Exam 2 -- Randomized List of All Exam 2 Flashcards
1
Q
What percentage of pituitary tumors secrete prolactin?
A
60%
2
Q
What is the treatment for hypothyroidism?
A
Fasting L-thyroxine (before breakfast)
3
Q
Chronic adrenal insufficiency is also known by what name?
A
Addison’s disease
4
Q
True or false: permanent remission of Graves’ disease occurs in more than half of patients after discontinuance of methimazole
A
False; 20-30% experience remission
5
Q
Regular insulin has fast action and can be administered IV. Regular insulin preparations have what in common to their names?
A
“R” – Humulin R, Iletin Regular, Novolin R
6
Q
Hypertension caused by _____________ and ______________ is curable by surgery. (Name the two conditions.)
A
Primary hyperaldosteronism; pheochromocytoma
7
Q
Which gender has a higher prevalence for AML? What factors are associated with its development?
A
Male; development is thought to be associated with chemical exposure and genetics
8
Q
Pernicious anemia is a type of macrocytic anemia. What is the underlying issue in this disease?
A
Loss of intrinsic factor (secreted during digestion; important for vitamin B12 absorption)
9
Q
All of the factors involved in the coagulation cascade are synthesized in the liver except one. Which is it, and where is it synthesized?
A
Von Willebrand Factor, which is synthesized in the blood vessel lining
10
Q
How would levels of VWF and factor VIII be a patient with Von Willebrand Disease?
A
Both would be low
11
Q
Immediately after radioiodine treatment, TSH receptor antibody concentrations initially _________ (rise/fall)
A
Rise, potentially making the orbitopathy appear worse
12
Q
What are a couple of causes of neutrophilia?
A
Smoking*, inflammation (gout, RA)
13
Q
Use of dopamine agonists to treat acromegaly is most effective in what type of tumors?
A
Tumors that secrete GH and prolactin
14
Q
True or false: medical therapy for acromegaly is as effective as transsphenoidal adenectomy
A
False.
15
Q
In AML, what are the myeloid precurors unable to do?
A
Mature, leading to accumulation of those immature forms.
16
Q
If intracellular glucose levels get high enough that they overwhelm the Krebs cycle, how is the glucose used?
A
It goes down the polyol pathway, in which it is converted by aldose reductase to sorbitol and fructose
17
Q
How long do RBCs live?
A
About 120 days
18
Q
Vitamin C deficiency (aka scurvy) takes how long to develop? How quickly can it resolve if the deficiency is resolved?
A
4-8 months to develop, days to weeks to resolve
19
Q
What is the treatment for iron deficiency anemia?
A
Oral iron supplement (ferrous sulfate, 100-200 mg/day)
20
Q
Suppose you were to call pheochromocytoma the 90% tumor. What would that mean?
A
90% of pheochromocytomas are benign, 90% are unilateral, 90% occur in adults
21
Q
What factors stimulate platelet secretion?
A
ADP, serotonin, fibrinogen, thromboxane A2, growth factors
22
Q
Why does hyperaldosteronism cause hypertension and hypokalemia?
A
Aldosterone causes sodium (and hence water) retention, increasing blood pressure. Whenever more sodium is retanied, less potassium is kept.
23
Q
True or false: Hashimoto’s thyroiditis is the most common cause of hypothyroidism in iodine-deficient populations
A
False; it is the most common cause of hypothyroidism in iodine-sufficient populations
24
Q
What are some consequences of cell sickling?
A
Reduced RBC life, impaired RBC circulation, infection, vaso-occlusive crisis
25
Von Willebrand Factor participates in platelet adhesion to damaged endothelium. It also stabilizes which coagulation factor?
Factor VIII
26
What is the treatment of choice for Cushing's disease?
Transsphenoidal adenectomy
27
Which hormones are secreted by the adrenal cortex?
Glucocorticoids (cortisol), mineralocorticoids (aldosterone), adrenocortico androgens (testosterone)
28
How would you treat a DVT or a pulmonary embolism?
Mobilization, elevate legs, use compression stockings, anti-coagulation meds
29
What sort of testing can be done for ALL?
CBC (looking for increased lymphoblasts); genetic testing
30
Starting with the pronormoblast, list the stages of development of an erythrocyte (RBC).
Pronormoblast-->Normoblast, which then expells its nucleus and is released from the bone marrow and becomes a-->Reticulocyte, which circulates for a couple of days until it is finally a mature-->Erythrocyte
31
Tissue insulin resistance could be due to what factors?
Decreased number of insulin receptors, or malfunctioning insulin receptors.
32
Renal failure is secondary only to what other condition as a cause of death in diabetic patients?
Myocardial infarction
33
Which gender and age group has a higher prevalence for ALL?
Males 2-5 years
34
How would you treat Hodgkin's lymphoma?
Chemotherapy and radiation
35
What percentage of Cushing's syndrome patients also have diabetes mellitus?
20%
36
Before treating Graves' disease itself, what class of drug would you give to help relieve some of the patient's symptoms?
Beta blockers slow everything down. Heart rate goal is below 90 bpm if the blood pressure allows. Atenolol 25-50 mg/day.
37
True or false: adrenal carcinomas are usually inoperable due to metastasis
True.
38
What are some of the non-insulin actions a person can take to help manage diabetes?
Maintain good diet, take baby aspirin to decrease thromboxane activity, exercise, good sleep, treat depresesion, get HbA1c below 7%
39
What is a typical presentation of a patient with Burkitt's lymphoma?
Jaw or belly tumor, in a child
40
What factor is involved with platelet adhesion?
Von Willebrand Factor
41
Which gender is more affected by primary hyperparathyroidism?
Female
42
Hemophilia causes a decrease in which coagulation factor? Which pathway is this factor a part of?
Factor VIII; intrinsic pathway
43
What is the prognosis of a person with polycythemia vera if treated? If untreated?
10 years if treated, 6-18 months if untreated
44
What is a common cause of eosinophilia?
Parasitic infections
45
aPTT can be variable in a patient with Von Willebrand Disease. Why is this?
Enough factor VIII, even in the absence of VWF, can normalize aPTT measurements
46
How would you treat ALL?
Chemotherapy, radiation, stem cell replacement, leukapheresis, hydration, antibiotics; neutropenic diet; tyrosine kinase inhibitors for patients with Philadelphia chromosome (helps decrease lymphoblast production)
47
What is an example of a buccally-absorbing insulin preparation? What type of diabetes is it approved for?
Oral-lyn; approved for T1 and T2 DM
48
Hemoglobin has two formations -- T and R. Which formation has low affinity for oxygen?
T formation (Taut, or Tight, oxygen can't get in)
49
Suppose a patient with vitamin K deficiency has a PT and aPTT done. What would be the results of these tests?
PT would be high, aPTT could be high or normal
50
What testing can be done for CLL?
CBC looking for elevated lymphocytes; blood smear (showing no blasts with normal-looking lymphocytes
51
What are the clinical features of pheochromocytoma?
Abrupt elevation of blood pressure with heachache, sweating, palpitations, tachycardia, tremor, and sense of apprehension, increased risk of stroke, cardiomyopathy, insulin resistance, possible abdominal pain with nausea and vomiting
52
How would you treat polycythemia vera?
