Med-DM/Endocrine Flashcards
(125 cards)
1
Q
What are the 4 ways to Diagnose DM
A
2
Q
Goal HbA1C and BP for DM pts
A
< 7% ; <140/90(also BP goal for CKD pts)
3
Q
When is Metformin contraindicated?
A
Creatinine > 1.5
4
Q
Sulfonylurea MOD ; List examples-3
A
Stimulates pancreas to release endogenous insulin
- Glimepiride
- Glyburide
- Glipizide
5
Q
Meglitinide MOD ; List examples-2
A
Stimulates pancreas to release endogenous insulin
- Nateglinide
- Repaglinide
6
Q
[Alpha glucosidase inhibitor] MOD ; List examples-2
A
inhibits a-glucosidease –> inhibits carb digestion;
- Acarbose
- Miglitol
7
Q
[DPP-4 inhibitors] MOD ; List examples-2
A
Inactivates [DPP-4 GLP1 peptidase] –> ⬆︎GLP1–> ⬆︎Glucose-induced insulin release
- SitaGliptin
- SaxaGliptin
8
Q
What are the GLP1 homologs?-2 ; What do they do?
A
⬆︎Glucose-induced insulin release
- ExenaTIDE
- LiragluTIDE
These require Injections
9
Q
Microalbuminuria is an indicator of __(3)___.
What lab value is used and what are the values for normal, micro and macro?
A
- DM
- HTN
- PSGN
Urine [Albumin Creatinine Ratio];
30-300
normal = < 30
micro = 30-300
MACRO = 300+
10
Q
How often should eye exams be done for DM pts
A
yearly
11
Q
for IDDM, how much daily insulin should be prescribed?
A
12
Q
[Nonketotic Hyperosmolar Coma] is a complication of DM
What Blood Glucose precipitates this?
A
Blood Glucose > 600
13
Q
What things cause HYPERKalemia? -6
A
14
Q
Classic Presentation for DM -4
A
15
Q
What are the opthalmological complications of DM-3; what causes them?
A
- Retinopathy (from ⬆︎VEGF –> abnormal angiogenesis)
- Glaucoma (⬆︎ Sorbitol eye pressure)
- Cataracts (Glycation of Ocular lens
16
Q
A: Clinical Manifestations of DiGeorge Syndrome (5)
B: Genetic Cause
C: Embryologic cause
A
“CATCh 22 & Pa3”
Cardiac (Tetralogy of Fallot + Aortic Arch abnormalitites)
Abnormal face (Bifid Uvula/low set ears)
Thymus Aplasia (Thymic shadow in image) –> Virus/Fungal infection
Cleft Palate
[hypOcalcemia from PTH deficiency] may–> Carpopedal Spasms
22q.11.2 deletion
Pharyngeal arch - 3rd/4th both fail to develop
17
Q
How does hypOthyroidism affect Neuro system - 4
A
- it causes ⬇︎ in DTR
- ⬇︎ motor relaxation phase
- Mood ∆
- Dementia
18
Q
Obesity w/Hyperphagia + Retardation should raise suspicions for what disorder?
A
Prader Willi Syndrome
19
Q
Common s/s of HYPERthyroidism -9
A
TT Feels ARCHED
- [Tremor & Tachycardia]
- Fatigue
- Appetite ⬆︎ but Wt ⬇︎
- Reflexes ⬆︎
- Cardio (Tachycardia, Palpitations,Exertional SOB)
- Heat intolerance –> SWEATING
- Exopthalmous with lid lag
- Diarrhea w/ possible dyspepsia
Older pts may only have Fatigue and Cardio sx!
20
Q
S/S of hypothyroidism is mostly opposite of Hyperthyroidism
What are 6 distincitve s/s of hypothyroidism?
A
Mosty opposite of TT Feels ARCHED but may also have…
- Cardio: Diastolic HF
- Depression
- Menorrhagia
- Pedal Edema
- HTN
- BOTH HAVE FATIGUE
21
Q
What type of radioiodine uptake do you see in Silent Painless thyroiditis?
this is a variant of Hashimoto chronic lymphocytic thyroiditis
A
22
Q
What happens to thyroid hormone serum level when drugs displace thyroid hormone? ; Which drugs do this?-3
A
Thyroid production will ⬇︎ –> ⬇︎TOTAL thyroid levels with normal free hormone levels ;
- ASA
- Furosemide
- Heparin
23
Q
Precocious puberty occurs in girls < __ years old and boys < ___ years old
How do you work this up?
