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Dermatology/ Endocrinology Flashcards

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1
Q

Infant with history of eczema give corticosteriods develops new rash and fever

Group monomorphic vesicles involving eczematous areas of infants extremities and face

Tx

A

Eczema herpeticum

Medical emergency

Due to propensity for HSV infection to spread systematically potentially affecting the brain

IV acyclovir immediately

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2
Q

Tx eczema

A

Corticosteroids are first line

Topical calcineurin inhibitors (tacrolimus) used for moderate to severe

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3
Q

Tx contact dermatitis

A

Corticosteriods

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4
Q

Severe red diaper rash with yellow scale, erosions and blisters

Cradle cap

Tx

A

Seborrheic dermatitis

Tx: adult- keroconazole, selium sulfide or zinc pyrithione shampoos and topical antifungals

Infant- routine bathing and application of emollients

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5
Q

Rash on extensor surface

A

Psoriasis

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6
Q

Rash on flexor surfaces

A

Atopic dermatitis

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7
Q

Biopsy of psoriasis

A

Elongated rete ridges

THickened epidermis

Absent granular cell layer

Preservation of nuclei in stratum corneum (parakeratosis)

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8
Q

Drug rash typically occurs

A

7-14 days later

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9
Q

Target lesions

Negative Nikolsky

A

Erythema multiforme

Supportive tx

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10
Q

Drugs that cause Stevens johnson syndrome or toxic epidermal necrosis

A 
Sulfonamides
Penicillin
Seizure medication (phenytoin, carbamazepine)
Quinolones
Cephalosporins
Steriods
NSAIDS
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11
Q

Erythema nodosum

A

Painful nodules on shins

Inflammatory process of subcutaneous adipose tissue triggered by infection (Strep, coccidioides, Yersinia, TB) drugs (sulfonamides, antibiotics, OCP) and chronic inflammatory disease (sarcoidosis, Crohns, UC, Behcet disease)

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12
Q

Blister

  • Nikolsky sign
A

Bullous pemphigoid

Autoantibodies against hemidesomes

Topical steroids

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13
Q

Flaccid blister

A

Pemphigus Vulgaris

Anti-desmosoglein

+ Nikolsky sign

High dose steroids (prednisone) + immunomodulatory therapy (azathioprine, mycophenolate mofetil, IVIG, rituximab)

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14
Q

Vesicles and erosions

Pruritic papules, vesicles, bullae, on elbows, knees, buttock, neck and scalp

Associated with

Tx

A

Dermatitis herpetiformis

Celiac disease

Dapsone and gluten free diet

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15
Q

Giant cells on Tzank smear

A

Herpes

Multinucleated

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16
Q

Cervical cancer

Genital warts

A

CC: HPV 16 and 18

Genital warts: HPV 6 and 11

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17
Q

Test for HPV

A

PCR

or Acetic acid turns lesion white

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18
Q

Tx Genital warts

A 
Cryotherapy
Podophyllin
Trichloroacetic acid
Imiquimod
5-FU
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19
Q

Impetigo caused by

Tx

A

Streptococcal
Staph

Localized: Mupirocin

Severe (Non-MRSA) : Oral Cephalexin, dicloxacillin or erythromycin

Severe (MRSA): Oral trimethoprim- sulfamethoxazole, clindamycin, or doxycycline

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20
Q

Bullous Impetigo

A

Always Staph aureus

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21
Q

Small pink papules on trunk in groups 10-20

Fever

GI involvement

Dx?
Tx?

A

Salmonella typhi

Fluoroquinoles and third generation cephalosporins

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22
Q

Necrotizing fasciitis caused by

Tx

A

S aureus
E. Coli
Clostiridium perfringens

TX: Surgical debridement
Pencillin (strep)
Clindamycin (decrease exotoxin production)

Anaerobic coverage: metronidazole or third gen cephalosporin

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23
Q

Tx Folliculitis severe

A

Topical mupirocin

Severe: cephalexin or dicloxacillin orally, escalating to clindamycin or doxycycline if MRSA

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24
Q

Progression of acne tx

A

Topial benzoyl peroxide, retinoid, or antibiotic —> oral antibiotic —> oral isotretinoin

