15q11 thru 13 ; 1. Frequent s**M**iling/Laughter (Moms make you smile) 2. Hand Flapping 3. short stature 4. mentally retarded

Answer 244

deposition of [glycosylation products], [oxidative stress] and [microvascular injury] all --\> small nerve AND Large nerve-length dependent axonopathy

Answer 245

Klinefelter XXY

Answer 246

*all [McCune Albright] does is **P P P*** etx = autonomous activity of endocrine tissue from defect in cAMP kinase

Answer 247

1. surgery^{(inadvertent removal)} 2. Autoimmune hypOparathyroidism 3. Congenital^{(failure to develop = DiGeorge vs 22q11 syndrome)} 4. [Familial Isolated hypOparathyroidism]^{(Rare mutation in PTH precursor)} 5. [AutoDOM hypOparathyroidism]^{(CaSR gain-of-function mutation)}

Answer 248

**TQT** + **BOD** + **C**_hvostek ## Footnote **T**rousseau^{(cutting off}**^T**^{ricep/forearm circulation causes Carpal Spasm)} **Q**T prolongation [**T**etany^{(Seizures/spasm)}] **B**rain^{(Parkinsonism/ ⇪ ICP)} **O**cular cataracts **D**entition abnormalities **C**_hvostek^{(tapping along [}**^C**^{heek-facial CN7) causes {Mouth/Nose/Eye-Contraction})}

Answer 249

- Organ resistance to PTH - AutoDOM - short 4th and 5th digits - short stature

Answer 250

PTH; CaSR; [(free ionized Ca+) ⬇︎] * * *

Answer 251

1. [ ⇪ Ca+ bone resorption^{*(via osteoclast activation)*} → ⇪ serum Ca+] 2. [⇪renal^PCTCa+ reabsorption] 3. [⇪GI Ca+ absorption] 4. renally kicks out (P) 5. Converts [_{inactive 25(OH)}VitD] to [**active 1,25(OH)₂**VitD] 6. ^{*_Intermittent PTH_*}[⇪bone formation by activating osteoBlast]

Answer 252

Evalutes for abnormalities of ANT eye (conjunctiva, cornea, ANT chamber, iris)

Answer 253

Vitreous Hemorrhage \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DM *Fundoscopy = Dark Red Glow with Loss of Fundus details*

Answer 254

1. Trauma 2. Foreign Body under eyelid 3. Contact lens --\> Corneal epithelial defect \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fluorescein exam revealing corneal staining defect

Answer 255

**⇪ intraocular pressure from…** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [⇪⇪ AH inflow/production]^{(tx = BB|[α2 R agonist] | CAI)} - - -or - - - [⬇︎⬇︎AH _uveoscleraloutflow = OaG]^{(tx = Latanoprost}^{topical prostaglandin}⁾ - - -or - - - \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ [⬇︎⬇︎AH _trabecularoutflow = CaG]^{(tx =Muscarinic agonist )} * * * * [AH: Aqueous Humor] |[OaG/CaG: Open/Closed angle Glaucoma]*

Answer 256

_{Glaucoma Problem 1}: [⇪⇪ AH inflow/production]^{(tx = **β🟥**|**α2🟢**| **CAI**)} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - - - - - - Problem 2[⬇︎⬇︎AH _uveoscleraloutflow]^{(tx = **[Prostaglandin🟢 _{*Latanoprost*^*TOPICAL*}]**

- - - - - -

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Problem: 3[⬇︎⬇︎AH _trabecularoutflow]^{(tx =**[Muscarinic🟢^{*Pilocarpine*}}]**

* * *

## Footnote

β🟥 --\> ⬇︎Aqueous humor secretion from Ciliary *Epithelium*}

Answer 257

"[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges" "An M3 **BEGS** for **P**rivate **L**ounges" **B**ladder(contraction) / **E**yes / **G**I / **S**kin / [**P**eripheral Vasculature] / **L**ungs

Answer 258

Anticholinergics / Sympathomimetics / Dim light ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Closed angle needs* **OPMAT ..** STAT!"

Answer 259

**Gradual Tunnel Vision**

Answer 260

Sensorineural

Answer 261

**AIR!** ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Air interacts with ossicles FIRST, which **A**mplifies the sound conduction to cochlea

Answer 262

Glaucoma \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Glaucoma affects peripheral vision --\> tunnel vision! OAG is more common in Blacks* ## Footnote 👓*cupping is caused by thinning of outer rim of optic disc head*

Answer 263

[⇪ lens **opacity**] --\> 1. [gradual BL NIGHT VISION ⬇︎] 2. halos around lights \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *Fundoscopy eventually shows lost of red reflex and retinal details*

Answer 264

*"Closed angle needs* **OPMAT ..** STAT!" [**O**PHTHO CONSULT STAT!^{(for Emergent Iris resection!)}] **P**ilocarpine*_{[Cholinergic M3 R agonist]}* **M**annitol **A**cetazolamide*_CAI* **T**imolol*_BB*

Answer 265

Retinoblastoma leukocoria

Answer 266

**Gonioscopy** vs Ocular Tonometry ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Closed angle needs* **OPMAT ..** STAT!"