A
24
Q
Precocious puberty occurs in girls < __ years old and boys < ___ years old
A pt has just been diagnosed with Gonadotropin Dependent Central Precocious Puberty
What are the major causes of this?-2
A
IDIOPATHIC > Pituitary tumor
ALL PTS WITH THIS SHOULD UNDERGO CONTRAST BRAIN MRI REGARDLESS OF +/- HA/VISION SX. Precocious Puberty may be the first sign before the tumor
25
Danazol MOA ; Indication
testosterone derivative with progestin effects ; endometriosis
26
Teenage boy comes in with gynecomastia
How do you work this up?
**YOU DONT!** - Pubertal gynecomastia is seen in up to 66% of teenage boys mid-late puberty. It can be uL, BL and/or painful
Tx = self-limited to ≤2 years
27
How long does it take radioiodine therapy to treat Hyperthyroidism? ; How does radioiodine therapy actually worsen Graves ophthalmopathy?
1-4 mo ; radioiodine eventually --\> hypothyroidism --\>⬆︎ thyroid stimulating autoantibodies --\> orbital tissue expansion from orbital fibroblast stimulation
28
Tight blood glucose control in DM pts mostly ⬇︎ their risk for what?
microvascular complications (retinopathy, neprhopathy)
## Footnote
*we dont know if it has an effect on MACROvascular disease such as MI or stroke*
29
You suspect a pt has Cushing Syndrome
How do you work this up?-2
1st: Determine if pt has ⬆︎Cortisol (Overnight low-dose dexamethasone test, late night salivary cortisol assay, 24 hr urine free cortisol)
2nd: If ⬆︎ Cortisol, determine if its from Cushing or adrenal adenoma (ACTH serum level)
30
Name the characteristics of Cushing Syndrome - 7
**F**at **H**eavy **P**eople **M**ay **HOG** the Cushing
1. **F**at distribution problems (central obesity, Moon face)
2. **H**yperpigmentation (from ACTH excess - can occur during excess or insuffiency)
3. **P**urple striae with skin atrophy and bruisability
4. **M**uscle atrophy
5. **H**TN
6. **O**steoporosis
7. **G**lucose intolerance
Dx = 1st-low dose Dexamethasone suppression test
*Cushing **SYNDROME** is caused by HIGH levels of Cortisol*
31
Riedel thyroiditis MOD
progressive **fibrosis** of thyroid gland and surrounding tissue (that looks like CA)
32
cp for HyperParathyroidism - 4
Painful **Bones** (to include Pseudogout), **Renal Stones**, **Abdominal Moans** (includes constipation), **Psychic Moans**
33
MEN-Multiple Endocrine Neoplasia 1 cp - 3
34
MEN-Multiple Endocrine Neoplasia 2A cp - 3
35
MEN-Multiple Endocrine Neoplasia 2B cp - 4
36
In Hashimoto chronic lymphocytic Thyroiditis, which antibodies are responsible for the attack on the thyroid gland?
Anti**T**hyroid**P**er**O**xidase
## Footnote
*AntiTPO is also a/w miscarriage!!*
37
Acromegaly cp - 12
heart = concentric LVH
38
Acromegaly Dx
GH stimulates IGF1 secretion most of the day --\> acromegaly sx
39
cp of hypopituitarism - 5
FLAT PiG
1. FSH/LH ⬇︎ --\> **Amenorrhea, testicular atrophy**
2. ACTH ⬇︎ --\> **⬇︎Cortisol BUT NOT ALDOSTERONE --\>** hypotension from ⬇︎arterial resistance
3. TSH⬇︎ --\> **Fatigue/hypOthyroidism**
4. Prolactin⬇︎ --\> **LACTATION FAILURE (1ST SIGN OF SHEEHAN!)**
5. GH⬇︎ --\> **Anorexia**
40
What are all the functions of Cortisol - 6
**BIG FIB**
1. ⬆︎**B**lood pressure (⬆︎a1 receptors)
2. ⬆︎**I**nsulin resistance --\> DM
3. ⬆︎**G**luconeogenesis
4. ⬇︎**F**ibroblast --\> striae
5. ⬇︎**I**mmune system (*WHITE*)
6. ⬇︎**B**one formation by ⬇︎osteoBlast
41
How does immobilization affect Ca+ levels
**INCREASES**
Immobilization --\> ⬆︎osteoclast activity --\> ⬆︎serum Ca+
42
Acute Rhabdomyolysis causes Ca+ to \_\_\_\_[increase/decrease] because of what?
