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PANCE > 7. Endocrine > Flashcards

7. Endocrine Flashcards

1
Q

Hormone Physiology Pathoway

Thyroid/Adrenal/Overies

A

Thyroid

  • TRH (HypoThalamus) -> TSH (Pituitary) -> T3/4 (Thyroid gland)
  • CRH (HypoThalamus) ->ACTH (Pituitary) -> Cortisol (Adrenal gland)
  • GnRH (HypoThalamus) ->FSH, LH (Pituitary) -> Overies - Estrogen, Progesterone, Testes - Testosterone
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2
Q

Hypo vs Hyper thyroid

Sx

Radioactive iodine test (RAIU) results

A

Hypo (slow)

  • Cold intolerance
  • Dry skin, weight gain
  • Hypoactivity
  • Bradycardia

Hyper (fast)

  • Hot intolerance
  • Wet skin, warm
  • Hyperactivity
  • Tachycardia

RAIU results

  • Diffuse uptake - Graves (hyper)
  • Decrease uptake - Thyroditis (Hypo)
  • Hot nodule - Toxic adenoma
  • Multiple Nodules - Toxic Multinodular goiter
  • Cold Nodules - Rule out malignancy
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3
Q

New born infant with low thyrodism

Name/Tx

A

Name: Cretinism

Tx: Levothyroxine

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4
Q

LOW Free T3/4 + LOW TSH

Name/Dx

A

Name: Euthyroid Sick Syndrome

Dx: LOW free T3/4, LOW TSH

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5
Q

Hypermetabolic state (fever, tachycardia, A Fib)

Name/Dx/Tx/Overdose

A

Name: Thyroid Storm

Dx: TSH low, T3/4 high

Tx: Propanolol -> PTU(methimazole) -> Iodine -> hydrocortisone

Overdose: BB + Dexamethasone

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6
Q

Bradycardia + hypoglycemia + hyponatremia

Name/Dx/Tx

A

Name: Myxedema crisis

Dx: HIGH TSH, LOW T3/4

Tx: IV Levothyroxine

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7
Q

Thryoid bruit + Lid lag + exophthalmos

Name/Dx/Tx

A

Name: Grave’s disease

Dx

  • TSH LOW, T3/4 High
  • Thyroid stimulating ab +
  • RAIU - Diffuse uptake

Tx

  • Iodine (MC)
  • Methimazole/PTU
  • Propanolol
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8
Q

Enlarge thyroid + but no eye or skin change + Dysphagia

2 possible Name/Dx/Tx

A

Name: TMG (Toxic multinodular goiter)

Dx

  • LOW TSH, HIGH T3/4
  • RAIU - Patchy area high and low uptake

Name: TA (Thyroid adenoma)

Dx

  • LOW TSH, HIGH T3/4
  • RAIU - Local high uptake (Hot nodule)

Tx: Iodine, PTU (preferred in pregnancy)

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9
Q

Difficulty swallowing due to enlarge thyroid + Cold Nodule

Name/Risk/PE(benign vs maligancy)/Dx/Tx

A

Name: Thyroid Nodule

Risk: age 60 or more

PE

  • Benign: smooth, firm
  • Maligant: rapid growth, fixed in place, no movement with swallowing

Dx

  • FNA with biopsy
  • RAIU - cold nodule (highly suspicious for malignancy)

Tx

  • Surgery
  • Observation
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10
Q

Thyroid Ab present + High TSH, LOW T3/4

Name/Dx/Tx

A

Name: Hashimoto’s thyroditis

Dx

  • Thyroid ab presents
  • HIGH TSH, LOW T3/4

Tx: Levothyroxine

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11
Q

Painful Tender Neck thyroid

Name/Cause/Dx/Tx/

A

Name: de QUERVAIN’s Thyroiditis

Cause: Post Viral infection

Dx: ESR high + No Thyroid Ab

Tx: ASA

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12
Q

Thyroid Carcinoma type/Risk/MET/Tx

A
  • Papillary (MC)
    • Risk: hx of acne, radiation exposure
    • MET: Cervical lymph node
    • Tx: thyroidectomy
  • Follicular
    • Risk: hx of radiation exposure
    • MET: distant METS (lung, brain)
    • Tx: Thyroidectomy
  • Medullary
    • Risk: Not related with radiation exposure, associated with MEN2
    • Tx: Thyroidectomy
    • MET: early cervical lymph, later distant (lung, brain)
  • Anaplastic
    • Risk: hx of radiation exposure
    • MET: Trachea
    • Tx: chemo, No surgery
    • Most aggresive/poor prognosis
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13
Q

