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Flashcards in Study Guide Info Deck (105):
1

is gynecomastia normal in pubertal boys?

Yes, in 70%

2

Drugs that can cause gynecomastia

alcohol
spironolactone
cimetidine
ketoconazole

3

Cause of gynecomastia

estradiol excess either from decrease in androgen production or increase in estrogen production

4

What is the genotype XXY called?

Klinefelter's syndrome

5

what will labs be like with Klinefelter's syndrome (FSH, LH< testosterone)

Elevated FSH and LH
low testosterone

6

What will be seen w/ Klinefelter's patients at puberty

varying degrees of hypogonadism
gynecomastia
small, firm testes <2 cm, azoospermia
tall and lnaky

7

are Klinefelter's patients fertile or infertile

often infertile or reduced fertility

8

What is the absence of 1st menses by age 16?

primary amenorrhea

9

labs to get w/ primary amenorrhea

hCG
FSH
LH
prolactin
TSH

10

most common cause of primary amenorrhea?

ovarian failure (Hypergonadotropic hypogonadism) followed by mullerian agenesis

11

What is mullerian agenesis

congenital absense of femal genital tract
results in primary amenorrhea

12

Structural causes of primary amenorrhea

vaginal obstruction
cryptomenorrhea
imperforate hymen
mullerian agenesis
absence of uterus

13

Gonadal causes of primary amenorrhea

17-alpha hydroxylase deficiency
dysgensis
resistant ovary
pregnancy

14

2 adrenal causes of primary amenorrhea

congenital adrenal hyperplasia
PCOS

15

development in women of androgen-dependent terminal body hair in a male pattern (excessive androgenic effect)

Hirsutism

16

most common disorder w/ hirsutism

PCOS (need abdominal US)

17

Medical tx for hirsutism

OCP
cimetidine
metformin (if PCOS)
spironoolactone or ketoconazole
GNRH agonist

18

tumors that can cause hirsutism

ovarian tumors (arrhenoblastoma and hilar cell)
adrenal tumors (cushing- adrenocortical carcinoma)

19

Drugs that can cause hirsutism

anabolic steroids (methyltestosterone, oxandrolone)
danazole
some OCPs

20

most common cause of galactorrhea

prolactinoma

21

how do women w/ a prolactinoma present?

amenorrhea and infertility

22

hypothalamic/ pituitary diseases that cause hyperprolactinemia

granulomatous dz (infiltration)
compression of pituitary stalk
acromegaly
primary hypothyroidism

23

what causes normal prolactin galactorrhea?

local breast stimulation/ irritation
OCP
recent pregnancy
stress

24

cessation of menses for >3 months in woman with previously normal cycle

secondary amenorrhea

25

most common cause of secondary amenorrhea

prengnacy

26

ovarian causes of secondary amenorrhea

chronic anvoluation
PCOS
premature menopause
ovarian tumor

27

what is scarring of the endometrium that can lead to secondary amenorrhea?

asherman's syndrome

28

adrenal causes of secondary amenorrhea

cushing's
androgen secreting tumor
adrenocortical insufficiency
congenital adrenal hyperplasia

29

Hypothalamic-pituitary dysfunction causes of secondary amenorrhea

exercise (athlete triad)
stress
eating disorders
hyperprolactinemia

30

consumption of what food suppressed progesterone effects and can lead to secondary amenorrhea?

papaya

31

how can hemochromatosis lead to secondary amenorrhea?

deposition of iron in the ovary

32

drugs that cause gyencomastia

spironolactone
cimetidine
flutamide

33

physiologic causes of gynecomastia

puberty
recovery from chronic illness/ starvatin
old age

34

A male with pseudohermphroditism due to absense of androgen receptors. Have cryptorchid testes. Elevation in serum testosterone

Testicular feminization

35

this deficiency causes males be unable to convert testosterone to a dihydrotestosterone resulting in a bifid scrotum, hypospadias. At puberty scrotum, phallus and muscle mass will enlarge though.

5 alpha-reductase deficiency

36

What differs the signs and symptoms of type 1 DM from type 2?

No ketosis or ketonuria in Type 2

37

what is a common initial complaint in men w/ T2DM?

erectile dysfunction

38

recurrent candidal vaginitis can be an early tip off to what?

DM

39

which type of diabetes has a stronger genetic component?

Type 2

40

main risk factor for T2DM?

central obesity then sedentary lifestyle

41

is gestational diabetes usually symptomatic?

No, usually asymptomatic

42

risks for gestational DM

marked obesity
personal hx
delivery of a previous large baby
glycosuria
PCOS

43

starting dose for insulin for DMT1

0.4-1.0 micrograms/kg per day

44

typical initial Rx for DMT2

metformin or sulfonylurea

45

cornerstone of management of T2DM?

diet and exercise

46

when is insulin the first therapy of choice w/ T2DM?

fasting glucose >240

47

2 makers associated w/ T1DM?