DECREASE ; release of Ca+ and Phosphorous in damaged muscles --\> CaPhosphate precipitation --\> drops free serum Ca+
HYPERcalcemia and HYPERphosphatemia can occur during the **re**mobilization phase during recovery
43
How does albumin levels affect ionized Ca+ levels?
IT DOESNT! - albumin only affects TOTAL ca+ levels and will NOT cause calcium-related symptoms
44
etx of PCOS ; What are the primary effects of this etx?-5
DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\>
1. Androgen characteristics (acne, balding, hirsutism)
2. menstrual irregularities from Anovulation
3. PCOS on US from Follicular atresia
4. Infertility from Anovulation
5. ⬆︎Estrogen (from Androgen conversion) --\> Endometrial ADC
Tx = Wt loss--\> OCP --\> [Clomiphene for infertility] and [Combined OCP for irregular menses]
45
Tx for PCOS - 3
DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\>
Tx = Wt loss--\> OCP --\> Clomiphene for infertility and [Combined OCPs for irregular menses]
**S****OCK**:**S**pironolactone,**O**CP (1st line after wt loss),**C**lomiphene for infertility,**K**etoconazole
46
What level of prolactin indicates a Prolactinoma
\>200
## Footnote
Prolactin inhibits LH release
47
Which CA is known for producing calcitonin?
Medullary Thyroid Cancer
also produces ACTH and VIP
*associated with MEN2A and 2B*
48
Why should pts with Medullary Thyroid Cancer have a fractionated metanephrine assay ordered?
Screen them for Pheochromocytoma
## Footnote
*MTC and Pheochromocytoma are associated with MEN2A and 2B*
49
How do you treat Papillary Thyroid Carcinoma - 3
Surgical Resection --\> +/- radioiodine ablation and suppressive doses of thyroid hormone (in pts with risk of recurrence)
50
When is a thyroid Radionuclide scan indicated?
pts with low TSH
evaluates for HOT nodules (which are usually benign)
51
When is a thyroid Fine needle aspirations indicated? - 3
pts with HIGH TSH who have:
1. cold nodules
2. thyroid CA fam hx
3. suspicious thyroid US findings
52
How is Mg associated with Ca+ levels
low Mg+ (especially in alcoholics) --\> ⬇︎PTH hormone release and PTH resistance ---\> ⬇︎serum Ca+ **AND low serum K+**
## Footnote
serum Phosphorous levels are NOT affected by this phenomena!
53
What are the distinguishing features of Pancreatic VIPoma - 5
1. **Tea colored** watery secretory diarrhea
2. hypOkalemia
3. hypOchlorhydria (from ⬇︎gastric acid)
4. HYPERcalcemia from ⬆︎bone resorption
5. Facial flushing
## Footnote
*tx = octreotide for diarrhea*
54
Osteomalacia etx
**defective mineralization** of bone matrix (usually from Vitamin D deficiency)
VitD deficiency --\> ⬇︎GI Ca+ and Phosphate absorption --\> secondary hyperparathyroidism --\> ⬆︎ALP
*mineralization = osteoclast create cavity that osteoBlast fill with osteoid. Ca+ and P then deposit in osteoid matrix to provide mineralization*
55
Most common causes of Osteomalacia - 5
usually Vitamin D deficiency from ...
1. Malabsorption
2. RYBG
3. Celiac sprue
4. Chronic liver disease
5. Chronic Kidney disease
56
Pts with untreated Hyperthyroidism are at risk of developing what conditions? - 2
1. Bone loss from ⬆︎osteoclast activity
2. cardiac tachyarrhythmias
## Footnote
Hyperthyroidism = Graves \> toxic adenoma \> multinodular goiter
57
Subacute DeQuervain Thyroiditis presents with a PAINFUL HYPERthryoid (release preformed thyroid hormone)---\>hypOthyroid all after having a ______ ; Tx?-2
URI
1. BBlockers
2. NSAIDs
*You may see ⬆︎inflammatory markers in this condition*
58
What is the most common side effect of AntiThyroid drugs (i.e. Methimazole, PTU)
agranulocytosis
## Footnote
* Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!*
* Radioactive Iodine tx can --\> worsening ophthalmopathy*
59
In HYPERthyroidism, what is the mechanism for why pts have HTN?