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25
Papules that drain odorless fluid Gardener
Sporotrichosis Sporothrix schenckii- fungus in plants Lesion along lymphatic drainage lines Itraconazole
26
Isotretinoin check what
B-HCG LFT Cholesterol Triglycerides
27
Fish like scales | Dry
Ichthyosis vulgaris Inherited mutation of filaggrin gene Tx: Emollients, keratolytics, and topical tertinoids
28
Brown waxy papules | stuck on
SEborrheic keratosis
29
Ulcer on site of scar, burns or ulcer
Marjolin ulcer Rare SCC
30
Multiple red to violaceous macules, papules or nodules that can progress to plaques Lower limbs, back, face, mouth and genitalia
Kaposi sarcoma Vascular proliferative disease HHV-8
31
Pigmented patch on palm or sole Slowly spreading African american or Asians
Acral lentiginous Type of Melanoma
32
Melanoma tx
Systemic chemotherapy Doxorubicin Paclitaxel Interferon-alpha
33
Inhibits hepatic gluconeogenesis and increases peripheral sensitivity to insulin SE CI
Metformin (first line) WL GI upset Lactic acidosis CI: Elderly >80 with - renal insufficiency - hepatic failure - or heart failure
34
Increases endogenous insulin secretion SE
Sulfonylureas - Glipizide - Glyburide - Glimepiride SE - Hypoglycemia - Weight gain
35
Increase insulin sensitivity SE CI
Thiazolidinediones - Rosiglitazone - Pioglitazone SE - WG - Edema - Hepatotoxicity - Bone loss CI in those w/ heart failure
36
Inhibit degradation of GLP-1 Increase insulin secretion Decrease glucagon secretion
DDP-4 inhibitors - Sitagliptin - Linagliptin ( liptins ) Weight neutral
37
GLP-1 agonists Delays absorption of food Increases insulin secretion Decrease glucagon secretion SE
Incretins - Exenatide - liraglutide (-tides) Injected subcutaneously ``` SE: Slow GI motility Nausea Pancreatitis WL ```
38
Inhibit SGLT2 in proximal tubule to decrease glucose reabsorption SE
SGLT2 inhibitors - Dapagliflozin (-flozin) UTIs Vulvovaginal candidiasis WL Decrease blood pressure
39
Decrease intestinal absorption of carbohydrates SE
Alpha-glucosidase inhibitors - acarbose - miglitol Flatulence Diarrhea Hypoglycemia
40
SE Insulin
WG | Hypoglycemia
41
1) Glipizide 2) Rosiglitazone 3) Sigagliptin 4) Exenatide 5) Glyburide 6) Acarbose 7) Liraglutide 8) Linagliptin 9) Pioglitazone 10) Dapagliflozin 11) miglitol 12) glimepiride
1) Glipizide= Sulfonylurea 2) Rosiglitazone= Thiazolidinediones 3) Sitagliptin= DDP-4 inhibitors 4) Exenatide= Incretins 5) Glyburide= sulfonylurea 6) Acarbose= alpha-glucosidase inhibitor 7) liraglutide= Incretins 8) linagliptin= DDP-4 inhibitors 9) pioglitazone= Thiazolidinediones 10) Dapagliflozin= SGLT2 inhibitors 11) miglitol= alpha-glucosidase inhibitor 12) glimepiride= sulfonylurea
42
Type 1 Diabetes diagnosis
1) Random plasma glucose level >= 200 plus symptoms 2) Fasting >8 hr plasma glucose >= 126 on two occasions 3) 2 hr postprandial glucose level >= 200 following an oral glucose tolerance test. Hemoglobin A1C > 6.5%
43
Type 2 diabetes diagnosis
Fasting glucose (first line) HbA1C > 6.5% is diagnostic 2 hr oral glucose tolerance test
44
When to test for diabetes
at 45 y.o every 3 years if < 5.7%
45
Drug that can cause thyroid issues
Amiodarone
46
Hyperthyroidism tx
Propranolol to manage symptoms Antithyroid medication - Methimazole - Propylthiouracil
47
Tx Thyroid storm
AF Fever Delirium ``` Beta blockers Antithyroid drugs (propylthiouracil or methimazole) ``` Give high dose potassium iodine 1 hr after antithyroid medication
48
Propythiouracil SE
Allergic reaction Rash Arthralgias Agranulocytosis Vasculitis Liver failure (black box)
49
Methimazole SE
Allergic reaction CI in pregnancy Agranulocytosis Cholestasis*
50
``` Severe hypothyroidism Decrease mental status Hypothermia Hypotension Bradycardia Hypoglycemia Hypoventiliation ```
Myxedema coma IV levothyroxine IV hydrocortisone
51
Most common thyroid neoplasm
Papillary Slow growing Thyroid hormone producing follicular cells Psammoma bodies Lymphatic spread
52
Thyroid tumor Calcitonin
Medullary Calcitonin-producing C cells Conside MEN2A or 2B
53
Bisphosphonates
Alendronate Risedronate Ibandronate Zoledronic acid SE - Reflux - Esophagitis - Esophageal ulcers
54
DEXA scan when
Women >65 | Men > 70
55
1) Teriparatide 2) Denosumab 3) Raloxifene
1) Teriparatide - PTH analogue - Tx Osteoporosis 2) Denosumab - A monoclonal ab to RANK-L - TX osteoporosis 3) Raloxifene - SERM - Tx osteoporosis
56
Increased Alkaline phosphatase | Normal gamma-glutamyl transpeptidase (GGT)
Bone etiology | not liver
57
Hats dont fit anymore - disease - associated symptom - x ray appearance - lab values - tx
Paget disease of bone Hearing loss Plain X ray shows: lytic and sclerotic lesions (diagnostic) Mosaic lamellar bone pattern Increased Alk Phos Normal Ca and phosphate levels Bisphosphonates (first line) Calcitonin (if intolerant to bisphosphonates) Calcium and Vit D supplements
58
Bone pain | Hearing loss
Paget disease of bone
59
Elevated PTH Hypocalcemia Hyperphosphatemia Associated with
Pseudohypoparathyroidism PTH resistance Albright hereditary osteodystrophy - shortened fourth and fifth metatarsal or metacarpal bones [Marshmallow baby]