Answer 267

Zoster Ophthalmicus \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *finding = Dendriform Corneal Ulcer*

Answer 268

Repeated Eye infections with Chlamydia Trachomatis A,B,C --\> **Inversion of Eyelashes** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (**INVERTED** & **PALE EYELASH HAIR FOLLICLES** with Conjunctival injection) --\> [Blindness from lash ulceration]

Answer 269

1. [_*sudden*nonpainful uL vision ∆ ^{(hazy|red hue|COMPLETE LOSS)}] 2. Floaters ^{*also seen with [Torn Retinal Detachment]*} | *dx = Vitreous Hemorrhage*

Answer 270

PARENTS CAN NOT REFUSE TX for any **F.A.T.** conditions!! | *🔎F.A.T.. = FATAL Although Treatable* ## Footnote PARENTS CAN NOT REFUSE ANY TX THAT IS **LIFE SAVING** ^{911 | non911} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ If pt [nonrmergent ailment] is a [*treatable* & **FATAL condition** (i.e. Cancer)] -- PARENTS CAN NOT REFUSE THAT LIFE SAVING TX ^{→ *M.D. can obtain a court order to give tx*} \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PARENTS ARE **NOT** ALLOWED TO REFUSE TX for *treatable* LIFE SAVING TREATMENT FOR THEIR CHILD (EVEN IF BASIS IS RELIGIOUS)

Answer 271

1. microaneurysms = simple type 2. retinal edema = simple type 3. newly formed vessels if malignant type

Answer 272

conductive

Answer 273

Glaucoma ## Footnote 📖

Answer 274

1. **PAINFUL** Red eye uL 2. Fixed Dilated pupil 3. Cloudy Cornea \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Closed angle needs* **OPMAT ..** STAT!"

Answer 275

Permanent Vision Loss within 2-5 hrs of onset! ## Footnote \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Closed angle needs* **OPMAT ..** STAT!"

Answer 276

[*_{(Zoster Ophthalmicus)}*Dendriform Corneal Ulcer] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *dx = Zoster Ophthalmicus*

Answer 277

10% ; abruptly * * * ⭐{[ **aLi**: CL❌SES 1st]^{*(idiopathic vs iris hypoxia)*} ➜ [ **aTic**: CL❌SES 2nd] = [**TMAD**❌]}⭐ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1) _centralIris and lens stick together^{*= **aLi** closes 1st*} 2) → *rapid* ⇪ IOP pushes _peripheralIris against Cornea 3) → *CLOSING* off **aTic** 2nd → [*RAPID* ⇪ ⇪ ⇪ IOP] 4) [*RAPID* ⇪ ⇪ ⇪ IOP] → [*RAPID* optic n damage] → Blindness^{within 2-5h of onset⚠️}! \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *"Closed angle needs* **OPMAT ..** STAT!" | 🟢=Open / ❌=closed ## Footnote *🔎**aLi** = **a**ngle _between **L**ens and **I**ris* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🔎[**aTic** : **a**ngle _at**i**ris ⼀{**_T_**_MAD}_ ⼀**c**ornea] | [TMAD: Trabecular Meshwork Aqueous_Humor Drain]

Answer 278

65% ; gradually * * * ⭐[ **aLi**: 🟢]. [ **aTic**: 🟢]. [**TMAD**: ❌].⭐ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. idiopathic vs [TMAD❌_{(Trabecular Meshwork Aqueous_Humor Drain ❌bstruction)}] 2. → [*gradually slow* ⇪ IOP] → [*gradual slow* loss of ^{(peripheral 1st)}sight over years] 3. aTic not affected = remains open \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | 🟢=Open / ❌=closed ## Footnote *🔎**aLi** = **a**ngle _between **L**ens and **I**ris* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 🔎[**aTic** : **a**ngle _at**i**ris ⼀{**_T_**_MAD}_ ⼀**c**ornea] | [TMAD: Trabecular Meshwork Aqueous_Humor Drain]

Answer 279

abnormally curved cornea that causes different refractive power at different axes

Answer 280

age-related ⬇︎lens elasticity → [⬇︎accommodation (near-vision)] ## Footnote 👣often needs reading glasses

Answer 281

1. age 2. smoking 3. EtOH 4. CTS 5. [DM (sorbitol)] 6. trauma 7. excessive sunlight 7. infection 8. galactosemia / galactokinase deficiency

Answer 282

[PGF_2α*Prosta*glandin analog ] = ⇪ outflow of aq humor \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Glaucoma ## Footnote 📝*side effect = darkens /causes iris "browning"*

Answer 283

Linear Growth of * long bones^{*(primary determinant of adolescent growth spurt)*} * cartilage * muscle * organ systems + [Blood Glucose promoter]

Answer 284

1. Catabolic for Fat 2. Anabolic for Muscle & Bone 3. Blood Glucose Promoter (INC Blood Glucose)

Answer 285

Effects of GH are mostly mediated by **IGF1**, which is released from the **liver** in response to **GH** ## Footnote [GHRH → GH ---> IGF1]