⬆︎Myocontractility and HR
60
Diabetic Gastroparesis cp-3 ; Tx-2?
1. **early satiety**
2. NV
3. postprandial fullness
Tx = Metoclopramide or Erythromycin
61
A pt comes in with hypOcalcemia \< 8.4
Describe your full work up
62
Why are pts who receive \> 1 unit of pRBC/blood transfusion at risk for hypOcalcemia?
pRBC and whole blood **CONTAIN CITRATE** and citrate chelates Ca+ AND Mg --\> paresthesias, Chvostek, Trousseau, Hyperreflexia
Leukoreduction ⬇︎risk of Febrile Nonhemolytic Reaction in trasfusion patients
63
What is the most beneficial therapy to ⬇︎ the progression of DM nephropathy?
BP control \< 130/80
## Footnote
*do not push HbA1C \< 7%*
64
Clomiphene Citrate MOA ; Indication
hypothalamic estrogen R blocker ; PCOS Infertility
65
Leuprolide ; Indication
GnRH agonist ; endometriosis
66
what type of abd pain does DKA pts have
DIFFUSE
67
How does DKA and HHONK affect total body K+ levels?
⬇︎**total body** K+ (REGARDLESS OF WHAT SERUM VALUE SAYS)
## Footnote
DKA & HHONK causes severe osmotic diuresis --\> ⬇︎total body K+ stores even though serum K+ level may be elevated
68
autoimmune adrenalitis is known as _____ disease
etx?
Addison's disease
**Autoimmune** Primary Adrenal Insufficiency (suspect this in pts with other Autoimmune diseases - pernicious anemia, vitiligo, hypothyroid!)
*Sx = HYPERKalelmia, hypOnatremia, wt loss, fatigue*
69
A Pt with Hyperthyroid pt develops Sore throat and Fever after being started on Methimazole
What should you assess for?
agranulocytosis
D/C the drug!
* Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!*
* Radioactive Iodine tx can --\> worsening ophthalmopathy*
70
What are the main causes of Primary Adrenal Insufficiency? (Addison disease) - 4
1. TB
2. Autoimmune adrenalitis
3. CA
4. Adrenal Hemorrhage
71
Dx for Addison's Primary Adrenal Insufficiency - 2
[8 AM serum cortisol and plasma ACTH] --\> ACTH stimualtion test for confirmation
72
A woman starts to rapidly develop facial and body hair
What test do you order first to determine etiology? - 2
DHEA and Testosterone
## Footnote
Hyperandrogenism suggest androgen secreting CA of ovary or adrenal glands so these test will help to determine that
73
Potassium Iodide Indication - 2
1. PreOp tx for Thyroidectomy in Graves
2. Thyroid Storm
74
In the context of thyroid disease, what is the indication for CTS - 3
1. Thyroid Storm
2. Type 2 amiodarone-induced thyrotoxicosis
3. SEVERE DeQuervain Subactue Thyroiditis
75
What are the two definitive treatments for thyroid disease
1. Radioactive Iodine
2. Thyroidectomy
76
Main sx for Addison's Primary Adrenal Insufficiency - 5
1. HYPERKalemia
2. hypOnatremia
3. Wt loss
4. fatigue
5. GI sx
77
Describe Euthyroid Sick Syndrome
*Euthyroid Sick (low T3) Syndrome*
syndrome characterized by **ISOLATED low T3** that can occur anytime the body is "sick"
78
When would you say a pt has subclinical hypothyroidism
elevated TSH but normal T4 and T3
## Footnote
*T3 remains normal until late stages of hypothyroidism*
79
What are the two most common thyroid CA
Papillary \> Follicular
80
Which microscopic finding is associated with Papillary Thyroid CA?
Psammoma bodies (large lamellated calcifications with ground glass cytoplasm)
81
Why can't Follicular Thyroid CA be evaluated with fine needle biopsy?
FTC involves **invasion of the tumor capsule** and/or blood vessels which can only be examined via surgical excision
This is also the reason FTC has the tendency to hematogenously spread
82
How does respiratory rate affect Calcium levels?
Tachypnea causes ⬇︎CO2 acid --\> H+ ions dissociate from albumin so they can help maintain pH --\> ⬆︎free albumin which bind to free ionized Ca+ --\> overall ⬇︎ in ionized unbound calcium
83
When is screening for DM (fasting bg or oral glucose tolerance test) recommended?