60
Elevated PTH NL/Decreased Calcium Elevated/NL PO4
Secondary hyperparathyroidism - Renal insufficiency (causes decrease production of 1-25 dihydroxyvitamin D) - Calcium deficiency - Vit D deficiency
61
Decreased PTH Increased Calcium Nl/Decreased Po4
Ectopic PTHrP
62
Cushing syndrome vs Cushing disease
Cushing syndrome - Too much cortisol Cushing disease - Too much cortisol from an ACTH producing pituitary adenoma - Low dose dexamethasone= remains elevated - Suppressed with high dose
63
Acromegaly diagnosis Tx Complication
IGF-1 levels (increased) Confirm w/ oral glucose supression test (GH levels will remain elevated despite glucose administration) Tx: Transphenoidal surgical resection Octreotide or lanreotide (somatostatn analogues) suppress GH secretion Pegvisomant (GH receptor antagonist) block peripheral actions of GH CHF leading cause of death
64
Hyperprolatinemia tx
Dopamine agonists - Cabergoline - Bromocriptine Resection if >= 3 cm
65
Diabetes insipidus MOA Diagnosis
Cant concentrate urine due to ADH dysfunction Central: Posterior pituitary fails to secrete ADH Nephrogenic: ADH resistance - Renal disease - Lithium - Demeclocycline Water deprivation test fails Desmopressin acetate replacement test (DDAVP) - Central: Decrease urine output increase urine osm - Nephr: NO effect
66
SIADH Tx
Inappropriate ADH secretion Tx: Fluid restriction If severe ADH antagonists - Tolvaptan - Conivaptan Chronic SIADH: Demeclocycline
67
Low cortisol | Increased ACTH
Primary adrenal insufficency Skin pigmentation Decreased glucocorticoids Decreased minerlocortcioids
68
``` HTN Headache Polyuria Muscle weakness Hypokalemia ``` Tx
Hyperaldosteronism Tx: - Adenoma: resection - Bilateral hyperplasia: aldosterone receptor antagonist (eplerenone)
69
Elevated 17-hydroxyprogesterone
21-hydroxylase deficiency Fluid resuscitation Salt repletion Give Cortisol to decrease ACTH and adrenal androgens FLudrocortisone if severe
70
Precocious puberty in male | Salt wasting
21 hydroxylase
71
Female: Virilization | Increased renin activity
21 hydroxylase
72
Female virilzation Decrease Renin activity Decreased aldosterone Increase BP
11beta-hydroxylase
73
Fmale virilzation Ambiguous external genitalia NO electrolyte or BP abnromalities
Congenital aromatase deficiency
74
MEN 1
Pancreas Pituitary Parathyroid Gastrinomas/ Insulinomas
75
MEN 2A
Medullary carcinoma of thyroid Pheochromocytoma or adrenal hyperplasia Parathyroid gland hyperplasia RET proto-oncogene
76
MEN 2B
Medullary carcinoma Pheochromocytoma Oral and intestinal ganglioneuromatosis (mucosal neuromas) Marfanoid habitus RET proto-oncogene
77
Basal cell carcinoma margins
Surgical excision with narrow margin
78
Eczema Nonblanching purple lesions on buttocks and thighs Pain w/ passive range of motion of hips Abdominal pain Also see
Henoch Schonlein purpura Hematuria followed by mild proteinuria
79
Elevated Ca | Low Phos
Decreased secretion of PTH
80
Elevated BUN Elevated Creatinine Hypercalcemia Polyuria Polydipsia
Milk-Alkali syndrome Excessive intake of calcium and absorbable alkali Antiacids (Calcium carbonate) for heart burn
81
``` Hypercalcemia WL Temporal wasting Low phos Increased Creatinine Increased Alk phos ```
Elevated PTHrP Hypercalcemia of malignancy
82
Irregular periods | Coarse hair on chin
Polycystic ovary syndrome Give OCP
83
Musty odor Dx
Pheylketonuria AR Mutation in phenylalanine hydroxylase Dx: Quantitative amino acid analysis (increased pheylalanine levels)
84
Infant given Fruits and vegetables Vomiting Poor feeding Lethargy Seizures
Aldolase B deficiency Hereditary fructose intolerance
85
First few days of life Jaundice Hepatomegaly Failure to thrive after consumption of breast milk or formula
Galactosemia Absence of galactose-1 phosphate uridyl transferase
86
Forced flexion of wrist when taking blood pressure Hyperreflexia
Hypocalcemia
87
Hemorrhage during labor Unable to breast feed ACTH Serum Na Serum K
Sheehan syndrome Adrenal insufficiency Cortisol deficiency Cortisol normally inhibits ADH —> SIADH and hyponatremia Adrenal cortex not affected, aldosterone synthesis unaffected, potassium is normal
88
Craniotabes (skull bones that depress w/ pressure) Widened wrists Delayed fontanel closure Swelling of wrist
Rickets Vit D deficiency
89
Fontanel closure
9-18 months from anterior fontanel to close
90
HTN Hemangioblastomas Painless vision loss Headaches Father has hearing impairment and intracranial hemorrhage Cause of HTN
Von Hippel Lindau disease Pheochromocytoma
91
Episodic flushing Wheezing Diarrhea Murmur Risk of deficiency of
Carcinoid syndrome Tricupsid regurgitation Niacin deficiency Dx: 5-HIAA CT/MRI of abdomen and pelvis for tumor Ocetreotide prior to surgery
92
Started breast feeding and then vomiting Jaundice Hepatomegaly Ecoli infxn Elevated liver enzymes Conjugated hyperbilirubinemia
Galactosemia GALT deficiency Inability to metabolize galactose to glucose AR Cataracts
93
Inadequate NADPH production for oxidative injury protection
