Monday, September 1, 2014

1. Eplerenone is a selective mineralocorticoid antagonist with low affinity for progesterone/androgen receptors, so it'll block aldosterone excess without causing libido effects or gyencomastia or menstural irregularities, like spironolactone can. useful for medical management of aldosterone secreting tumor or adrenal hyperplasia.
2. Androgen insensitivity: 
- Androgen receptors insensitive to testosterone
- Elevated T (within normal male ranges 300-1100 but over normal female ranges 20-80)
- Normal testes develop, secrete mullerian inhibiting factor leading to agenesis of upper vagina, uterus, fallopian tubes
- Normal breasts as testosterone is converted to estrogen peripherally
- VS mullerian agenesis, which have absence of same internal organs but XX karyotype and normal female levels of T
- Random fact: Wolffian ducts become seminal vesicles, epididymis, ejaculatory ducts, and ductus deferens
3. DDx of primary hypoparathyroidism: 
- Post surgical (most common - after thyroid or parathyroid resection)
- Autoimmune hypoparathyroidism (most common after surgical)
- Congenital absence of parathyroids (ie DiGeorge)
- Infiltrative replacement of parathryoids (ie. Wilson's, hemochromotosis, neck radiation)
- Defective calcium sensing receptor (I guess it would be the opposite of familial hypocalciuric hypercalcemia)
4. Hyperparathyroidism:
- Primary: parathyroid hyperplasia, adenoma, (rare) carcinoma
- Secondary: vitamin D deficiency or renal failure (cannot convert 25-OH vitamin D to 1,25-OH vitamin D). Leads to low serum Ca, thus serum PTH elevates to compensate, which leads to Phos losses in urine. {source}
5. Congenital diseases:
- Toxo: chorioretinitis, intracranial calcifications, hydrocephalus, hepatosplenomegaly, lymphadenopathy, microcephaly, micropthalmia
- Rubella: Cardiac anomalies (PDA, ASD), congenital deafness, cataracts, congenital glaucoma
- Syphillis: fever, osteitis, osteochrondritis, mucocutaenous lesions, persistent rhinitis
- HSV: encephalitis, chorioretinitis, but no structural congenital malformations (ie microcephaly)
6. management of acute limb ischemia from embolus: 
- IV heparin
- IA tPA or embolectomy with either vascular surgery or IR
7. Pancreatic pseudocyst:
- Not a true cyst as lacks epithelial layer; actually surrounded by fibrous capsule
- Diagnose with ultrasound
- Indication for draining: not resolved after 6 weeks, >5cm, superinfected
- May erode into blood vessel causing hemorrhage
- Can complicate acute or chronic pancreatitis
8. Other bad things that can happen to pancreas:
- Hemorrhagic pancreatitis (presents like hemorrhagic shock + necrotic pancreas)
- Infected pancreatitic necrosis - occurs 1-2 weeks after acute pancreatitis with infection picture then septic shock picture. Manage with surgery
- Pancreatic ascities: rupture of pancreatic duct or cyst into peritoneal cavity - abd distention + shifting dullness
- pancreatic abscess: tender epigrastic mass, fever, leukocytosis
9. Blastomycosis
- Can cause ulcerating skin lesions, lytic bone lesions, lung lesions that resemble TB, "B symptoms" (weight loss, night sweats, etc)
- Highest infection rate is wisconsin, affects great lakes, ohio, mississippi river basins
- Broad based budding yeast
- Tx with itraconazole, amphotericin B
10. Bone conditions:
- Avascular necrosis: steroid use, lupus, sickle cell, alcoholism
- Osteitis deformans = paget's disease, increased osteoclast activity
- Osteitis fibrosa cystica = von recklinghausen disease. Occurs with severe hyperparathyroidism- primary (carcinoma), secondary, or tertiary.

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