Hydroxyurea (severely reduced RBC production), remove blood, Jakafi
53
Nephropathy can cause capillary and glomerular changes, making the glomerulus leaky. What protein can be found in the urine as the first clinical sign of nephropathy?
Albumin. This is after significant renal damage has occurred.
54
What are some of the signs and symptoms of multiple myeloma?
Bone pain (70%)*, spinal cord compression, increase in osteoclasts*, hypercalcemia, renal failure, anemia (73%), neutropenia, thrombocytopenia, recurrent infections
55
What is the underlying issue in thalassemia?
No/few alpha or beta globin chains produced
56
Radioiodine ablation of the thyroid is achieved within what time period?
6 to 18 weeks
57
What sort of treatment of Graves' disease is used most commonly in the US?
Radioiodine ablation of the thyroid
58
Deep Vein Thrombosis (DVT) is when a thrombus occurs in a deep vein, often in the legs. If a fragment breaks from a DVT, where does it commonly end up?
Lungs
59
What factor is incorporated into a clot for later fibrinolysis (clot breakdown)?
Plasminogen; it breaks down the clot after being converted to plasmin
60
Thyroid neoplasms are not uncommon. What characteristics may indicate that a thyroid nodule is more likely to be neoplastic?
A solitary nodule that does not take up radioactive iodine in a younger male.
61
What causes acute adrenal insufficiency?
Sudden stress placed on a patient with chronic adrenal insufficiency, or sudden withdrawal of exogenous steroids.
62
What age is the peak incidence of Graves' disease?
Between 20 and 40 years
63
How would TSH, T3, and T4 levels be in a patient with primary hypothyroidism?
High TSH, low T3 and T4
64
What percentage of CLL arises from B cell proliferation?
95%
65
What is polycythemia vera?
Proliferation of RBCs and myeloid cells -- kind of the opposite of anemia
66
What are some ocular manifestations that can occur in sickle cell anemia?
Retinopathy ("sea fan"), retinal detachment, artery occlusions, fibrosis
67
What is the median age of onset for AML?
65 years
68
Hemoglobin has two formations -- T and R. Which formation has high affinity for oxygen?
R formation (Relaxed)
69
What are symptoms of a pulmonary embolism?
Shortness of breath, chest pain, cough.
70
What are the symptoms of hyperparathyroidism?
Painful bones, renal stones, abdominal groans (constipation, nausea, peptic ulcers, pancreatitis, gallstones), psychic moans (depression, lethargy, seizures). Nonspecific symptoms include fatigue, weakness, anorexia, mild depression, missed work
71
Anemia is defined as decrease in what?
RBCs or hemoglobin
72
The parathyroid glands release parathyroid hormone in response to what signal?
Low blood calcium levels
73
Suppose a patient with hemophilia has a PT and aPTT done. What would be the results of these tests?
aPTT would be high, PT would be normal
74
How much more common is peripheral vascular disease in diabetic patients compared to normal patients?
4X
75
What are the components of blood?
55% plasma (which is 90% water and 10% proteins), 44% RBCs, and 1% WBCs and platelets
76
There are a few varieties of neuropathies that can occur in diabetes. Which one involves loss of vibration, pain, temperature, and proprioception?
Symmetrical mainly sensory polyneuropathy (distal)
77
Along with AGEs and the polyol pathway, activation of protein kinase C is one of the mechanisms of complications due to diabetes. What is the result of activation of protein kinase C?
Increased endothelial proliferation, agniogenesis, and vascular permeability (production of VEFG)
78
Hyperpigmentation of the face, axillae, nipples, palms, etc., can occur in what conditions?
Adrenal insuffiency and ACTH-dependent Cushing's syndrome
79
What are a few surgical treatment options that are either available or may someday be availabe for diabetes?
Artificial pancreas, islet cell transplant into liver, stem cell generation of insulin cells, bariatric surgery for obese T2DM patients
80
What is the median age of onset for CLL?
70 years
81
What is an example of an ultra-long-acting insulin preparation?
Insulin degludec (DegludecPlus)
82
What would therapy for metabolic syndrome consist of?
Education, diet, and exercise, smoking cessation, control of blood pressure and FPG
83
What is a blast crisis in CML?
It's when blast cells can start showing up and causing problems. It occurs in a patient with CML if they go untreated for a long time. You'd want to treat a blast crisis as if this were an acute leukemia.
84
Although insulin resistance can be a factor in T2DM, what are other factors that may be in play?
Possible malfunction of GLUT (protein that transports glucose into the cell) or of PPAR (transporting glucose into the nucleus), impaired insulin secretion (the threshold to release insulin from the pancreas is higher; possible glucose-sensitive cells in hypothalamus are damaged)
85
True or false: pernicious anemia is common in the elderly
True.
86
Vitamin K is a fat-soluble vitamin needed in the coagulation process. It is involved with several coagulation factors (II, VII, IX, X). Which of these factors was mentioned in class as being more dependent on vitamin K than the others?
Factor VII (extrinsic pathway)
87
The clotting cascade, in a basic way, involves thrombin converting fibrinogen into fibrin. What are two cofactors important in this cascade?
Calcium and vitamin K.
88
What is the most common cause of Cushing's syndrome?q
Administration of exogenous steroids (iatrogenic)
89
Sideroblastic anemia can be caused by a genetic disorder or it can be acquired. What are some acquired causes of this disease?
AML, CML, isoniazid (TB medication), alcohol, lead toxicity, rheumatoid arthritis
90
The Philadelphia chromosome is a modified form of chromosome 22. What types of leukemia is the Philadelphia chromosome associated with?
CML (97% of CML patients); ALL (30-40% of ALL patients)
91
What are some causes of aplastic anemia?
Chemical exposure (benzene, toluene, glue sniffing), infection (hepatitis, TB, HIV), chemotherapy meds, pregnancy
92
What is the most common cause of chronic adrenal insufficiency?
Autoimmune adrenalitis
93
True or false: multiple myeloma is the most common hematologic malignancy.
False; it is the second most common hematologic malignancy
94
When and where does hemoglobin synthesis occur?
In mitochondria of developing RBC in the bone marrow
95
What is the mechanism of action for meglitinides? What benefits do they have as compared to sulfonylureas? When should they be taken? What do the names of the drugs in this class have in common?
They stimulate glucose from beta cells in a glucose-dependent manner; they are less likely than sulfonylureas to cause hypoglycemia (but just as likely to cause weight gain); should be taken 1 to 30 minutes before a meal; "glinides" -- repaglinide and nateglinide
96
Hypothyroidism is more common in which gender?
Female 8:1
97
What are some of the signs/symptoms of hemophilia?
Spontaneous bleeding, hemoarthrosis (blood in joint) potentially leading to joint deformiity and crippling
98
How would you treat pernicious anemia?
Oral or IM B12, folic acid supplement
99
B cells, T cells, and NK cells make up the lymphocytes. What is their function?
They respond to viral and bacterial infections; B cells create antibodies.