HLA-DR3
HLA-DR4

48

what causes destruction of the beta cells w/ T1DM?

autoantibodies (cytotoxic T cells)

49

what is the period where there is recovery of some of the beta cell function so exogenous insulin level needs drop w/ T1DM?

honeymoon period

50

T1DM is sometimes believed to follow what?

infectious or toxic insult (mumps, coxsackie)

51

onset w/ rapid acting insulins (Humalog, Novolog)

5-15 minutes

52

peak of rapid acting insulin

1-1.5 hours

53

duration of rapid acting insulins

3-4 hours

54

onset of regular (Humulin or Novolin R) insulins

30-60 minutes

55

peak of regular insulins

2 hours

56

duration of regular insulins

6-8 hours

57

onset of NPH (humulin or novolin N) insulins

2-4 hours

58

peak of NPH insulins

6-7 hours

59

Duration of NPH insulins

10-20 hours

60

Onset of insulins glargine (lantus)

1.5 hours

61

peak w/ insulin glargine (lantus) and insulins determir (levermir)

flat

62

duration of insulin glargine (lantus)

24 hours

63

duration of insulin determir (lantus)

17 hours

64

patients taking excess doses or oral hypoglycemic agents have high levels of what?

insulin
C-peptide

65

what does C-peptide tell you?

tell the difference between insulin produced by the body and insulin injected into the body.
It is produced if insulin is made by the pancreas

66

what do low values of c-peptide indicate?

pancreas is producing little or no insulin

67

what is reactive (postprandial) hypoglycemia?

symptoms occur w/i 4 hours of eating a meal

68

what causes low blood sugar w/o any symptoms

loss of glucagon and epinephrine responses over time
autonomic dysfunction
delayed counterregulatory responses of GH and cortisol

69

Criteria for DKA

Hyperglycemia (plasma glucose level of >250 mg/dL)
Ketosis: moderate to severe ketonemia and moderate ketonuria
Acidosis: pH < or equal to 7.3 or bicarb < or equal to 15 mEq/L

70

physiologic types of cushing's syndrome

stress
last trimester of pregnancy
persons who do strenuous exercise

71

pathologic causes of cushing syndrome

exogenous steroids
severe psychiatric states (depression or alcoholism)

72

ACTH dependent causes of Cushings syndrome

pituitary sources
ectopic ACTH
rare ectopic sources of CRH-tumors

73

ACTH independent causes of cushings syndrome

adrenal adenomas/ carcinomas
micronodular adrenal dz
autonomous macronodular adrenal dz

74

what is used to discern b/w cushing's disease and syndrome

high dose dexamethasone suppression

75

Autoimmune destruction of adrenal glands - most common cause of primary adrenal insufficiency

Addison's Dz

76

causes of addison's

TB
autimmune adrenalitis
sarcoidosis
histoplasmosis
amyloidosis
hemochromatosis
adrenal hemorrhage

77

thyrotoxicosis in Graves disease is due what?

the overproduction of an antibody that binds the TSH receptor.

78

Occurs in older patients with long-standing multinodular goiter, especially in patients from iodine-deficient regions who are exposed to increased dietary iodine or receive iodine-containing radiocontrast dyes.

toxic multinodular goiter

79

T3 and T4 levels are normal with a suppressed TSH.

subclinical hyperthyroidism

80

classified as acute, subacute, and chronic. Initial presentation is due to acute release of T4 and T3.

thyroiditis

81

from the destruction of normal thyroidal architecture by lymphocytic infiltration results in hypothyroidism and goiter.

Hashimoto or lymphocytic thyroiditis

82

results from ingestion of excessive amounts of thyroxine often in an attempt to lose weight.

Thryotoxicosis Factitia

83

T4 and T3 levels are normal or low with mildly elevated TSH

Subclinical hypothyroidism

84

weight gain with cushings

obesity is centripetal, with a wasting of the arms and legs
buffalo hump
moon face

85

common sx of cushings in younger adults

thinning of the skin on the top of the hands

86

lab findings in cushing's

elevated plasma alkaline phosphtase levels , glucose intolerance,

87

most common form of thyroid cancer

papillary carcinoma

88

presentation of thyroid cancer

painless neck swelling and single, palpable non-tender firm mass
often feels stony and hard

89

what type thyroid cancer presents w/ flushing, diarrhea, fatigue and cushing's syndrome

medullary carcinoma

90

most common cause of hyperthyroidism

Grave's disease

91

what is MEN IIA (sipple)?

medullary carcinoma of the thyroid
hyperparathyroidism
pheochromoctyoma

92

What is MEN IIB?

medullary carcinoma of the thyroid
mucosal neuromas
intestinal ganglioneuromas
marfanoid habitus
pheochromoctyoma

93

presents w/ HTN, hypervolemia, hypokalemia, hypernatremia, muscle wekaness, fatigue, HA

hyperaldosteronism

94

more common presentations in females w/ pituitary prolactinoma

anovulation
oligomenorrhea or amenorrhea
infertility
galactorrhea

95

male presentation w/ pituitary prolactinoma

erectile dysfunction
infertiliy
decrease muscle mass
galactorrhea
gynecomastia

96

what do patients w/ Addison's Dz need before undergoing surgery

150-300 mg hydrocortisone

97

Adverse rxns following a thyroidectomy

hypoparathyroidism
recurrent laryngeal nerve severed (hoarseness)

98

typical approach for a pituitary resection

transsphenoidal surgery

99

what can reduce risk of nodule growth and decrease size, but is controversial

levothyroxine

100

how to manage a benign thyroid nodule

observe nodule for 1 year after inital bx
recheck seize by US (q 6-12 months)
perform another bx if enlarging

101

Manifestatiosn of peripherals vascular dz

ischemic skin ulcers
claudication
limb loss

102

first line for distal sensory neuropathy

TCAs (have anticholinergic ADRs)

103

S/S of autonomic insufficiency with DM neuropathy

postural HPOTN
impotence
urinary retention

104

Drug that can tx gastroparesis

metoclopramide

105

Tx for diarrhea w/ DM?

broad spectrum (neomycin or tetracycline)