Conditions

Question 1

How does obesity cause hypertension in metabolic syndrome?

Answer 1

Increased adipose production of angiotensinogen leads to production of Ang II–> which leads to vasconstriction

Question 2

what is the primary cause of low HDL (good cholesterol)

Answer 2

liver insulin resistance

Question 3

What is the framingham risk calculator?

Answer 3

includes the risk factors of age, total cholesterol, HDL cholesterol, systolic BP, treatment for HTN and cigarette smoking- Gives 10 year risk estimate for myocardial infarction and/or coronary death

Question 4

fasting plasma glucose of 110-125 range

Answer 4

impaired tolerance

Question 5

fasting plasma glucose equal or greater than 126

Answer 5

Diabetes Mellitus

Question 6

2 hour glucose test levels of 140-199

Answer 6

Impaired tolerance

Question 7

2 hours glucose test greater 200

Answer 7

diabetes mellitus

Question 8

random plasma glucose over 200

Answer 8

diabetes mellitus

Question 9

water content independent of temperature and pressure

Answer 9

osmolality

Question 10

water content dependent on temperature and pressure

Answer 10

osmolarity

Question 11

what is the action of ADH at the V1 receptor?

Answer 11

it mediates vasoconstriction, enhancement of corticotropin release, and renal prostaglandin synthesis

Question 12

what is the action of ADH at the V2 receptor?

Answer 12

It mediates the antidiuretic response

Question 13

what values would you expect to see in Central DI?

Answer 13

decreased ADH release form posterior pituitary–> polyuria and polydipsia
an elevated serum Na+ (increase in osmo) stimulates thirst to replace urinary water loss
- increase serum osmolality and decrease urine osmolality

Question 14

what are symptoms of hypernatremia?

Answer 14

lethargy, edema, weakness, irritability and NM excitability

Question 15

what happens to the urine in chronic renal disease?

Answer 15

Increased solute excretion due to nephron (V2) damage

Question 16

what can be used to distinguish central from nephrogenic DI?

Answer 16

central= reduction in urine output+ increase in urine osmolality

nephrogenic= continued production of large amounts of dilute urine

Question 17

what medications can be used to treat central diabetes insipidus?

Answer 17

Chloropropamide- most commonly used antidiuretic after desmopressin
carbamazepine: good for partial central DI
Clofibrate: increases posterior pituitary ADH release- also for “partial” Central DI

Question 18

what is an example of positive feedback? How does that mechanism work?

Answer 18

Oxytocin
this mechanism allows the release of the oxytocin horomone when a trigger occures. The hormone then causes an action in the body, such as milk release or the start of labor contractions, which signals more production of oxytocin

Question 19

what is an example of negative feedback? How does that mechanism work?

Answer 19

insulin
High blood glucose is detected by insuling secreting cells of the pancreas. The pancreas secretes the hormone insulin in response, insulin causes the liver cells to take up glucose. As the body takes up glucose, blood glucose declines -release of insulin stops

Question 20

what type of complication is diabetic neuropathy? what usually causes it?

Answer 20

Microvascular complication
occulsion of vasa nervosum

Question 21

what is the most common type of diabetic neuropathy?

Answer 21

distal symmetric sensory neuropathy

Question 22

loss of touch and temperature
minor trauma goes unnoticed

Answer 22

Sensory neuropathy

Question 23

abnormal weight bearing, callus formation, ulceration

Answer 23

disorders of proprioception

Question 24

abnormal foot biomechanics
structural changes

Answer 24

motor neuropathy

Question 25

what are diabetic patients more prone to getting with peripheral arterial disease?

Answer 25

Arteriosclerosis obliterans

Question 26

peripheral arterial disease can cause?

Answer 26

calcification of the tunica media increased blood flow with lack of elastic properties of the arterioles complicates ulcer healing

Question 27

what are some risk factors for diabetic foot?

Answer 27

DM> 10 years duration peripheral neuropathy abnormal foot structure peripheral arterial disease smoking previous ulceration/amputation poor glycemic control

Question 28

what are non-invasive vascular evaulations that can be done for diabetic foot?

Answer 28

* Doppler segmental pressure and waveform analysis (PVR) * ankle brachial pressure index * transcutaneous CO2

Question 29

What is the classification system for diabetic foot ulcerations?

Answer 29

Wagner's classification

Question 29

What is the classification system for diabetic foot ulcerations?