Stones, bones, abdominal, groans, psychic moans

Name/MC cause/PE/Dx/Tx

A

Name: Hyperparathyroidism

MC cause: Parathyroid adenoma

PE: decrease DTR

Dx: Serum Increase calcium + increase PTH + decrease Phophate

Tx: Surgery

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14
Q

hx of thyroid surgery + Trousseau’s & Chvostek’s sign

Name/Dx/Tx

A

Name: Hypoparathyroidism

Etio: hx of thyroid surgery

Dx: Low calcium, Low PTH, High Phosphate

Tx: Calcium supplementation & Vitamin D

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15
Q

Prolonged QT interval + chvostek sign

2 type Name/Dx/Tx

A

2 type of hypocalcemia

  • Hypocalcemia + PTH low - MC hypoparathyroid
  • Hypocalcemia + PTH high - Vit D deficiency

Dx: Ca low + ECG - Prolong QT interval

Tx

  • Calcium gluconate IV - Severe
  • PO calcium + Vitamin D - mild
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16
Q

Shortened QT interval + kidney stone + bones

2 type Name/Dx/Tx

A

Name

  • Primary Hypercalcemia - High PTH, Low phosphate
  • Malignancy Hypercalcemia - Low PTH

Dx: Ca low + Shorten QT interval

Tx

  • Mild - No treatment needed
  • IV saline + furosemide (1st)
    • HCTZ avoid
  • calcitonin, bisphonates (severe)
17
Q

Post menopausal women + frequent fx + loss of vertebral height

Name/2 Major cause/Dx/Tx

A

Name: Osteoporosis

2 Major Cause

  • Menopause
  • prolonged use of corticosteroid

Dx: Dexa scan (2.5 below osteoprosis, 1.0-2.5 ostepenia)

Tx: Bisphosphonate (alendronate) + Vit D

18
Q

Spontanous fx in childhood

Name/Other sx

A

Name: Osteogenesis Imperfecta

Other sx: Blue tinted sclera, presenile deafness

19
Q

Long bone bowing or fontanel closure delay

2 type Name/Dx/Tx

A

Name

  • Osteomalacia - bowing bone + adult
  • Rickett - fontanel delay closure, growth delay

Dx: Vit D low, Ca low, Phosphate low, Alkaline high

  • X-ray: looser line

Tx: Vit D

20
Q

Ca low, Phosphate high + bone pain

Name/Dx/Tx

A

Name: Renal osteodystrophy

Dx: Lab PO4 high + Ca low

  • X-ray (salt and paper appearance of the skull)
  • Cystic brown tumor on biopsy

Tx: Phosphate binder + Vit D

21
Q

Hyperpigmentation + hx of corticosteriod usage

2 type name/Lab value/Dx/Tx

A

Name: Chronic Adrenocortical insufficiency

  • Primary (addison) - Adrenal gland destruction
  • Secondary - exgenous steriod use MC

Lab: Hyponatremia + Hyperkalemia + Metabolic Acidosis

Dx

  1. ATCH @ 8am initial screening test (Normal - increase cortisol, No increase cortisol means addision possible)
  2. CRH given if low cortison to find any pituitary vs adrenal
    • ACTH rise + cortisol low (ACTH works so this is adrenal problem)
    • ACTH low + cortisol low (No effect on ACTH means pituitary problem)

Tx: Glucocorticoid (Hydrocortisone) + Mineralocorticoid (Fludrocortisone)

22
Q

Shock (low BP, hypovolumia) + hx of abruptive withdrawal of glucocorticoids

Name/Dx/Tx

A

Name: Acute adrenal crisis

Dx: HyperK, HypoNa, Hypogly

Tx: IV normal saline + IV Corticosteriod

23
Q

Moon facies, buffalo hump

Name/Sx/Dx/Tx

A

2 type name

  • Cushing syndrome - cortisol excessive
  • Cushing disease - pituitary adenoma

Sx: Moon facies, buffalo hump, central obesity, wasting extremities, belly striae

Dx: Screening initial

  • Dextametasone test (should be supressed cortisol level which means normal)
  • Cortisol collecting (24 hrs urine)
  • Salivary cortisol

If initial test is positive then go for Plasma ACTH Level check

  • ACTH level low - Adrenal adenoma or carcinoma
  • ACTH level normal high - Pituitary adenoma or Ectopic
    • High dose dexamethasone suppressing test (Dex supress the ACTH -> low cortisol (normal))
      • if high Dose DM does not effect - ectopic
      • if high Dose DM supress - Pituitary adrnoma

Tx

  • Cushing disease - transsphenoidal surgery
  • Ectopic ACTH tumor - tumor remove
  • Iatrogenic steriod therapy - Gradual tapering
24
Q

HTN + hypoK + polyuria

Name/Dx/Tx

A

Name

  • 1° Hyperaldosteronism - idiopathic
  • 2° Hyperaldosteronism - Renal artery stenosis

Dx

  • Lab: HypoK
  • Renin ratio screening: ARR>20, Plasma aldosterone>20
  • Saline infusion test (Definitive)