G6PD deficiency Jaundice Hemolytic anemia Liver enzymes normal
94
Loss of function mutation in the WAS gene
Wiskott-Aldrich syndrome Recurrent infxn Eczema Thrombocytopenia
95
Mutation in proteins linking the red blood cell membrane to its cytoskeleton
Spherocytosis Jaundice Hemolytic anemia Increased MCHC
96
Single amino acid substitution within the beta globin chain
Sickle cell disease Hemolytic anemia
97
Exercise on glucose
Exercise increased uptake of glucose Exercise induced hypoglycemia If diabetic need to reduce insulin dose
98
Prolactinoma 1.5 cm
Prolactin level > 200 ow LH Normal TSH
99
Tx Tinea pedis
Miconazole cream
100
Cephalexin is for
Cellulitis
101
Triamcinolone
Topical corticosteroid Tx acute contact dermatitis
102
Nystain used for
Candida infections
103
Primary polydipsia vs Diabetes insipidus
Primary polydipsia - low Na and dilute urine Diabetes insipidus > Na w/ dilute urine
104
Tx Ring worm
Topical antifungals (clotrimazole, terbinafine)
105
Tx Bartonella henselae
Cat scratch Azithromycin
106
HTN Undetectable plasma renin level Hypokalemia
Primary hyperaldosteronism Hypernatremia Metabolic alkalosis
107
Upper lip cancer
Basal
108
Lower lip cancer
SCC
109
Blisters on back of hands after being in sun Untreated Hep C
Porphyria cutanea tarda Disorder of heme synthesis Painless blisters taht heal w/ scarring Increased skin fragility Triggered by ethanol and estrogen Tx Phlebotomy or hydroxychloroquine
110
Sweating Headache Tremor Palpitation Confused
Insulin excess Hypoglycemia
111
Acanthosis nigricans associated with
DM Obesity Polycystic ovarian syndrome
112
Young patient w/ HTN Mass on left adrenal gland Renin level Aldosterone Bicarbonate
Conn's syndrome Primary hyperaldosteronism Low renin Elevated aldosterone High bicarb
113
Dark patch with hairs on infant
Congenital melanocytic nevus (CMN)
114
Congenital dermal melanocytosis
Mongolian spots
115
``` WG Muscle weakness HTN Easy bruising Hyperpigmentation Dark hair on upper lip/chin ``` Acne
Cushing syndrome Key features - Muscle weakness - Bruisability
116
DM leads to what neuronal problems
Sensorimotor polyneuropathy Small fiber - positive symptoms - Pain - Paresthesia - Allodynia Large fiber - Negative symptoms - Numbness - Loss of proprioception - Loss of vibratory sense - Diminished ankle reflexes
117
Salt craving Reduced body hair
Primary adrenal insufficiency (Addison disease) Stimulation testing w/ cosyntropin Low production of cortisol following cosyntropin administration= PAI
118
Precocious puberty check what
Bone age
119
HTN Impaired fasting glucose Dyslipidemia
Metabolic syndrome Central abdominal fat distribution Insulin resistance
120
Tx Hair loss
Men - Minoxidil - Finasteride Women - Moinoxidil
121
Diabetic gastroparesis Tx
Nausea Vomiting Early satiety Postprandial fullness Tx: Metoclopramide
122
What is reduced in DKA
Total body potassium
123
Acne Hair loss Get what test
Polycystic ovary syndrome Oral glucose tolerance test
124
Normal TSH Low T3 T4 Erectile dysfunction
Chronic liver disease T3 T4 produced in liver
125
Mycosis fungoides
Hypopigmented rash on trunk Severe pruritus Presentation less acute Lesions relapse and remit over time regardless of sun
126
``` Hyperglycemia Cant lose weight Muscle weakness HTN Depression ```
Cushing syndrome Overnight low-dose dexamethasone suppression test
127
1) Early morning cortisol 2) Overnight low-dose dexamethasone suppression test 3) Serum ACTH 4) Serum aldosterone to plasma renin activity ratio 5) Serum testosterone level
1) Early morning cortisol will be low in patients with primary adrenal insufficiency 2) Overnight low-dose dexamethasone suppression test to identify cushing syndrome 3) Serum ACTH measured to determine if ACTH-dependent hypercortisolism (cushing disease, ectopic ACTH) or ACTH-independent (adrenal adenoma) 4) Serum aldosterone to plasma renin activity ratio used to evaluate priamry hyperaldosteronism (HTN, hypokalemia) 5) Serum testosterone level to check hyperandrogenism
128
Evaluating precocious puberty
1) Check bone age 2) Check LH level - If high= central precocious puberty 3) If Low, check GnRH stimulation test - If increased w/ stimulation= central precocious puberty 4) If Low LH after stimulation= peripheral precocious puberty Peripheral precocious puberty - nonclassic congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency Central precocious puberty (gonadotropin-dependent) - idiopathic precocious puberty (premature activation of hypothalamic-pituitary-gonadal axis) - pituitary microadenomas [Have High LH]
129
Precocious puberty Hypopigmented patches Fibrous dysplasis of bone
McCune-Albright syndrome
130
Maternal hx of graves disease Low birth weight Tachycardia Irritable Warm skin - Name - MOA - Tx
Neonatal thyrotoxicosis Transplacental passage of anti-TSH receptor antibodies Tx: Methimazole plus beta blocker Resolves in wks
131
Polyarteritis nodosa
Nodular lesions resembling erythema nodosum Associated with fever, arthralgias, WL Renal insufficiency Abdominal pain
132
Elevated T4 Normal TSH Fatigue Anxiety Normal thyroid Normal vitals OCP use