Answer 29

Wagner's classification

Question 30

what is the wagner classification for diabetic ulcer (from 0-5)

Answer 30

* 0- intact skin (impending ulcer) * 1 -superficial * 2- deep to tendon or ligament * 3- deep abscess, osteomyelitis * 4- gangreen of toes or forefoot * 5- gangreen of entire foot

Question 31

where is the most common site of ulcers for diabetic foot?

Answer 31

plantar surface of the foot

Question 32

what are treatment options for diabetic foot?

Answer 32

offloading debridement wound dressing antibiotics surgery

Question 33

benefits of debridement?

Answer 33

removes biofilm stimulates capillary growth- bleeding good for chronic to acute wound

Question 34

what are the phases of wound healing?

Answer 34

inflammatory phase- first 2 days cellular proliferaton phase- peak 10-12 days maturation phase- neodermis

Question 35

what would you use for wound care of a large exudate?

Answer 35

foam alignates= debridement

Question 36

what would you use for wound care for light to moderate exudate?

Answer 36

hydrocolloid= not with infection collagen

Question 37

what would you use for wound care when there is no exudate?

Answer 37

hydrogel = necrotic wound

Question 38

what would you use for an infected wound?

Answer 38

antimicrobial

Question 39

what type of antibiotic would you use for diabetic wounds? why?

Answer 39

broad spectrum most diabetic wounds are multimicrobial

Question 40

what are indications for amputation?

Answer 40

* uncontrollable infection or sepsis * inability to obtain a plantar grade foot that can tolerate weight bearing * non-ambulatory patient

Question 41

severe non-infective bony collapse with secondary ulceration?

Answer 41

charcot foot

Question 42

decreased sensation + repetitive trauma= joint and bone collapse

Answer 42

neurotramatic charcot foot

Question 43

increased blood flow--> increased osteoclast activity---> osteopenia---> bony collapse glycolization of ligaments--->brittle and frail--> joint collapse

Answer 43

neurovasclar charcot foot

Question 44

what is the classification of charcot foot called? what are the classifications?

Answer 44

Eichenholtz 1- acut inflammatory process (often mistaken for infection) 2- coalescing phase 3- reconstructive

Question 45

most common location for charcot foot?

Answer 45

midfoot

Question 46

what is prolactin's function in reproduction?

Answer 46

it negatively modulates gonadal function by inhibiting GnRH release

Question 47

what is the clinical presentation of hyperprolactinemia?

Answer 47

hypogonadism- both sexes galactorrhea/amenorrhea- women Mass Effect- greater in men

Question 48

what two hormones is growth hormone under the influence of? what causes the negative feedback?

Answer 48

under the influence of GHRH and somatostatin negative feedback from IGF-1

Question 49

what are some pharmacologic causes of GH excess

Answer 49

insulin induced hypoglycemia norepinephrine clonidine estrogen

Question 50

diagnosis of Acromegaly-Gigantism?

Answer 50

serum growth hormone- post glucose administration IGF-1(insulin- like growth factor) Head MRI

Question 51

what medications can be used to treat acromegaly-gigantism?

Answer 51

octreotide dopaminergic drug GH receptor blocker (pegvisomant)

Question 52

best way to diagnose varicoceles?

Answer 52

Duplex Ultrasonography

Question 53

release inhibin- keeping FSH low

Answer 53

sertolli cells

Question 54

responsible for the release of testosterone?

Answer 54

LH

Question 55

which class of medications can cause ejaculatory disfunction?

Answer 55

alpha blockers 5- alpha reductase inhibitors

Question 56

the consisten or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity

Answer 56

erectile dysfunction

Question 57

what would organic erectile dyfunction look like

Answer 57

* Gradual onset * risk factors present * consistent dysfunction * masturbation a problem * orgasm may be preserved, even if flaccid * sleep erections absent

Question 58

what would psychogenic ED look like?

Answer 58

* sudden onset * risk factors absent * situational and varying dysfunction * non-coital erections may be present * orgasm absent * sleep erections present

Question 59

what is an important thing to consider for younger patients presenting with Erectile dysfunction?

Answer 59

ED may be the first sign of underlying CVD

Question 60

What are some shared risk factors for ED and cardiovascular disease?

Answer 60

Hypertension diabetes dyslipidemia Depression smoking obesity sedentary lifestyle

Question 61

The pathogenesis of ED is related to ?

Answer 61

Endothelial dyfunction * decrease endothelium dependent vasorelaxation * increased adhesion of leukocytes to endothelium

Question 62

symptoms of low testosterone?

Answer 62

* diminished libido/erectile dysfunction * diminished energy/ vitatlity * depressed mood * cognitive changes * decreased muscle mass/ strength

Question 63

signs of low testosterone?