\>45 yo with BP\>135/80
## Footnote
*and those with additional DM risk factors*
84
cp for Glucagonoma - 3
1. **N**ecrotic Migratory Erythema (perioral, extremities, perineum)
2. **A**nemia
3. **D**iarrhea
85
dx for Glucagonoma
Glucagon \>500
## Footnote
Look for **N**ecrotic Migratory Erythema!
86
Tx for Prolactinoma \>1cm or Symptomatic - 3
1. Cabergoline dopamine agonist OR
2. Bromocriptine dopamine agonist
3. Transsphenoidal resection if refractory
87
Tx for Prolactinoma \>3cm
Transsphenoidal resection
88
How does Hyperthyroidism affect muscle function?
HYPERthyroidism AND hypOthyroidism can both cause myopathy characterized as proximal muscle weakness
89
Graves Ophthalmopathy etx ; risk factors?-2
Activated T cells and **Thyrotropin Autoantibodies** both stimulate retroorbital fibroblast --\> orbital tissue expansion
Smoking, Female
90
In DM, explain how the disease destroys nerves ; compare cp for large nerve fiber vs small nerve fiber damage
deposition of glycosylation products, oxidative stress and microvascular injury all --\> small AND Large nerve damage length dependent axonopathy
small nerves --\> positive sx = pain, pareshtesias
LARGE nerves --\> negative sx = loss of 2TVP, ⬇︎ankle reflexes
91
What is the most common cause of primary hypogonadism in males? ; cp for this?-5
Klinefelter XXY
1. hypogonads (small testes)
2. gynecomastia
3. small phallus
4. hypospadia
5. Cryptochidism
92
The most common enzyme deficiency for Congenital Adrenal Hyperplasia is \_\_\_\_\_\_
cp?-3
21 hydroxylase
1. Virilization (acne, premature adrenarche/pubarche)
2. Loss of Aldosterone
3. Loss of Cortisol
93
Why do pregnant patients or patients started on OCPs require increased doses of levothyroxine if they're taking it
Estrogen --\> ⬇︎clearance of Thyroid Binding Globulin --\> additional TBG binds up all the free T4 --\> ⬇︎free T4
94
What would you expect Radioactive iodine uptake to be in DeQuervain Subactue Thyroiditis
Decreased
## Footnote
The hyperthyroid phase (which eventually becomes hypothyroid) is caused by release of preformed thyroid hormone
95
Thyroid Toxic Adenoma hyperthyroidism MOD
autonomous production of thyroid hormones from hyperplastic thyroid follicular cells
## Footnote
*if multiple uptake present, consider multinodular goiter*
96
How does looking at Thyroglobulin levels help determine etiology of thyroid disease?
Thyroglobulin is the base needed to make thyroid hormone. If thyroid hormone is elevated...and so is thyroglobulin then that means Thyroid is producing a lot of thyroid hormone
If Thyroglobulin is low, then that means thyroid hormone is exogenousouly given
97
What is Conn's syndrome
Primary Hyperaldosteronism
98
List the ophthalmoscopy findings for simple Diabetic Retinopathy - 3 ; What procedure prevents this?
1. microhemorrhages
2. retinal edema
3. exudates
Argon laser photocoagulation
99
What are the precipitants of Pheochromocytoma?-3 ; which medication should be given prior to these precipitants?
1. Anesthesia
2. Surgery
3. General Beta Blcokers (allows unopposed alpha stimulation)
Phenoxybenzamine (irreversible general alpha blocker)
100
PTHrelatedProtein is associated with Cancer (Humoral Hypercalcemia of Malignancy)
What is the major mechanism difference between PTHrP and PTH
true PTH ⬆︎ conversion of 25VitaminD to 1-25VitaminD
## Footnote
*PTHrP comes from SQC, renal, bladder, breast, ovarian CA*
101
What are the triggers of Thyrotoxicosis - 5
1. iodine contrast
2. infection
3. childbirth
4. surgery
5. trauma
102
What is Milk Alkali Syndrome
HYPERcalcemia from excessive intake of PO Ca+ supplement and absorbable alkali usually in pts taking Ca+ supplement for osteoporosis
103
Refeeding Syndrome etx
surge of insulin after severe starvation --\>
VERY LOW **MPK**
1. **M**g
2. **P**hosphorous
3. **K**+
104
What is the best way to monitor a pt being treated for DKA - 2
1. Serum Anion Gap
2. Beta Hydroxybutyrate levels
105
Primary Hyperparathyroidism and Familial hypocalciuric Hypercalcemia both present with serum Ca+ that is _____ (low/high)
How do you differentiate the two?