100
What is the mechanism of action for GLP-1 agonists? Which type of diabetes should it be used for? What are some examples of drugs in this class?
Slows gastric emptying, decreases glucagon release, stimulates insulin release; used for T2DM; "tide" drugs (exenatide, liraglutide, albiglutide) as well as Bydureon and Trulicity
101
Thalassemia is more common in what parts of the world?
Africa and the Mediterranean
102
CML is characterized by uncontrolled production of mature WBCs. What percentage of adult leukemias are CML?
About 15%
103
True or false: more than half of non-traumatic amputations are on diabetic patients
True.
104
What sorts of issues can cause vitamin K deficiency?
Cirrhosis, alcohol OD or chronic alcohol use (things that affect the liver, since vitamin K is stored there)
105
What are later findings of Cushing's syndrome?
Truncal obesity, moon face, buffalo hump, decreased muscle mass/weakness, hyperglycemia, glucosuria, polydipsia, thinning of skin, acne, easy bruising, osteoporosis, hyperpigmentation (only if ACTH-dependent Cushing's), increased risk for infection, mental disturbances, hirsutism, cataracts
106
What role does tuberculosis have in the history of chronic adrenal insuffiency?
It used to account for the majority of cases but then decreased. It is now on the upswing again*
107
What two types of leukocytes make up the majority of WBCs? Which WBCs are least abundant?
Neutrophils and lymphcytes (B cells, T cells, and NK cells) make up about 90% of WBCs; basophils make up only 0.5%.
108
What age group has the highest incidence of T1DM?
10-14 years
109
Of the dopamine agonists used to treat prolactinoma, which is more efficacious? Which might be better for a woman who wishes to get pregnant?
Cabergoline is more efficacious and bromocriptine might be better for the woman who wishes to get pregnant.
110
What percentage of the US population has Graves' disease?
0.4-1.0%
111
What is the most common cause of primary hyperaldosteronism? What is the cause of most other cases of primary hyperalldosteronism?
Idiopathic bilateral hyperplasia is the most common cause, followed by unilateral aldosterone-secreting adenoma
112
What can cause thrombocytopenia?
Aplastic anemia, spleen enlargement, alcohol*, vitamin deficiency, drugs (aspirin, warfarin, chemotherapy)
113
What can cause thrombocytosis (too many platelets)?
Splenectomy, polycythemia vera, inflammatory conditions (IBD), metastatis cancer, trauma
114
Damage to the tissue and subsequent release of coagulation factors from the tissue itself is part of the __________ pathway (intrinsic/extrinsic)
Extrinsic
115
What is the function of platelets?
Repair vascular endothelium, prevent excessive blood loss
116
Of the ways to monitor glycemic control -- urine testing, FPG, HbA1c, fructosamine, and home blood glucose monitoring -- which is useful for determining glucose control when treatment plans have been changed?
Fructosamine -- it indicates the levels of blood glucose over two to three weeks, so you don't have to wait as long to see how the new treatment is working long-term
117
Thyroid neoplasms are not uncommon. What characteristics may indicate that a thyroid nodule is more likely to be benign?
Multiple nodules that do take up radioactive iodine in an older female.
118
What are the clinical features of acromegaly?
Headache, enlargement of jaw and separation of teeth, hand and feet enlargement, osteoarthritis, entrapment neuropathies, abnormal glucose tolerance, and heart failure
119
Intestinal alpha-glucosidase inhibitors should be taken right before meals. What is their mechanism of action? Which drugs are in this class?
They slow carbohydrate breakdown, thus decreasing glucose absorption; acarbose, miglitol
120
True or false: a patient with Hashimoto thyroiditis may first experience transient hyperthyroidism
True; this is due to disruption of thyroid follicles and subsequent release of the thyroid hormone they contain
121
What are the treatment options for CML?
Tyrosine kinase inhibitors (Imatinib) results in a 95% response rate, chemotherapy, stem cell transplant
122
How many hemoglobin molecules are there per RBC?
280 million
123
Multiple myeloma is characterized by overproduction of what type of cells?
Plasma cells from bone marrow (secrete IgG, IgA, sometimes IgM)
124
What are the clinical features of hyperthyroidism?
Increased basal metabolic rate (unexplained weight loss), nervousness, irritability, tremor, hyperreflexia, tachycardia (may lead to HF in the elderly), hypermotility of the gut with malabsorption and hyperdefecation, staring gaze with lid retraction from sympathetic innervation, heat intolerance, insomnia, oligomenorrhea
125
What is the function of blood?
Carries nutriens, Abs, hormones, oxygen, and waste; forms clots, regulates body temperature through vasodilation and constriction
126
What is the most common cause of hyperthyroidism? What are some other causes?
Diffuse hyperplasia due to Graves' disease, hyperfunctional thyroid goiter, hyperfunctional thyroid adenoma, thyroid inflammation, ingestion of excess thyroid hormone, weight-loss herbal supplements
127
Where can iron be stored in the body?
Liver, spleen, bone marrow
128
Hodgkin's lymphoma is associated with what virus?
Epstein-Barr Virus
129
Ideally, thionamides can help the patient achieve a euthyroid state in how long?
3 to 8 weeks
130
What are some ocular complications that can arise from diabetes?
Cataracts, retinopathy, glaucoma
131
Is hypoparathyroidism more or less common than hyperparathyroidism?
Much less common
132
Which is more common, T1DM or T2DM?
T2DM
133
Adrenalectomy is one of the treatment options for Cushing's disease. What are some of the significant side effects?
Addison's disease (adrenal insufficiency), possible Nelson's syndrome (rapid tumor growth)
134
For a patient is on warfarin, be aware that AREDS (for AMD), omega-3, and alcohol may cause additional bleeding due to increased blood thinning properties
Free card!
135
What testing can be done for multiple myeloma?
Urine testing (looking for increased protein), X-ray (looking for decreased bone mass and "peper pot" defects in skull), bone marrow biopsy
136
During which stage of pregnancy would iodine deficiency cause the most harm?
During the first trimester, iodine deficiency could cause severe mental impairment
137
Erythropoeietin is produced in what organ(s)?
Kidneys (90%) and liver (10%)
138
Which of the DPP4 inhibitors is used for patients with renal problems?
Linagliptin
139
What is the prognosis for a treated patient with Hodgkin's lymphoma?
About 80% cured
140
Is MODY antibody negative or antibody positive?
Negative (It's a variant of T2DM)
141
What is the treatment of choice for prolactinoma?
Dopamine agonists (cabergoline and bromocriptine) work rather well to decrease prolactin secretion and can actually shrink the size of the tumor.
142
What can cause Von Willebrand Disease?
Autosomal dominant or recessive diseases
143
Which gender and ethnic group have a higher prevalence for multiple myeloma?
Males; African Americans
144
Gestational diabetes is a subtype of ______________
T2DM
145
True or false: Burkitt's lymphoma is associated with Epstein-Barr Virus
True.
146
In terms of leukemia, what does the term "chronic" mean?
It means that the symptoms last over a longer period of time; it also refers to mature cells being involved. Generally, chronic forms of leukemia are more common in adults.