Answer 63

Decreased bone density anemia truncal obesity

Question 64

Fluid imbalance marked by polyuria, nocturia and polydipsia

Answer 64

diabetes insipidus

Question 65

increased levels of ADH causes water retention

Answer 65

SIADH

Question 66

what is the urinary output (osmolarity) in diabetes insipidus?

Answer 66

High- polyuria

Question 67

what is the urianry output for SIADH?

Answer 67

low- oliguria

Question 68

treatment for diabetes insipidus?

Answer 68

central- desmopressin Nephrogenic- hydrochlorthiazide

Question 69

treatment for SIADH?

Answer 69

fluid restriction

Question 70

water retention/decrease urine production

Answer 70

increase in ADH

Question 71

increase urine production

Answer 71

decrease in ADH

Question 72

major stimuli for relase of ADH hormone?

Answer 72

plasma hyperosmolality circulating volume depletion

Question 73

excessive thirst and excretion of a large amount of dilute urine. Decreasing the intake of fluid does not change urine concentration

Answer 73

Diabetes insipidus

Question 74

site of defect for central diabetes insipidus?

Answer 74

hypothalamus or possibly posterior pituitary

Question 75

central diabetes insipidus left untreated would result in ______ serum Na+

Answer 75

high to normal range

Question 76

Increase serum osmolality and decreased urine osmolality

Answer 76

Central DI

Question 77

which receptor mediates vasoconstriction, enhancement of corticotrophin release and renal prostaglandin synthesis?

Answer 77

V1

Question 78

Mediates the antidiuretic response

Answer 78

V2

Question 79

What is needed for diagnosis of SIADH?

Answer 79

* Hyponatremia * serum osmolality <275 * urine osmolality >100 | must have nml cardiac, renal, hepatic and thyroid fxn

Question 80

type of SIADH where patient may have decreased reaction times, cognitive slowing, ataxia resulting in frequent falls

Answer 80

chronic SIADH

Question 81

SIADH that may be relatively asymptomatic, but may also have anorexia, nausea, malaise, headache, muscle cramps, weakness, seizures or coma

Answer 81

Acute SIADH

Question 82

what pharmacologic agents are responsible for hyperprolactinemia?

Answer 82

anti-depressants H2 blockers opioids

Question 83

excess growth hormone after growth plates closed

Answer 83

Acromegaly

Question 84

excess growth hormone before the epiphysis closes

Answer 84

Gigantism

Question 85

what do you have to give in order to get a correct serum GH

Answer 85

glucose

Question 86

what is first line treatment of acromegaly/gigantism? what second line?

Answer 86

1st line: transsphenodial surgery pharmacologic: dopaminergic like ocretinide/pegvisomant

Question 87

what genetic testing should be offered for patients entering IVF/ICSI with nonobstructive azoospermia or counts <5mil/ml

Answer 87

Karyotyping Y chromosome analysis

Question 88

what genetic test should be offered for patients with vasal agenesis or unexplained epididymal/ED obstruction (absence of vas defrens, blockage in prostate)

Answer 88

CFTR testing to rule of cystic fibrosis mutations

Question 89

retrograde or anejaculation can be caused by?

Answer 89

alpha blockers (tamulosin)

Question 90

ejaculatory dysfunction is can be caused by?

Answer 90

5 alpha reductase inhibitors

Question 91

Total testosterone =

Answer 91

Free T + albumin bound T + sex hormone binding globulin (SHBG) bound T

Question 92

bioavailabe testosterone =

Answer 92

Free T + albumin bound T

Question 93

intramuscular dosing of testosterone?

Answer 93

every 2-3 weeks

Question 94

absorbable gel dosing of testosterone?

Answer 94

once daily

Question 95

oral dosing of testosterone?

Answer 95

3-4 times daily

Question 96

nonscrotal patch dosing of testosterone?

Answer 96

once daily

Question 97

mucoadhesive dosing of testosterone?

Answer 97

twice daily

Question 98

nasal dosing of testosterone?

Answer 98

three times daily

Question 99

SQ pellets dosing of testosterone

Answer 99

every 3 months

Question 100

one step glucose test for gestional diabetes

Answer 100

fasting >92mg 1 hr >180mg 2 hr >153mg

Question 101

two step criteria for gestational diabetes

Answer 101

after 50g oral glucose if 1hr > 130mg/dl step 2: diagnosis is confirmed if fasting >95mg 1hr >180mg 2 hr > 155mg 3 hr> 140mg