Normal thyroid function with estrogen induced increase in T4 binding globulin
133
Things that increase thyroid binding globulin
Estrogens - Pregnancy - OCP - Hormone replacement therapy - Estrogenic medications (ttamoxifen) Acute hepatitis
134
Things that decrease thyroid binding globulin
Androgenic hormones High dose glucocorticoids/ hypercortisolism Hypoproteinemia (nephrotic syndrome, starvation) Chronic liver disease
135
Displacement of thyroid hormones from binding proteins
Normal hypothalamic pituitary feedback, displace of T4 leads to decreased thyroid hormone production Low T4 Normal free hormone levels Medication that cause this - Salicylates - furosemide - heparin
136
Urine albumin-creatinine ratio
< 30 30-300 moderately increased albuminuria Diabetic nephropathy Give ACE-I
137
Toxic adenoma
Single hot spot Hyperthyroidism
138
Congential hypothyroidism
Thyroid dysgenesis - asplasia - hypoplasia - ectopic gland [Not transplacental TSH-receptor Ab or defect in synthesis of T4]
139
Firm Hyperpigmented nodule Lower extremities Dimpling in center when pinched
Dermatofibroma
140
Dome shaped firm moveable nodule Small central punctum No drainage
Epidermal inclusion cyst
141
``` Weakness WL Hyponatremia Hyperkalemia Normal cortisol ``` Reduced appetite Intermittent diarrhea Hypotension
Primary adrenal insufficiency (Addison disease) Measure ACTH
142
Small papules and pustules Erythematous rash on checks and chin waxes and wanes Tingling sensation after sun exposure Tx
Papulopustular Rosacea Tx: Topical metronidazole Azelaic acid Ivermectin
143
Flushing cheeks Dilated blood vessels in cheeks Erythematous
Erythematotelangiectatic rosacea Topial brimonidine Laser/ intense pulsed light therpay
144
18 month old Vaccinated Fever Facial rash - numerous painful clear vesicles over erythematous skin on both cheeks Scattered lesions with overlying dark red crusting Submandibular lymphadenopathy
Herpes simplex virus Atopic dermatitis Eczema herpeticum Hemorrhagic crusting Acyclovir tx
145
Graves tx that worsen proptosis and swelling of periorbital tissues
Radioactive iodine —> increases levels of thyrotropin receptor antibodies (TRAB) Which can worse ophthalmopathy Tx: Give glucocorticoids w/ RAI
146
Pruritic rash on back Unrelenting for months Antihistamines not help Flat irregular plaques Purple/pink - Name - Assoc with (3) - Tx
Lichen planus Associated with - Hep C - ACE-I - Thiazide Tx: High potency glucocorticoids (betamethasone)
147
Pityriasis rosea
Herald patch Outbreak macules and papules across neck, trunk and proximal limbs Resolves 4-6 weeks
148
Chronic skin condition Little red bumps over posterior arms
Keratosis pilaris (IP) retained keratin plugs in hair follicles
149
Miliaria
Heat rash Due to blocked eccrine sweat ducts
150
Pseudofolliculitis
Ingrown hair
151
Acne Tx Develops sun sensitivity
Doxycycline (Tetracycline)
152
Infant ambiguous genitalia Elevated testosterone 46, XX - Na - K - Glucose
Congenital adrenal hyperplasia AR 21- hydroxylase deficiency Salt wasting syndrome Decreased Na Elevated K Decreased Glucose [Not seen till 1-2 wks] Elevated 17-hydroxyprogesterone [17-OHP is converted to testosterone in peripheral tissues]
153
Infant ambiguous genitalia Normal testosterone If masculinize at puberty
5-alpha reductase deficiency
154
Lack of menarche Breast tissue vagina ends in blind pouch 46 XY
Androgen insensitivity syndrome Elevated testosterone, estrogen, and LH
155
Virilization of fetus and mother
Placental aromatase deficiency
156
6 months after birth first 2-3 months had anxiety and worried frequent Now fatigued and irritable Constipation
Postpartum thyroiditis
157
Well demarcated depigmented macules on face and distal extremities Associated with
Vitiligo Associated with other autoimmune conditions
158
Pulmonary embolism effect on calcium
PE —> hyperventilation and respiratory alkalosis Hypocalcemia - crampy pain - paresthesias - carpopedal spasm Increase in extracellul pH from respiratory alkalosis causes hydrogens to dissociate from albumin free albumin to bind w/ calcium Increased affinity of albumin for calcium —> decreased levels of ionized calcium
159
Hyperosmolar hyperglycemic state
Hyperventilation Increase in serum osmolality with little to no keronemia or acidosis Normal or mildly elevated potassium level due to insulin deficiency and hyperosmolality But have total body potassium deficit due to excessive urinary loss Insulin therapy for HHS can shift potassium back into cells —> abruptly lowering K levels —> severe hypokalemia
160
Tense bullae Parkinson disease Linear IgG and C3 deposits
Bullous pemphigoid Tx Topcial clobetasol IgG autoantibodies against hemidesmosomes
161
Celiac sprue Bone pain Increased PTH Increased Alk Phos Decreased Ca Decreased Phos
Osteomalacia Impaired osteoid matrix mineralization
162
Osteoporosis characterized by
Low bone mass Bone has adequate mineralization Normal - Ca, Phos, PTH, Alk phos
163
Hyperprolactinemia | -Risperidone vs pituitary adenoma
Risperidone has no effect on TSH level
164
High PTH Normal Ca Low Phos