147
Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) are sometimes included in CBC and are tests that can be done to test the coagulation pathways. Which of these tests is for the intrinsic pathway? Which is for the extrinsic pathway?
PT is for the extrinsic pathway; aPTT is for the intrinsic pathway
148
How would you treat vitamin K deficiency?
Oral or IV vitamin K (90mcg for women, 120mcg for men); discontinue anti-coagulants such as warfarin
149
What are some treatment options for hemophilia?
Factor VIII infusion, desmopressin (increases factor VIII and VWF), anti-fibrinolytic agents, gene therapy
150
Mean corpuscular volume (MCV) measures what?
The average volume of RBCs.
151
When might transsphenoidal adenectomy and/or raditherapy be considered in treatment of a prolactinoma?
If medical therapy fails, or if the tumor is larger than 3cm and the woman wishes to get pregnant
152
What is the function of eosinophils and basophils?
They release histamine, cytokines, heparin, and prostaglandins as part of allergic and infectious response.
153
How would you treat thrombocytosis?
Hydroxyurea, aspirin
154
How does the remission rate for ALL in children compare to that in adults?
Complete remission occurs in 80% of children but only 25-30% of adults
155
What are some causes of iron deficiency anemia?
Blood loss, pregnancy, growth phases, poor diet, celiac disease (malabsorption), NSAIDs (GI bleeding), gastric bypass surgery
156
Hashimoto's thyroiditis is an autoimmune disease. What type of hypersensitivity is it?
Type IV
157
T1DM most often is due to an autoimmune-mediated destruction of beta cells in the pancreas. What type of hypersensitivity is this?
Type IV
158
What is the Bohr effect?
A phenomenon in which oxygen dissociates from hemoglobin wherever CO2 concentrations are high (which acidifies the blood); oxygen associates with hemoglobin wherever CO2 concentrations are lower (higher blood pH).
159
What is the lifespan of a platelet?
About 8 days
160
Warfarin is contraindicated in what common condition?
Pregnancy
161
What would be the levels of ACTH and cortisol in a patient with Cushing's disease?
High ACTH and high cortisol (the pituitary releases ACTH, which stimulates adrenal cortex to release cortisol)
162
What factors are involved in platelet activation?
Collagen*, thrombin*, ADP, epinephrine
163
What sort of hormone levels would be found in a Graves' disease patient?
High T3 and T4, low TSH
164
Which of the thionamides is preferred in the treatment of Grave's disease? Why?
Methimazole: has longer duration of action, lower incidence of SE
165
True or false: gestational diabetes is more common in overweight women
False.
166
What is a common cause of lymphocytosis
Smoking*
167
What would be the levels of ACTH and cortisol in a patient with Cushing's syndrome due to ectopic ACTH secretion?
High ACTH and high cortisol (ectopic tumor releases ACTH, which stimulates release of cortisol; though hypothalamus is stimulated to tell pituitary to decrease ACTH release, the ectopic tumor isn't under hypothalamic control)
168
What is the recommended daily intake of vitamin C?
75 mg
169
What is the most common cause of endogenous Cushing's syndrome?
Cushing's disease (usually small ACTH-secreting pituitary adenoma, though could be a hypothalamic adenoma) accounts for more than half of endogenous Cushing's syndrome
170
The sickling of sickle cell disease is exacerbated by what factors?
Infection, dehydration, cold, stress
171
How long can radiotherapy take to normalize GH levels in the treatment of acromegaly?
3-10 years
172
Graves' disease can include a triad of findings. What are these findings?
Thyrotoxicosis with goiter (same symptoms as any other hyperthyroidism, plus the antibody is stimulating the TSH receptors enough to cause hyperplasia and hypertrophy of the thyroid), infiltrative ophthalmopathy with exophthalmos (the antibodies against TSH receptors also attack some receptors in the EOM, causing aggregation of WBCs and swelling of EOMs; hypo deviation can be seen), localized, infiltrative dermopathy (pretibial myxedema; thickening and pigmentation of skin over lower leg)
173
Patients with metabolic syndrome have how much greater risk for developing cerebrovascular disease?
3X
174
What are a few common causes of primary hypothyroidism?
Thyroid ablation via surgery or radiation therapy, Hashimoto's thyroiditis, primary idiopathic hypothyroidism
175
What are some clinical features of hypothyroidism?
Mimics depression early on, slow speech, weight gain, fatigue, cold intolerance, bradycardia, heart failure, delayed deep tendon reflexes, decreased bowel motility with resultant constipation
176
Sorbitol and fructos are products of the polyol pathway. What are important results of this pathway?
Sorbitol and fructose increase the intracellular osmolarity since they are bigger than glucose and cannot move in and out of the cell freely. This pathway also creates free radicals, which increases oxidative stress on the cell.
177
True or false: if surgery or medical therapy fail in treatment of acromegaly, radiotherapy may be used
True.
178
What are some pathologic causes of hyperprolactinemia?
Prolactinoma, damage to hypothalamus or pituitary stalk (loss of dopamine inhibition of prolactin release), hypothyroidism (low TH increases TRH from hypothalamus, which increases TSH and prolactin from pituitary), dopamine antagonists (antipsychotics, verapamil, cimetidine)
179
Comparing syringes and insulin pens, which allows you to mix insulin? Which is more comfortable and why?
Syringe allows for mixing, insulin pen is more comfortable because the needle is sharper
180
What is the CDC recommended daily intake of iron for individuals 30 years of age?
Men: 11 mg/day; women: 18 mg/day
181
Maturity-onset diabetes of the young (MODY) is an autosomal dominant cause of diabetes. Generally, what is the molecular malfunction that occurs?
Insufficient insulin production or insufficient insulin release
182
How are platelets shaped?
Biconvex
183
What class of drug could you use to treat Graves' disease itself? What is the mechanism of these drugs?
Thionamides (methimazole and PTU); they inhibiti oxidation of iodine in the synthesis of thyroid hormone
184
Damage to the blood vessel endothelium and subsequent release of coagulation factors is part of the ______________ pathway (intrinsic/extrinsic)
Intrinsic
185
True or false: although T2DM patients may eventually need insulin, usually they can manage with diet, exercise, and oral agents
True.
186
A blood smear in a patient with AML would show what?
Increased myeloblasts and Auer rods
187
Excessive growth hormone causes growth of what types of tissue?
Soft tissue, increased bone density
188
What are the symptoms of adrenal insuffiency?
Anorexia, nausea and vomiting, diarrhea, weight loss, hypotension, hyperpigmentation, weakness and fatigability.
189
Which gender is more affected by CLL?
Males
190
What would be the levels of ACTH and cortisol in a patient with Cushing's syndrome due to adrenocortical hyperplasia or neoplasm?
Low ACTH and high cortisol (hyperplasia or neoplasm releases excess cortisol, which signals to hypothalamus to tell pituitary to decrease ACTH release)
191
What are some of the symptoms that a patient with Hodgkin's lymphoma might present with?
Painless enlargement of a lymph node, fever, night sweats, weight loss, pruritus (itching)
192
What is the peak age of onset for Hodgkin's lymphoma?
It shows a bimodal distribution -- about age 20 and age 65
193
Which gender has a higher prevalence for anemia?