Answer 286

* Hyperlipidemia * Cardiac Muscle Atrophy * [Fatigue / Depression / Malaise]

Answer 287

Pituitary problem

Answer 288

[SERMorelin_*GHRH*] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SOMAtrem SOMAtropin \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ mecaSERMin

Answer 289

sermoRELin

Answer 290

1. Somatropin 2. Somatrem

Answer 291

Recombinant IGF1

Answer 292

**SPAWN** 1. **P**ediatric growth failure (associated w/GH/chronic Renal Failure/Prader Willi/Turner) 2. **N**o idea: Idiopathic short stature (\>2.25 SD below mean height) 3. **A**dult GH deficiency 4. **W**asting in AIDS pts 5. **S**hort Bowel Syndrome in pts receiving nutritional support (it INC SA for digestion)

Answer 293

identical to native hGH ## Footnote *(Somatropin = Synthetic GH structurally identical to native hGH)*

Answer 294

Pediatric IGF1 deficiency from [Laron GH receptor Dwarfism] vs. [Ab against GH]

Answer 295

Somatostatin Analogue (45x more potent and long lasting) --\> blocks GH secretion

Answer 296

* Pitutiary microadenoma * Carcinoid Crisis (flushing/diarrhea/Cyanosis) * Secretory Diarrhea 2° to VIP tumors * Acute GI Bleeding

Answer 297

Replaces FSH and LH - Menotrophins (FSH and LH) - hCG - Urofollitropin (FSH from menopausal women urine) - Follitropin

Answer 298

1. Ovulation^{*[in women with hypOgonadotropic hypOgonadism] vs. IVF*} 2. Infertility^{*[in Men with hypOgonadotropic hypOgonadism]*} 3. PCOS/Obesity | *ex: Menotrophins | Follitropin | UroFollitropin | hcG*

Answer 299

Stimulates Gonadotroph cells to make/secrete LH & FSH

Answer 300

**Desensitizes** GnRH receptors and **inhibits** FSH and LH release ^{*[LONG half life GnRH analog] = GnRH🟥*}

Answer 301

GnRH➿ 1st: ***short**^{1/2 life}* = FLARE effect = Transient (7-10 days) FLARE (INC) in gonadal hormone levels from agonist effect 2nd: ***LONG**^{1/2 life}*-lasting suppresion of Gonadotropins and gonadal hormones from inhibition | {GnRH➿ = *GnRH analogs*}

Answer 302

[*specific* = **aef** ] 1. **a**ndrogen dependent Prostate CA] adjunct 2. **e**ndometriosis 3. **f**ibroids_Uterine \_\_\_\_\_\_\_\_+\_\_\_\_\_\_\_\_\_ [*ALL* = **BOPIA**] 4. **B**reast CA 5. **O**varian CA 6. **P**COS 7. **I**nfertility 8. **A**menorrhea | {GnRH➿ = *GnRH analogs*} ## Footnote {[_Goserelin_ GnRH🟢➿] indication} = {[_*specific***[a|e|f ]**] + [_*GENERAL***BOPIA**]}

Answer 303

**aefcr** 1. [**a**ndrogen dependent Prostate CA] adjunct 2. **e**ndometriosis 3. **f**ibroids_uterine 4. **c**entral precocious puberty 5. [**r**eproductive IVF^{*(keeps LH surge low → multi-oocyte maturation)*} ] \_\_\_\_\_\_\_\_+\_\_\_\_\_\_\_\_\_ [*ALL* = **BOPIA**] 4. **B**reast CA 5. **O**varian CA 6. **P**COS 7. **I**nfertility 8. **A**menorrhea | {GnRH➿ = *GnRH analogs*} ## Footnote {[_Leuprolide_ GnRH🟢] indication} = {[_*specific***[a|e|f |c|r ]**] + [_*GENERAL***BOPIA**]}

Answer 304

"Don't Block me from getting my *Rolex*" 1. Ganirelix 2. Cetrorelix 3. Abarelix *These are Dose-Dependent*

Answer 305

1. [GnRH R Blockers] produce immediate Blocking effect = Duration of Admin is shorter during IVF 2. [GnRH R Blockers] **don't produce Flare Effect**

Answer 306

* Gonadotropin injection is given 3 days after menses to immediately start developing Follicles. * {[_{_LONG_1/2}GnRH analogs] or [GnRH R Blockers]} are given to prevent premature LH surge

Answer 307

1. Mammogenesis 2. Milk production 3. Milk secretion 4. [Inhibits GnRH secretion → Suppresses Ovulation]

Answer 308

1. Bromocriptine 2. Cabergoline 3. Pergoline These are [D2-dopamine🟢] ^{*(Dopamine blocks [Lactotrope_PROLACTIN] secretion)*}

Answer 309

1. Pituitary Prolactinoma 2. PMS 3. Acromegaly (Use High Doses and only if tumor secretes both Prolactin & GH) 4. Parkinson's Dz 5. Type2DM

7 ⼀ENDOCRINE/OPHTHO Flashcards

(350 cards)