Vit D deficiency
165
Pediculosis capitis
Head lice
166
Telogen effluvium
Diffuse hair loss (not patchy) Emotional distress
167
High serum osmolaity Urine studies show low osmolality Specific gravity
Diabetes insipidus Specific gravity < 1.006
168
Scaly annular plaques that come together to form giant plaque Potassium hydroxide microscopy shows segmented hyphae
Dermatophyte infection (Tinea corporis) Check for HIV, DM, or glucocorticoid use
169
Red papules yellow hard growth coming out of it Painful Rapid growth
Keratoacanthoma
170
Flat topped itchy violet papules
Lichen planus
171
Cradle cap
Seborrheic dermatitis
172
Antibodies to thyroid peroxidase (TPO)
Hastimoto thyroiditis
173
Stones, bones, groans and psychiatric overtones
Hypercalcemia
174
HTN Hypokalemia Metabolic alkalosis
Primary Hyperaldosteronism
175
Patient presents with weakness, nausea, vomiting, WL, and new skin pigmentation Lab results show hyponatremia and hyperkalemia
Primary adrenal insufficiency (addison) Tx Glucocorticoids Mineralocorticoids IV fluids
176
Tx DKA
Fluids Insulin Electrolyte repletion (K+)
177
Bone pain Hearing loss Increased Alk phos
Paget disease
178
Dermatitis herpetiformis Assoc with Tx
Associated with celiac Dapsone Gluten free diet
179
Chronic scaly irregular plaques with ulceration Central hypopigmentation surrounded by hyperpigmentation
Discoid lupus erythematous
180
Patchy nonscarring hair loss Itches before falls out
Alopecia areata Tx: Intralesional triamcinolone (corticosteriods)
181
Tx Tinea versicolor
Selenium sulfide lotion
182
Nummular eczema
Coin shaped lesion Tx Topical glucocorticoids
183
Acute diffuse, noninflammatory hair loss Hair loss in audlt > 20 % fibers are pulled out
Telogen effluvium Self limiting
184
Androgenetic alopecia
Uneven hair loss Men have thinning at the frontotemporal hairline and vertex
185
Trichorrhexis nodosa
Fragility of hair with breaking of strands
186
Pruritic rash on feet Hyperkeratosis and flaking
Tinea pedis Miconazole Tolnaftate
187
Discrete firm hyperpigmented nodule < 1 cm in diameter Dimpling in center
Dermatofibroma Cryosurgery or shave excision
188
Persistent facial erythema/ flushing Telangiectasias Worsen with alcohol
Rosacea
189
Staphylococccal scalded skin syndrome
Seen in children <6
190
Psoriasis caused by
HIV Glucocorticoid withdrawal Antimalarials Indomethacin Streptococcal pharyngitis
191
Thickening of toe nails
Onychomycosis Risk factors - Advanced age - Tinea pedia (Trichophyton rubrum) - Diabetes - Peripheral vascular disease Tx: Terbinafine, itraconazole
192
Tx acne
Topical retinoids Benzoyl peroxide Add Antibiotics - Erythromycin - Clindamycin If becomes cystic: oral isotretinoin
193
Facial tumor Hypopigmented lesion
Tuberous sclerosis Facial angiofibromas
194
Ichthyosis vulgaris
Diffuse dermal scaling Mutations in filaggrin gene
195
Toxic adenoma with hyperthyroidism is left untreated at risk for
Hyperthyroidism can develop rapid bone loss Leading to osteoporosis
196
N/V Constipation Hypercalcemia Low PTH Cr 1.9 Glucose 180 Normal 25- hydroxyvitamin D 1,25- dihydroxyvit D (normal)
Hypercalcemia of malignancy
197
WL Nausea Abdominal pain Postural dizziness Prednisone for asthma Hypotension Tonsillar enlargments Hyperpigmentation Vitiligo Hyponatremia Hyperkalemia Eosinophilia Low serum cortisol
Autoimmune adrenalitis Primary adrenal insufficiency
198
Hyperosmolar hyperglycemic state (HUS) tx
NS IV insulin Potassium
199
Painless muscle weakness WG Bone loss HTN Hirsutism
Cushing syndrome Hypercortisolism —> Muscle atrophy
200
Low serum cortisol Abnormal ACTh Hyperpigmentation
Primary adrenal insufficiency Tx Hydrocortisone If continue to have deficiency then add Fludrocortisone
201
Tx Orthostatic HTN
Midodrine
202
Adrenal mass Hirsutism Virilization ( clitoromegaly Acne, facial hair on woman
High androgen levels due to androgen producing neoplasm Elevated DHEA Elevated testosterone Low LH
203
WL Anemia Glucose 176 Erythematous plaques with central clearing and eroded border on the right thigh Painful pruritic rash Watery stools
Glucagonoma Necrolytic migratory erythema
204
HTN Hypokalemia Check what
Plasma aldosterone/ renin ratio If elevated check adrenal suppression test If positive get adrenal imaging [Suspected primary hyperaldosteronism]
205
Dexamethasone suppression test
Can diagnose Cushing syndrome
206
Cosyntropin stimulation testing
Adrenal insufficiency
207
How to monitor resolution of DKA
Monitor anion gap Looking for it to normalize
208
Causes of myopathy (7)
Polymyositis/ dermatomyositis Hypothyroidism Thyrotoxicosis Cushing syndrome Electrolytes (decreased K, Ca, Phosphorous) Corticosteriods Statins
209
45 y.o Myalgias Proximal muscle weakness Elevated creatine kinase level Reduced DTR What test?
Hypothyroid myopathy TSH/ Free T4 If normal chest ANA and muscle biopsy
210
Correct calcium level due to low albumin Ca 7.5 Albumin 2.2
Correct Ca= (measure calcium) + 0.8 (4.0- serum albumin) Ca= 7.5 + 0.8( 4-2.2) = 8.94 Hypocalcemia due to hypoalbuminemia
211
25-hydroxylation of vit D occurs
In liver
212
1-alpha- hydroxylation occurs