Females
194
Patients on dopamine agonists for treatment of prolactinoma have what procedure done every two years?
Cardiac ultrasound due to possibility of valvular disease.
195
What are the types of white blood cells?
Leukocytes (monocytes, basophils, eosinophils, neutrophils) and lymphcytes (B cells, T cells, and natural killer cells)
196
What is some testing you can do for vitamin B12 deficiency?
B12 levels, bone marrow biopsy, serum bilirubin (would be increased), Schilling test
197
Which gender has a higher prevalence for Graves' disease?
Female (7x)
198
What type of histocompability antigens are associated with T1DM?
HLA-DR 3,4,7,9
199
The lymphatic system consists of B cells and T cells. What is the function of this system?
Fight infection, remove fluid from tissue
200
What are some tests that can be done for Hodgkin's lymphoma?
Lymph node biopsy showing Reed-Sternberg cells ("owl eyes"), PET scan, chest X-ray
201
In order to try and standardize PT findings, the international narmalized ratio (INR) was developed. What is a normal INR?
1
202
Where does hematopoiesis occur (in adults)?
Mostly in the bone marrow, though it can occur in the liver and spleen if there is a severe enough need.
203
After how long of dopamine agonist use can reduction of dosage begin? How long until complete drug cessation is possible?
1 year for reduction and 2 years for cessation
204
True or false: about 40% of US adults have metabolic syndrome
True.
205
There are a few varieties of neuropathies that can occur in diabetes. Which one involves diffuse pain? Does this type of neuropathy ever remit?
Acute painful neuropathy; usually remits after 3-12 months of good control
206
Of the ways to monitor glycemic control -- urine testing, FPG, HbA1c, fructosamine, and home blood glucose monitoring -- which is performed in office but required no special patient preparation?
HbA1c
207
A CBC count would show what in a patient with AML?
High WBC, low RBC and low platelets
208
Are there any risks to using GLP-1 agonists?
They are associated with acute pancreatitis and acute kidney injury
209
How much iron is normally absorbed by the body? How much can be absorbed if iron is taken as a supplement?
10% normally absorbed; 20-30% in supplements
210
True or false: non-Hodgkin's lymphoma does not metastasize
False; it can metastasize
211
Leukemia is an overprodution of either immature "blast" cells or mature WBCs. This overproduction can suppress production of _________________ and _________________
RBCs (Anemia) and platelets (thrombocytopenia) -- these two are specifically low in AML (part of testing)
212
Of the ways to monitor glycemic control -- urine testing, FPG, HbA1c, fructosamine, and home blood glucose monitoring -- which is least useful?
Urine testing -- the level at which glucose shows up in the serum is way higher than safe blood levels
213
What are the treatment options for CLL?
Chemotherapy (Chlorambucil), stem cell transplant, radiation
214
Extremely fast action insulin preparations most closely match normal insulin response and are used in insulin pumps. What are some of the names of these preparations?
Insulin lispro (Humalog), gluulisine [these two can be administered IV], and aspartate (NovoLog)
215
Biguanides are the first line drugs for obese patients, as they don't lead to weight gain. What is the mechanism of action for this class? What is an example of a biguanide?
Decreases gluconeogenesis in liver, and increases glucose uptake by skeletal muscle through GLUT-4 activity
216
What are the symptoms of anemia?
Fatigue, HA, fainting, angina, claudication, palpitations
217
Describe the effect of the antibodies in Graves' disease.
Antibodies are directed against thyroid stimulating hormone receptors. These antibodies stimulate the receptor, causing the hyperthyroidism. These antibodies could also just block the receptors, potentially leading into Hashimoto's thyroiditis
218
What is another name for an aldosterone-secreting adenoma?
Conn's syndrome
219
True or false: CBC for polycythemia vera would reveal elevated hemoglobin, WBC, platelets, and RBC
True.
220
Intermediate-acting insulin preparations utilize zinc to slow absorption from the subcutaneous site, and are often mixed with regular insulin. What are a few examples of these preparations?
Neutral Protamine Hagedorn (NPH, Humulin N, Iletin II NPH, Novolin N); Lente
221
Pheochromocytoma is an uncommon tumor. It is also known as the 10% tumor. What does this mean?
10% are malignant, 10% are bilateral, 10% occur in children (they also tend to recur, and to run in families, and to present with stroke)
222
LADA is most often seen in what type of patient?
Nonobese patients over 35
223
True or false: as soon as a patient is diagnosed with MODY, they should be placed on insulin
False; it is usually controllable without insulin for at least 2 years
224
Hemophilia is a coagulation disorder. What is it caused by? What is its prevalence?
X-llinked recessive disease (1/5000 males)*
225
Which hormones are secreted by the adrenal medulla?
Catecholamines (mostly epinephrine)
226
Although subtotal thyroidectomy is an unpopular therapy in treating Graves' disease, what are a few indications for its use?
Very large/obstructive goiter, active ophthalmopathy, antithyroid drug allergy, coexisting suspicious or malignant thyroid nodule
227
What are the different types of microcytic anemias?
Iron deficiency anemia, thalassemia, and sideroblastic anemia
228
In aplastic anemia (which is a normocytic anemia), MCV is normal. How do hemoglobin levels and hematocrit appear? What causes this change?
Both are decreased due to loss (or underproduction) of pluripotent stem cells in the bone marrow. Since the stem cells are affected, WBC and platelet counts are low, too.
229
True or false: the prevalence of normocytic anemia increases with age
True.
230
The sickling in sickle cell anemia occurs because one amino acid in hemoglobin is replaced by another, which causes the hemoglobin to collapse on itself. Which amino acid is replaced with which other amino acid?
Glutamic acid is replaced by valine*, which is hydrophic (hence the collapsing)
231
What test can be used to differentiate the two ACTH-dependent Cushing's syndrome causes (i.e., pituitary ACTH tumor from ectopic ACTH tumor)? What would this test show in a non-Cushing's patient? In a Cushing's disease patient? In an ectopic ACTH patient?
Dexamethasone suppression test; in a non-Cushing's patient, cortisol levels would be low; in a Cushing's disease patient, cortisol levels would drop slightly; in an ectopic ACTH patient, cortisol levels would not drop at all.
232
What are some signs of peripheral vascular disease?
Leg pain relieved by rest, cold feet with reduced or absent pulses, nocturnal leg pain relieved by dangling legs over side of bed or walking, loss of hair on foot and toes.
233
DPP4 degrades GLP-1, so DPP4 inhibitors potentiate GLP-1. What is the mechanism of action for this class of drugs? What type of diabetes should it be used for? What do the names of these drugs have in common?
Triggers pancreas to release more insulin, decreases liver production of glucose; used for T2DM; names end in "gliptin" -- sitagliptin, saxagliptin, linagliptin, alogliptin
234
If a venous thrombosis occurs, it is caused by valve stasis or venous obstructions. What are risk factors that increase the likelihood of this happening?
Increased weight, age, bed rest
235
Why is subtotal thyroidectomy is an unpopular therapy in treating Graves' disease?
