9 - Endcrinology, Rheumatology, Allergology, and Immunology 2025 (Updated)

Metformin

Best initial medical therapy for diabetes mellitus

• Sulfonylureas

• Thiazolidinediones

• Insulin

Antidiabetic agents promoting weight gain

• Metformin

• Alpha-glucosidase inhibitors

• SGLT2 inhibitors

• GLP1 receptor agonist

Antidiabetic agents promoting weight loss

Low HDL, High Tg, High LDL

Pattern of dyslipidemia in Diabetes

Dawn phenomenon

Patients with diabetes may experience this phenomenon wherein glucose levels rise in the early morning as growth

hormone and cortisol secretion peak

Somogyi effect

A phenomenon that can be tied to evening timing of insulin doses

Hypoglycemia

Most serious complication of therapy for diabetes mellitus

IV hydration and insulin administration

Best step in the management of DKA

Pemberton sign

Presents as venous distention over the neck and difficulty breathing especially when the arms are raised, seen in large retrosternal goiters

Tachycardia

Most common sign of thyrotoxicosis

Hyperactivity, irritability, dysphoria

Most common symptom of thyrotoxicosis

Stimulates Na+/K+ ATPAse pump causing trancellular shift

Mechanism of hypokalemia in thyrotoxic hypokalemic periodic paralysis

Struma ovarii

Ovarian tissue that makes active thyroid hormones

Jod-Basedow phenomenon

It happens when an iodine-deprived thyroid is exposed suddenly to an iodine-rich diet. The thyroid avidly takes up more iodine and the thyroid machinery produce more FT4 and FT3

Iodine deficiency

Most common cause of hypothyroidism worldwide

Dry coarse skin, cool peripheral extremities

Most common sign of hypothyroidism

Tiredness, weakness

Most common symptom of hypothyroidism

TSH

Single best tool used in the assessment of thyroid status

Papillary thyroid cancer

Most common type of thyroid cancer

Calcitonin

Biomarker of medullary thyroid cancer

Thyroglobulin

Biomarker of papillary thyroid cancer, anaplastic thyroid cancer, follicular thyroid cancer

GH → FSH / LH → TSH → ACTH

Sequential loss of hormones during pituitary compression

Osteoarthritis

Most common type of arthritis; most common cause of chronic knee pain in persons >45 years old

Joint space loss or narrowing

Typical radiographic finding in osteoarthritis

Bouchard’s nodes

PIP joint hypertrophy in OA

Heberden’s nodes

DIP joint hypertrophy in OA

Nodular RA, Splenomegaly, Neutropenia

Components of Felty syndrome

Methotrexate

Initial treatment of choice in the management of RA

Anti-CCP antibodies

Single most accurate test in the diagnosis of RA

Swan neck deformity

Hyperextension of the PIP joint with flexion of the DIP joint

Boutonniere deformity

Flexion of the PIP joint with hyperextension of the DIP joint

Cardiovascular disease

Most common cause of death in Rheumatoid Arthritis

Perimysial and Perivascular inflammation

Feature of Dermatomyositis on muscle biopsy

Endomysial and Perivascular inflammation

Feature of Polymyositis on muscle biopsy

Metatarsophalangeal joint of the 1st toe

Most commonly involved joint in gout

Allopurinol

First-line urate lowering drug among patients with gout

ANA

Best screening test for SLE

Anti-dsDNA

Associated with disease activity of SLE

Anti-Sm

Specific for SLE but has no other disease correlations

Anti-Ro (SS-A)

Associated with congenital heart block and sicca syndrome among SLE patients

Anti-histone

Associated with drug-induced SLE

Class IV

Most common and most severe type of lupus nephritis

Epinephrine 0.3-0.5 mL of 1:1000 (1mg/ml) IM with repeated doses at 5-20 min intervals as needed for a severe reaction

Treatment of first choice for anaphylaxis

Avoidance from triggers

Most effective means of controlling allergic disease and preventing anaphylaxis