in kidney
213
Irregular menses Every 2-3 months Heavier bleeding Difficulty concentrating at work Irritable Depressed mood FSH TSH Prolactin
Low FSH High TSH High Prolactin Hypothyrodism Disruption of hypothalamic pituitary ovarian axis
214
24 y.o with lump in neck TSH and calcium normal Calcitonin is elevated U/S biopsy shows malignancy What following test to get?
Plasma fractionated metanephrine assay To rule out MEN If positive, RET mutation testing and screening for pheochromocytomas with plasma fractionated metanephrine (can cause life threatening hypertensive crisis)
215
Urine albumin/ creatinine ratio
Normal < 30 If elevated (30-300) then add ACE-I
216
Testing for acromegaly
1. Check IGF-I level 2. If elevated check oral glucose suppression test 3. If inadequate GH suppression get MRI brain
217
Proximal muscle weakness Anxiety Tachycardia WL Muscle atrophy
Chronic hyperthyroid myopathy
218
Approach to hypocalcemia
1. Low serum calcium - correct for serum albumin 2. Is magnesium level low? 3. PTH
219
Physiologic defense against hypoglycemia
1. Decrease insulin - Decrease peripheral glucose utilization - Increase hepatic gluconeogenesis and glycogenolysis 2. Increase Glucagon - Increase hepatic gluconeogenesis and glycogenolysis 3. Increase Epinephrine - Increase hepatic gluconeogenesis and glcogenolysis - Increase mobilization of gluconeogenic substrates 4. Increase cortisol and growth hormone - Alters transcription of many genes to conserve glucose Results in decreasing blood glucose level
220
Patient with diabetes and chronic pancreatitis resulting in adult onset cystic fibrosis
Lose glucagon secreting alpha cells Risk for insulin induced hypoglycemia
221
Adrenal mass on imaging Abdominal pain HTN Hypokalemia Mild Hypernatremia Elevated plasma aldosterone/plasma renin level Refuses surgery, what medication to give
Primary hyperaldosteronism Aldosterone antagonists - Spironolactone - Eplerenone Surgery (if unilateral)
222
DKA vs thyrotoxicosis
DKA - Hyperglycemia - Low bicarb Increased anion gap metabolic acidosis Thyrotoxicosis - Hyperglycemia - Normal bicarb - Palpitations, WL
223
Thyroid storm caused by
Thyroid or non thyroid surgery Acute illness (trauma infection) Childbirth Acute iodine load (iodine contrast)
224
DM on metformin HTN and previous MI What medication to add (2) MOA Effect SE
Option 1: Canagliflozin Empagliflozin [SGLT-2 inhibitors] Increased urinary glucose excretion (blocks PT glucose reabsorption) also increase Na excretion Induce WL Slow progression of albuminuria AE: genitourinary tract infections Option 2: GLP-1 receptor agonists - Semaglutide - Liraglutide Slows gastric emptying, suppressing glucagon secretion and increases glucose-dependent insulin release SE: Gi disturbances Pancreatitis
225
Hyperthyroidism vs thyrotoxicosis
Hyperthyroidism: characterized by increased thyroid hormone synthesis and secretion from thyroid gland Thyrotoxicosis: clinical syndrome of excess circulating thyroid hormones, irrespective of source
226
HTN in patient with hyperthyroidism due to
Increased myocardial contractility Decrease in systemic vascular resistance (BP rises due to positive inotropic and chronotropic effects)
227
Hypercalcemia of malignancy labs
Hypercalcemia > 14 Suppressed PTH level
228
``` Crohn disease Proximal muscle weakenss Osteopneia Bone pain Pseudofractures ``` Ca Phos PTH
Osteomalacia Reduced mineralization of osteoid at bone forming sites Common in malabsorptive disorders Chronic deficiency of Vit D Low Ca High PTH Low Phos
229
Menopause Hypothyroidism on Levothyroxine Addition of estrogen effect of thyroid
Requirement for L-thyroxine would increase Increase dose Oral estrogen decreases clearance of thyroxine binding globulin leading to elevated TBG levels [If normal thyroid can readily increase thyroxine production to saturate TBG binding sites, if not results in decreased free thyroxine and increased TSH]
230
Hypotension Hyperpigmentation in palmar crease Labs
Primary adrenal insufficiency (autoimmune adrenalitis) Addison disease Cosecretion of melanocyte stimulation hormone with ACTH Hyperkalemia Hyponatremia Low morning cortisol High ACTH
231
Hyperpigmentation
Cushing's syndrome - HTN or Primary adrenal insufficiency - Hypotension
232
Foul smelling diarrhea, WL, fatigue
Steatorrhea and malabsorption Steatorrhea prevents usual fat emulsification and disrupts chylomiron mediated absorption of Vit D Vit D deficiency Mediated Ca and phos reabsorption
233
Diagnosis of hypercalcemia
1. Correct albumin concentration 2. Measure PTH level 3. If suppressed, measure PTHrP, 25-hydroxyvit D, and 1,25dihydroxyvitD
234
Male Loss of sexual desire and failure to attain erections Intermittent bilateral hand pain DM Peripheral neuroapthy Has a child Small testes Sensation decreased in both ankles What next step?
Hereditary hemochromatosis Excessive absorption of iron and deposition of iron in tissues ``` Hyperpigmentation Arthropathy Hepatomegaly HCC DM Hypogonadism Hypopituitarism ``` Elevated liver transaminases Elevated ferritin, transferrin saturation Tx Phlebotmy if ferritin > 1000