Surgery risk of hypothyroid and damage to laryngeal nerve
236
What is the mechanism of action for sodium-glucose uptake transporter 2 inhibitor drugs? What are some benefits? Some risks? Contraindications? What do the names of these drugs have in common?
They inhibit glucose reabsorption in proximal renal tubules; this promotes weight loss; it also increases genitourinary trarct infections and urination and risk for fracture, as well as breast and bladder cancer; renal impairment may be a contraindication; "flozin" -- canagliflozin, dapagliflozin, empagliflozin, remogliflozin
237
It is estimated that diabetes is accountable for what percentage of vascular deaths?
11%
238
MODY is most often seen in what type of patient?
Thin young adults (under 25 years)
239
Which is more common, Hodgkin's or non-Hodgkin's lymphoma?
Non-Hodgkin's lymphoma
240
What types of medications can be used for management of acromegaly?
Somatostatin analogues (inhibitors of growth hormone) octreotide and lanreotide, GH receptor antagonist pegvisomant, dopamine agonist cabergoline.
241
Which endogenous cause of Cushing's syndrome is considered ACTH-independent, and why?
Primary adrenocortical hyperplasia or neoplasm (neoplasm more commonly). The hyperplasia or neoplasm would release excess cortisol regardless of ACTH presence.
242
What are the signs of anemia?
Pallor, tachycardia, cardiac failure, brittle or spoon shaped nails, pica (eating things that have no nutritional value)
243
What are a couple of causes of neutropenia?
Chemotherapy, radiation; nutritional deficiency
244
What genetic abnormality is seen in most patients with CML?
Philadelphia chromosome
245
What are some precipitating factors for Hasimoto's thyroiditis?
Infection, stress, pregnancy, iodine intake, radiation exposure.
246
Hodgkin's lymphoma is slightly more common in _________________ (males/females)
Males
247
Patients with metabolic syndrome have how much greater risk for developing liver cancer?
2X
248
True or false: if a thrombus occurs in an artery, it is most commonly at a bifurcation
True.
249
What are the clinical features of hyperprolactinemia?
Oligomenorrhea or amenorrhea, galactorrhea (in men and women), and loss of libido. VF defects and HA can occur if the hyperprolactinemia is caused by a prolactinoma.
250
What is the 5-year survival rate for CML?
90%
251
What are some clinical features of neonatal hypothyroidism?
Impaired development of skeletal system (short stature), mental impairment, coarse facial features
252
What is the cause of thalassemia?
Autosomal recessive disorder
253
Pancytopenia refers to low counts of RBCs, WBCs, and platelets. What signs/symptoms can be seen with low levels of each of these components of blood?
Anemia (low RBC), frequent infections (low WBC), easy bruising, nose bleeds (low platelets)
254
What is some testing you can do for sickle cell disease?
Blood smear, Hemoglobin S (for sickled)
255
How would you treat sideroblastic anemia?
Pyridoxine (B6, for hemoglobin formation), treat any underlying condition, blood transfusion
256
True or false: Graves' disease is the second most common cause of endogenous hyperthyroidism
False; it is THE most common cause of endogenous hyperthyroidism
257
How would you treat sickle cell disease?
Fluids, oxygen, pain meds for acute attacks, antibiotics, vaccines, transfusion if severe, hydroxyurea (helps inhibit sickling)
258
Graves' disease is an autoimmune disorder. What type of hypersensitivity is it?
Type II
259
How long might you expect an individual with multiple myeloma to live, if they are treated?
5 years
260
Which oral drug for diabetes is used as an amylin analog? What does it do? What type of diabetes should it be used for? When should it be used?
Symlin; it decreases glucagon release and slows gastric emptying (so may be useful for weight reduction); can be used for either T1 or T2 DM patients; should be given subcutaneously at mealtime with insulin
261
What therapy would you recommend for a patient with hyperparathyroidism?
Remove adenoma, increase fluid uptake, decrease calcium in diet, maintain vitamin D uptake, do physical activity
262
Hashimoto's thyroiditis is more common in which gender and age group?
Women between 45 and 65
263
What is the peak onset age of CML?
50-60 years
264
Mononeuropathies can occur in diabetes. Which cranial nerves are most often affected? Do these mononeuropathies remit?
CN III (pupils spared), CN VI; patients spontaneously recover in 3-6 months
265
True or false: CLL is the least common adult form of leukemia.
False; it is the most common adult form of leukemia, making up 1/3 of adult leukemias
266
What are the treatment options for thalassemia?
Blood transfusion, folic acid supplement, bone marrow transplant
267
Macrocytic anemia features high MCV (>100 fL). How might the shape of these large RBCs differ from normal?
Balloon or tear-drop shape
268
Which gender is more commonly affected by Burkitt's lymphoma?
Male
269
What are the symptoms of polycythemia vera?
HA, weakness, sweating, burning/tingling in extremeties, transient vision loss, scotomas, ophthalmic migraines, retinopathy, hypercoagulation
270
True or false: lymphoma is the most common form of blood cancer
True.
271
Although some patients with CLL die within 2-3 years, what is the median survival rate?
10 years
272
What would be the levels of ACTH and cortisol in a patient with Cushing's syndrome due to exogenous steroids?
Low ACTH and low cortisol (the exogenous steroids resemble cortisol enough that the hypothalamus tells pituitary to stop releasing ACTH)
273
What is the most common form of leukemia in children?
ALL; it accounts for 1/3 of all childhood cancers
274
What is a normal value for a PT?
~15 seconds
275
What are some other terms for metabolic syndrome?
Syndrome X, insulin resistance syndrome
276
What are some consequences of AGEs?
Atherogenesis, capillary BM thickening, inflammatory response
277
Red bone marrow contains stem cells that differentiate into ________, ___________, and _____________.
RBCs, WBCs, and platelets
278
What percentage of patients who undergo radioiodine treatment of Graves' disease need to have subsequent doses?
10-20%
279
Neutrophils are also known as polymorphic leukocytes (PMNs). What is their function?
Ingest and kill bacteria and damaged cells
280
Hemolytic anemia is characterized by shortened life of RBCs (less than 100 days) and increased plasma hemoglobin due to this breakdown. Sickle cell anemia is one type of hemolytic anemia. What ethnicity has a higher prevalence of sickle cell anemia?
African*
281
It is believed that the incidence of T1DM is preceded by what sort of event?
Preceding viral infection
282
What percentage of patients with acromegaly are cured through transsphenoidal adenectomy?
60-90% (if the tumor is small))
283
What is the treatment option for pheochromocytoma?
Adrenalectomy
284
True or false: primary hyperparathyroidism is one of the most common endocrine disorders
True.
285
Heparin and warfarin inhibit the coagulation cascade in different ways. How might you want to monitor a patient on heparin? On warfarin?
Heparin: monitor with aPTT since it inhibits the intrinsic pathway; warfarin: monitor with PT and INR since it inhibits the extrinsic pathway
286
What is the most common cause of primary hyperparathyroidism?
Parathyroid adenoma.
287
What are the SE of sulfonylureas that metformin does not have?
Sulfonylureas can cause hypoglycemia and weight gain; metformin does neither. (Sulfonylureas also tend to lose effect after 1-3 years and have been shown to increase risk for cardiac-related death).