Tx

  • Spironolactone
  • Angioplasty
25
Q

Urine metanephrine presents

Name/Sx/Dx/Tx

A

Name: Phechromocytoma

Sx: PHE (palpitation, HA, Excessive sweating)

Dx: 24h urinary catecholamine

Tx: Complete adrenalectomy

  • Phenoxybenzamine or phentolamine first + BB (esmolol or labetalol)
26
Q

Amenorrhea + Galactorrhea

Name/Dx/Tx

A

Name: Prolactinomas

Dx: MRI

Tx: Carbergoline, Bromocriptine

27
Q

Enlargement of Jaw, hand, Feet

Name/Dx/Tx

A

Name: Somatotropinoma

Dx: MRI

Tx: Transsphenoidal surgery (TSS) + Bromocriptine

28
Q

Hx of spironolactone, ketoconazole + enlargement of breast in males

Name/Risk/Tx

A

Name: Gynecomastia

Risk: hx of spironolactone, ketoconazole

Tx: SERM (selective estrogen modulators) - tamoxifen

29
Q

Polyuria + Polydipsia + Polyphagia

3 type name/4 type Complication/Risk/Dx/Screening/Tx

A

3 type

  • Type 1 DM - Genetic, childhood DKA
  • Type 2 DM - insuline resistance, impairment of insulin
  • Gestational diabetes

4 type complication

  • Neuropathy
  • Retinopathy - cotton wool, dot, flamed shape hemorrage
  • Nephropathy - microalbuminuria
  • Macrovascular - may leads to CAD, PVD, stroke

Risk - CHAOS

  • Chronic HTN, Atherosclerosis, Obesity, Stroke

Dx

  • Fasting plasma glucose: 126<
  • A1C: 6.5<
  • 2hr glucose tolerance test: 200<

Screening

  • ADA: 45 q3 or BMI 25 above + 1 risk factor
  • USPSTF: any 40-70 BMI 25 above

Tx

  • Diet (most important), exercise
  • Glucose - Hgb A1C <7.0
  • Lipid - LDL <100, HDL >40, TG <150
  • Neuropathy - gabapentin
  • Retinopathy - DM control
  • Nephropathy - ACE Inhibitors
30
Q

Insulin Type/Onset time/Coverage

Name

A
  • Rapid acting/5-15min/same time of meal
  • Short acting/30-1h/give 30-60min before meal
  • Intermediate/2-4h/Half day
  • Long acting/6-8h/1 day

Name

  • Rapid acting - lispro, aspart
  • Short acting - Regular
  • Intermediate
    • Humulin N, Novolin N (NPH)
    • Humulin L, Novolin L (Lente)
  • Long acting
    • Lantus, Levemir
31
Q

Dawn Phenomenon vs Somogyi effect

A

Dawn - hyperglycemia middle of night (2am-8am)

  • Tx: give insulin before bed time

Somogyi - hypoglycemia middle of night

  • Tx: decrease insuline before bed or give snack before bed time
32
Q
  • Bigunides Name/MOA/SE
  • Sulfonylureas Name/MOA/SE
  • Meglitides Name/MOA/SE
  • Alpha glucosidase inhibitors Name/MOA/SE
  • TZD Name/MOA/SE
  • GLP-1 agonist Name/MOA/SE
  • DDP4 Inhibitor Name/MOA
  • SGLT-2 inhibitor Name/MOA
A
  • Metformin/hepatic production/Lactic acidosis, Cr>1.5
  • Glipizide, Glyburide, Glimepiride/Pancreatic production/Hypoglycemia + weight gain + disulfiram like
  • -glinide/Pancreatic production/Hypoglycemia
  • Acarbose, Miglitol/Delays intestinal glucose absorption/Hepatitis
  • -glitazone/adipose & muscle tissue/MI(Avandia), CHF
  • Exenatide, Liraglutide/mimics incretin, Delay gastric empty/Contraindiacate hx of gastroparesis
  • -gliptin/inhibit GLP-1 degradation
  • -gliflozin/inhibit renal glucose threshold (urinary glucose excretion)
33
Q

DKA vs HHS

Patho/Sx/PE/Dx/Tx

A

Patho

  • Patho DKA: hypergly -> dehydration ->ketone -> K low
  • Patho HHS: hypergly ->dehydration -> K low

Sx

  • Special DKA - abd pain
  • Special HHS - mental change

PE: DKA - kassmaul breathing, fruity with acetone smell

Dx: HHS - 600<, DKA - 250< + ketone

Tx

  1. IV fluid saline 0.9 -> glucose 250 -> change to 0.45
  2. Insulin
  3. K repletion
  4. Bicarb
34
Q

Metabolic dx criteria

A
  1. HDL <40
  2. BP >135, >85
  3. Trigly >150
  4. blood sugar >100
  5. Waist >40

PANCE (12 decks)

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