235
thin habitus Dry skin Excoriation of forearms Pitting edema of ankles Distended abdomen Hypotension BMI 17 Also see?
Anorexia nervosa Decreased bone mineral density
236
Antimitochondrial Ab
Primary biliary cholangitis Fatigue Pruritus Elevated Alk phos
237
Recurrent miscarriage Enlarge non tender firm thyroid gland High TSH Normal T4 What antibody
Chronic lymphocytic thyroiditis (Hashimoto) Antithyroid peroxidase (anti-TPO)
238
Anticardiolipin antibodies
Antiphospholipid antibody syndrome | SLE
239
Thyroid stimulating immunoglobulin
Graves
240
TSH receptor blocking antibody
Less common hypothyroidism than Antithyroid peroxidase Have thyroid atrophy (not enlargement)
241
Fatigue Weakness Decrease appetite ``` Cold intolerance Constipation Erectile dysfunction Low libido Skin dry and pale Testes small ``` Hypotension Bradycardia Delayed DTR Anemia Hyponatremia Hypoglycemia T4? Serum cortisol? Aldosterone?
Hypopituitarism ACTH deficiency - Postural hypotension - Tachycardia - Fatigue - WL - Hypoglycemia Hypothyroidism - Cold intolerance - Constipation - Dry skin - Bradycardia - Slowed DTR Gonadotropins - Loss libido Low free T4 Low Cortisol and ACTH Low FSH, LH and testosterone Aldosterone not affected
242
Watery diarrhea Flushing N/V Muscle weakness/cramps Hypokalemia Hyperglycemia Mass at pancreatic tail
VIPoma
243
VIPoma vs carcinoid syndrome
Flushing Diarrhea Carcinoid - small intestine VIPoma - pancreas
244
Heat intolerance Increased appetite WL Enlarged nontender thyroid Free T4 increased Total T3 increased Low TSH Radioactive iodine uptake <5% (normal 8-25%)
Painless thyroiditis Brief hyperthyroid phase Small nontender goiter Spontaneous recovery +TPO antibody (seen in hashimoto) Low radioiodine uptake
245
Struma ovarii symptoms
Pelvic mass Ascites Abdominal pain Thyroid not enlarged
246
Acromegaly seen on 1) Echo 2) Pulm (2) 3) GI (2) 4) Enlarged organs (7) 5) Endocrine (5)
1. Echo: Concentric left ventricular hypertrophy (Heart failure, arrthymias) 2: Pulm: Sleep apnea, narcolepsy 3. GI: Colon polyps/cancer, diverticulosis ``` 4. Enlarged organs: Tongue Thyroid Salivary glands Liver Spleen Kidney Prostate ``` ``` 5. Endocrine Galactorrhea Decreased libido DM Hyperparathyroidism Hypertriglyceridemia ```
247
Fatigue WG Mild HTN Elevated lipids Check what
Hypothyroidism Check serum TSH Hypothyroidism causes decreased LDL turnover due to decreased expression of LDL receptors —> elevated circulating levels of total cholesterol and LDL Decreased activity of lipoprotein lipase —> hypertriglyceridemia [If untreated hypothyroidism and statin started —> statin myopathy, can cause worsening on hypothyroid myopathy]
248
Propylthiouracil Methimazole SE
Agranulocytosis - Occurs in 90 days - WBC < 1000 discontinu eddrug
249
Hyperthyrodism Given propylthiouracil Two weeks later complains of sore throat Fever Tonsils are red and swollen Do what?
Discontinue propylthiouracil Agranulocytosis*
250
Intense glycemic control (A1c between 6-7%) with insulin reduces risk of
Retinopathy | Nephropathy
251
Urine osm > 600
Primary polydipsia
252
Demeclocycline
Tx SIADH Inhibits ADH mediated aquaporin insetion in the CT and helps dilute urine
253
Tolvaptan
V2 vasopressin receptor antagonist Causes selective water loss in the kidney without affecting sodium or potassium excretion Cost SE: increased liver enzymes Reserved for significant hypervolemic (due to heart failure) or euvolemic (SIADH) hyponatremia that doesnt improve with fluid restrictions
254
Immunocompromised Erythematous and edematous lesions that develops into a bulla surrounded by erythema Bulla ruptured and left painless ulcer with black center Organism
Ecthyma gangrenosum P aeruginosa
255
Subepidermal blisters
Bullous pemphigoid
256
Long term HTN Leg cramps Tx
Primary hyperaldosteronism Tx Aldosterone antagonists - Spironolactone - Eplerenone
257
39 y.o progressive muscle weakness. Difficulty combing hair. 20 lb weight gain, irregular menses with vaginal dryness and low libido. HTN, hyperlipidemia and seasonal allergies. Oily facial skin with prominent acne and scattered bruises on her arms and lower legs. Abdomen is obese soft and nontender. Elevated K Elevated Bicarb Hyperglycemia
Cushing syndrome Hypercortisolism High level of ACTH —> increase androgen production from the zona reticularis of the adrenal cortex —> androgenic symptoms (irregular menses, acne)
258
DKA caused by A. Fatty acid breakdown in the liver B. Glycogenolysis in the skeletal muscles C. Impaired bicarbonate reabsorption in the Proximal renal tubules D. Impaired urine acidification in the distal renal tubules E. Increased renal excretion of ketoacids F. Peripheral lipolysis due to decreased catecholamine levels
A. Fatty acid breakdown in the liver Insulin deficiency —> increased lipolysis of peripheral fat stores due to high catecholamine levels Fatty acids are delivery to the liver and broken down into ketones Ketone accumulation responsible for clinical manifestations of DKA

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