288
True or false: all hematologic malignancies are more common in Caucasians
False; leukemias and lymphomas are more common in Caucasians, multiple myeloma is more common in African Americans
289
Besides the treatment of choice, what other treatment options are available for a patient with Cushing's disease?
Pituitary irradiation, adrenalectomy, pasireotide (somatostatin analog)
290
Ectopic ACTH secretion can be a cause of endogenous Cushing's syndrome. What type of tumor is commonly the cause of the secretion?
Small cell carcinoma of the lung.
291
Amongst men, women, and children, which are more commonly affected with iron deficiency anemia?
Women and children --women lose more blood, children have higher need because of growth phases
292
The amount of advanced glycosylated end products (AGEs) is dependent on what factors?
Amount of elevated blood glucose and how long it has been elevated
293
What is a possible cause of pernicious anemia?
Autoimmune attack of parietal cells that release intrinsic factor
294
In terms of leukemia, what does the term "acute" mean?
It means that the symptoms occur relatively suddenly; it also refers to "blast" cells (immature) cells being involved. Generally, acute forms of leukemia are more common in children.
295
When it is time for a RBC to die, it is sent to the liver. What happens to the hemoglobin?
The heme and globin portions are dissociated from each other. The iron is removed from the heme portion, and the heme portion is converted to bilirubin. Bilirubin is transported from the spleen to the liver. The liver converts bilirun to bile to be used in digestion. Eventually bilirubin is excreted by the kidneys.
296
What type of medication is useful in managing LADA?
Sulfonylureas (squeeze a little extra insulin out of the pancreas)
297
What roles do vitamins B12, B9, and B6 have in terms of blood?
B6 helps with hemoglobin creation; B9 helps with RBC creation; B12 helps with both
298
What percentage of clinically recognized pituitary tumors are prolactinomas?
30-40%
299
Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma and is the fastest growing human tumor. It is the most rapidly prolierating type of lymphoma, involving what type of lymphocyte?
B cells
300
True or false: prolactinomas are more common in women than in men
True.
301
What is another term for hyperthyroidism?
Thyrotoxicosis
302
Latent Autoimmune Diabetes in Adult (LADA) is a subtype of T1DM. It is slowly progressive (in part) due to HLA-DR2, which brings about the disease but is protective against getting it in childhood. What type of antibodies are found in LADA patients?
Glutamic acid decarboxylase antibodies. Important to note is that these antibodies are found in regular T1DM as well, but more references are made to GAD antibodies as they associate with LADA in literature.
303
What percentage of endogenous Cushing's syndrome is caused by adrenocortical hyperplasia or neoplasm?
15-30%
304
What are some precipitating factors for Graves' disease?
Genetic susceptibility, infection, smoking, pregnancy/stress, iodine-containing drugs in a patient with an iodine deficient diet and the autoimmune condition
305
True or false: the main cause of aplastic anemia is idiopathic
True.
306
What causes polycythemia vera?
Mutation of JAK2 gene
307
True or false: non-Hodgkin's lymphoma has the same symptoms as Hodgkin's lymphoma but can also progress to involve the CNS
True.
308
Vitamin C (aka ascorbic acid) plays what important roles?
Aids in collagen synthesis, reduces free radicals, maintains plastaglandin/prostacyclin balance
309
Macrocytic anemia is very commonly caused through vitamin deficiency. What are some causes of vitamin deficiency?
Alcohol (decreases absorption of vitamin B), liver disease, methotrexate (B9 deficiency), vitamin B6 or B12 deficiency, abnormal B9
310
What are the symptoms of pernicious anemia?
Symmetric paresthesia in fingers and toes, progressive weakness and ataxia, smooth tongue without papillae, dementia, hallucinations, optic atrophy* (if you see bilator optic nerve pallor, possible B12 deficiency)
311
Sideroblastic anemia can be caused by a genetic disorder or it can be acquired. What type of genetic inheritance pattern is seen in this disease?
X-linked recessive (so more common in males)
312
How would you treat AML?
Chemotherapy, radiation, stem cell replacement, leukapheresis, hydration, antibiotics
313
What can cause hypoparathyroidism?
Surgical removal of parathyroid glands (most common); autoimmune disease, though this is much less common
314
What is the underlying issue in sideroblastic anemia?
There is excess iron in the bone marrow and RBCs, but it can't be incorporated into the hemoglobin
315
What are the early manifestations of Cushing's syndrome?
HTN and weight gain
316
What is a vaso-occlusive crisis?
Pain in hand/feet/bones, pulmonary HTN, acute chest pain, leg ulcers, neurologic complications
317
The lymphatic system is composed of what structures?
Lymph nodes, bone marrow, thymus, spleen, tonsils, GI tract
318
What are some of the signs and symptoms of leukemia?
Fatigue*, fever*, retinal hemorrhages, CWS, anemia, thrombocytopenia, abdominal discomfort (splendomegaly), weight loss, night sweats, headaches, recurrent infections, lymphadenopathy, bone pain
319
True or false: pulmonary embolisms are the most common preventable cause of hospital deaths
True.
320
What is the recommended daily intake of B12?
2.4 ug
321
Monocytes, if found in the tissue, are called macrophages. What is their function?
They engulf and kill bacteria, create pro-inflammatory response to the infection, and clear cellular debris.
322
Long-acting insulin preparations allow for 24 hour control through slow release at the injection site. The injection is painful due to drug acidity. What commonality do these preparations have in their names?
Trade names begin with "L" -- Insulin glargina (Lantus), determir (Lavemir)
323
The testing and treatment for non-Hodgkin's lymphoma is the same as for Hodgkin's lymphoma, with one exception. What is that exception?
Lymph node biopsy in non-Hodgkin's lymphoma would not show Reed-Sternberg cells (no "owl eyes")
324
Glucosuria is when there is glucose in the urine. At what glucose plasma concentration do you start finding glucose in the urine? What glucose plasma concentration is a diagnostic finding for diabetes?
180 mg/dL is the level at which you start finding glucose in the urine, 126 mg/dL is diagnostic of diabetes
325
Describe the Schilling test.
Patient ingests radioactive B12. An hour later, an IM injection is given to saturate liver B12 binding sites. This is done so that if radioactive B12 is absorbed from the GI system as it should be (i.e., if intrinsic factor is present), the radioactive B12 passes into the urine instead of binding in the tissues. You want to see more than 10% of the radioactive B12 passed into the urine. If less, give them intrinsic factor. If this helps with absorption, this is indicative of pernicious anemia.
326
How would TSH, T3, and T4 levels be in a patient with secondary hypothyroidism?
Low TSH, low T3 and T4
327
Sickle cell disease is a genetic disease. What is its inheritance pattern?
Autosomal recessive
328
What causes neonatal hypothyroidism?
Iodine deficiency in the diet of the mother while pregnant (possible iodine deficiency in child itself after birth???)
329
The neuropathy that can accompany diabetes is induced by what kind of molecular changes?
Schwann cell damage that delays nerve conduction, changes to vasa nervonum that decreases blood supply to the nerves.