HIGH
FHH = urine calcium:creatinine ratio \< 0.01
Primary Hyperparathyroidism = ucc\>0.02
106
Sialadenosis etx
NONinflammatory swelling of the salivary glands caused by liver disease or malnutrition (DM, bulimia)
107
In DKA and HONK management, when do you hold the insulin?
K\<3.3
## Footnote
*Remember that ALL DKA and HHONK pts are Total Body K+ depleted due to osmotic diuresis regardless of what serum values say*
108
In DKA and HONK management, when do you add dextrose 5% to the IVF replenishment?
glucose≤200
109
In DKA and HONK management, when do you consider using Sodium Bicarbonate?
pH\<6.9
110
Demeclocycline MOA ; Indication?
inhibits ADH-mediated renal cortical collecting duct aquaporin insertion; SIADH
111
Tolvaptan MOA ; Indication?-2
V2 vasopressin R blocker ;
1. SIGNIFICANT Hypervolemia secondary to HF
2. refractory SIADH
112
In pts with Diabetes Insipidus, how do you differentiate between Central and Nephrogenic causes?
Water Deprivation Test
## Footnote
give Demopressin AVP after water deprivation and if urine becomes more concentrated = Central DI. If no change = nephrogenic DI. This is ALSO helpful for r/o Primary Polydipsia
113
cp for Primary Hyperparathyroidism
Asymptomatic Hypercalcemia
## Footnote
*Hypercalcemia sx: Painful Bones, Renal Stones, Abd Groans and Psychic Moans*
114
Struma Ovarii etx
**RARE** - ovarian teratoma produces thyroid hormone --\> Hyperthyroid state
115
cp for Thyroid Storm - 3
Hot, Head and Heart
1. Hot = Fever
2. Head = CNS dysfunction with tremor
3. Heart = Tachycardia, palpitations, HTN, HF
tx = Propranolol --\> PTU ---(1 hr later)--\> Potassium Iodine and CTS
116
tx for Thyroid Storm - 4
## Footnote
Thyroid storm can be triggered by iodine contrast, surgery, trauma, infection
Hot, Head and Heart
Propranolol --\> PTU ---(1 hr later)--\> Potassium Iodine and CTS
117
A DM pt is not well managed on single therapy Metformin
Out of the other DM drug classes, which is most effective for inducing weight loss?
GLP1 agonist (exenaitde, liraglutide)
118
A DM pt is not well managed on single therapy Metformin
When is it appropriate to consider adding insulin?
HBA1c\>8.5%
119
A DM pt is not well managed on single therapy Metformin
Out of the other DM drug classes, which have the potential to actually cause weight gain?-3
1. Insulin
2. Sulfonylurea
3. Meglitinides
120
cp for McCune Albright syndrome-3 ; etx?
1. **P**recocious puberty
2. **P**igmented cafe au lait spots
3. **P**olyostotic fibrous dysplasia --\> bone defects
etx = autonomous activity of endocrine tissue from defect in cAMP kinase
121
etx for Prader Willi Syndrome ; cp?-4
**PATERNAL** deletion of chromo15q11 thru 13 ;
1. Hyper**P**hagia --\> **P**hat (Obesity), Gastric rupture, DM2
2. hypOtonia
3. short stature
4. Mentally retarded
122
etx for Angelman Syndrome ; cp?-4
**maternal** deletion of chromo15q11 thru 13 ;
1. Frequent s**M**iling/Laughter (Moms make you smile)
2. Hand Flapping
3. short stature
4. mentally retarded
123
The most common enzyme deficiency for Congenital Adrenal Hyperplasia is \_\_\_\_\_\_
Which lab value is diagnostic for this deficiency?
21 hydroxylase
⬆︎17 Hydroxy**PROGESTERONE**
124
What should you suspect in a pt with Hashimoto chronic lymphocytic Thyroiditis who develops B-symptoms?
Conversion of Hashimoto to Thyroid Lymphoma
125
How is the Thyroid related to Bone homeostasis?
Thyroid hormone ⬆︎osteoclast activity --\> bone loss