330
Though insulin has good effect on blood glucose and HbA1c, what are some downsides?
You have to inject it, it can cause hypoglycemia and weight gain.
331
What dosage of methimazole would you use for a mild case of Graves' disease? For a severe case?
10mg/day for mild case; 20-30 mg/day for severe case
332
What causes secondary hyperaldosteronism?
Renal disease or heart failure that makes the body think there is not enough blood, and so activates the renin-angiotensin system (results in increased aldosterone levels)
333
Patients will experience increase anti-coagulation if they take warfarin and they're also on what other drugs?
Anti-depressants, anti-psychotics, sulfonamides, antibiotics, aspirin, alcohol
334
How would you treat Hashimoto's thyroiditis?
L-thyroxine qd, possible q1week
335
What is the recommended daily intake of folate?
400 ug
336
Which is more common, hyperthyroidism or hypothyroidism?
Hypothyroidism
337
What are some diagnostic features of DM?
Casual plasma glucose test over 200 mg/dL with polyuria, polydipsia, fatigue; fasting plama glucose greater than 126 mg/dL on two or more occasions; HbA1c (how much hemoglobin is glycated) greater than 6.5%; oral glucose tolerance test greater than 200 mg/dL within the two hours
338
Thiazolidinediones are not used as much as they once were. What is their mechanism of action? What are some drawbacks? What do the names of these drugs have in common?
Imrpove insulin actio nin liver and skeletal muscles; they are associated with weight gain, fluid retention, and heart failure; "glitazone" (pioglitazone)
339
Sulfonylureas used to be the #1 treatment for T2DM. What is their mechanism of action? What are examples of these drugs?
Stimulate release of insulin from pancreatic beta cells and enhance beta cell sensitivity to glucose; glipizide, glyburide, glimepiride
340
Thrombus vs. embolus: which is a solid mass attached to a blood vessel wall? Which is a fragment that can travel throughout the BVs?
Thrombus is the solid mass attached to a BV wall; embolus is the travveling fragment
341
What percentage of deaths of patients with acromegaly are due to heart failure?
60%
342
Obese T2DM makes up what percentage of T2DM?
More than 80%
343
True or false: males are more affected by Cushing's disease than females, and the incidence is normally in the third to fourth decade
True and false: females (not males) are the more affected gender, but the peak incidence is indeed in the third to fourth decades
344
What sort of therapy would be recommended for a patient with hypoparathyroidism?
Vitamin D and calcium; synthetic parathyroid hormone is being evaluated
345
What are iron levels like in a patient with thalassemia, low, high, or normal?
Normal
346
How long do WBCs live for?
3-4 days
347
What is a normal value for an aPTT?
30-50 sec
348
What are some treatment options for Von Willebrand Disease?
VWF infusion, factor VIII infusion, desmopressin (increases factor VIII and VWF), anti-fibrinolytic agents, gene therapy
349
If a patient you suspected of having iron deficiency anemia does not improve with iron supplements, what are a few differentials you need to consider?
TB, Crohn's, rheumatoid arthritis, lupus, polymyalgia rheumatica, sideroblastic anemia, thalassemia
350
Types of anemia can be based on the mean cell volume and/or hemoglobin concentration (too little, normal, too much) or a shortened lifespan of RBCs. What is the MCV of microcytic anemia?
Less than 80 fL (normal is 88 fL)
351
What are key characteristics of metabolic syndrome?
Central body obesity, insulin resistant, lipid abnormalities, elevated BP, FPG (100-125mg/dL), HbA1c (5.7-6.4%)
352
Lymphomas are the ___________ most common malignancy in the Western world
5th
353
What are some physiologic causes of hyperprolactinemia?
Pregnancy and stress (stress doesn't cause very much prolactin increase)
354
There are a few varieties of neuropathies that can occur in diabetes. Which one is the least common? What symptoms does it involve?
Autonomic neuropathy; tachycardia, postural hypotension, vomiting, loss of blasdder tone, erectile dysfunction
355
Metabolic syndrome is highly associated with prediabetes. Patients with metabolic syndrome have how much greater risk for developing diabetes?
5X
356
Some drugs that act in the stomach can decrease intrinsic factor release. Name two drugs that can have this effect.
Pepcid, Prilosec (they decrease parietal cell function)
357
What are some signs and symptoms of diabetes mellitus?
Glucosuria, polyuria, polydipsia, fatigue, possible weight loss (due to fasting metabolism being activated), hyperglycemia (not only due to lack of insulin action but also glycogenolysis and gluconeogenesis in the liver), ketonemia, ketonuria, ketoacidosis (due to liver metabolizing FFA metabolism)
358
Of the ways to monitor glycemic control -- urine testing, FPG, HbA1c, fructosamine, and home blood glucose monitoring -- which allows direct assessment of day-to-day activities on glucose levels?
Home blood glucose monitoring
359
What testing can be done for CML?
CBC looking for elevated WBC, and genetic testing for Philadelphia chromosome
360
True or false: thionamides can be used for years, as long as they work well
True.
361
Though multiple myeloma is not curable, there are a few treatment options. What are they?
Chemotherapy, radiation therapy, bisphosphonates, stem cell transplant
362
True or false: sideroblastic anemia is the most common cause of anemia
False; iron deficiency anemia is the most common cause of anemia
363
Orbitopathy due to Graves' disease can include what findings?
Exophthalmos, EOM weakness (particularly inferior muscles), diplopia (especially in upgaze), lid retraction (Darylmple's sign) and lid lag, lid edema, keratitis from dry eye, compressive optic neuropathy (due to EOM compression)
364
Metastatic neoplasms of the adrenal gland can cause adrenal insufficiency. True or false: these neoplasms usually originate in the lungs and liver.
False; they usually originate from the lungs and breasts
365
Which gender has a higher prevalence for primary hyperaldosteronism, and at what age?
Female (2:1) middle age
366
What is the remission rate for AML?
40% of patients under 60 experience remission, but prognosis is worse for elderly males
367
What are three different ways that thrombosis treatment drugs can work? Give a couple of examples of drugs in each category.
Inhibit platelets (aspirin, clopidogrel), break down clots (streptokinase), inhibit coagulation factors (heparin, warfarin, dabigatran)
368
True or false: the median age of onset for multiple myeloma is below 50
False; it is over 60 years
369
What are some clinical signs of hypoparathyroidism?
Latent tetany such as Cvostek's sign (tap on facial nerve, causes contraction of facial muscles, upperlip [Dick Cheney sneer]) and Trousseau's sign (inflation of blood pressure cuff for 3 minutes causes carpal spasm)
370
What is the basic structure of hemoglobin?
Four heme groups (with iron), two alpha globin chains and two beta globin chains
371
At what age does thalassemia manifest?
6-12 months
372
Bleeding disorders can include what types of signs/symptoms?
Petechiae (broken capillaries), purpura (larger broken capillaries), ecchymosis (bruise), epistaxis (nosebleed), menorrhagia (heavy menstrual period), subconjunctival hemorrhages, gum bleeding.
373
True or false: most patients with non-Hodgkin's lymphoma survive 6-10 years from diagnosis
True.
