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3P/Certification Exam > APA Endocrine > Flashcards

APA Endocrine Flashcards

1
Q

Parathyroid regulates which mineral?

A

Calcium

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2
Q

Pt who is on metformin but struggling decreasing FBS, what is a good second choice drug?

A

Sulfonylurea (Glipizide/Glucotrol, Glyburide/Diabets) decreased FBS as well as postprandial.

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3
Q

For a pt on metformin but struggling with postprandial spikes but maintaining fbs, what second line therapy would be beneficial?

A

DPP4 (sitagliptin/Januvia), SGLT2 (Canagliflozin/Invokana or Empagliflozin/Jardiance) are both oral agents that exert action mostly on postprandial glucose level

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4
Q

Patient with hypotension, hypoglycemia, n/v, loss of appettie, pale in appearance with muscle fatigue and slow/sluggish movements should be screened for what condition?

A

Addisons (adrenal isufficiency) would have low am cortisol levels

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5
Q

How is addisons disease treated?

A

Corticosteroid replacent & ample sodium after potential insensible fluid loss.

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6
Q

How would a patient with Cushings disorder present?

A

Progressive weight gain increased abd obesity, fatty deposits upper back (buffalo hump), striae on abd, moon facies, thin and fragle skin (easily bruises), fatigue/muscle weakness, and hirsutism.

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7
Q

What tests would be done to confirm cushings disorder?

A

AM cortisol level (high)

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8
Q

What drug is used to reduce symptoms in hyperthyroid crisis?

A

Beta blockers (propranolol)

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9
Q

A non-tender and fixed thyroid nodule >4cm with dysphonia is likely to be?

A

Malignancy

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10
Q

In >4cm thyroid nodule with elevated TSH, what is the most common next step?

A

FNA (nodule is not metabolically active)

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11
Q

If TSH is low with a large thyroid nodule, what is the next step?

A

Nuclear med thryoid scan
Hot- metabolically active: radioactive ablation or surgery
Non hot- metabolically inactive: FNA

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12
Q

What laboratory findings are suggestive of hyperparathyroidism?

A

elevated Ca+and PTH

With low K+/Pho_

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13
Q

When TSH is low or normal BUT t4 is low, what is the likely condition?

A

Secondary hyperthyroidism (pituitary/hypothalmic disease)

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14
Q

Loss of lateral third of eyebrows and thin/brittle nails is suggestive of?

A

Hypothyroidism

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15
Q

Patient with hypothyroidism, what additional laboratory findings and associated conditions may be present?

A

Hyperlipidemia, macrocytic anemia, and hyopnatremia

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16
Q

What TSH levels generally indicate need for treatment with levothyroxine?

A

TSH >10, although 4.5-10 would consider based on clinical presentation

17
Q

What is the usual starting dose and treatment protocol for levothyroxine in hypothyroidism?

A

Levothyroxine starting 25-5mcg and increasing 12.5-60mcg q 2 mo until TSH normalizes. Usually dose is 1.6mcg/kg/d

18
Q

How should patients be instructed to take levothyroxine?

A

In am (same time) on empty stomach without any other medications

19
Q

When should branded version of levothyroxine (synthroid) be considered?

A

When unable to regulate with generic, some pts cannot metabolize generic.

20
Q

Armour thyroid is ____?

A

Dessicated T3 and T4

It is not recommended for cardiac pts, older and pregnant women.

21
Q

Low TSH but normal FT4/T3- what condition is likely present and what test should be ordered?

A

Subclinical hyperthyroidism (order radioactive uptake and scan)

22
Q

What tests should be done w/ palpable nodules?

A

Thyroid scan

23
Q

How does acute adrenal Insufficiency usually presents?

A

Shocky: hypotension, N/V anorexia, confusion, weakness, fever

24
Q

Common causes of acute adrenal insufficiency?

A

Sudden and abrupt cessation of steroids
Pituitary destruction, adrenalectomy/trauma
Stress,trauma, infection or prolonged fasting in someone with Addisions disease

25
Q

Chronic adrenal insufficiency is known as?

A

Addisons disease

26
Q

What are the hallmark laboratory signs suggestive of addison’s disease?

A

Hypotension and hyperkalemia

27
Q

What are common signs of addison’s disease

A

Excessive pigment, volume and sodium depletion, chronic maliase/weakness/fatigue, anorexia n/v, scant pubic and axillary hair. Can have mild to mod depression and psychosis.

28
Q

What is the treatment for addison’s disease

A

Lifelong replacement of gluticosteroids and mineralcorticoids

29
Q

Addisons disease is caused by?

A

Autoimmune destruction of adrenal cortices which causes chronic cortisol, aldosterone and adrenal androgen deficiency.

30
Q

Common causes of cushing’s?

A

Syndrome: Adrenal hyperplasia or tumor, extra-adrenal tumors, Chronic glucocorticoid use

Disease: pituitary adenoma causing ACTH hypersecretion

31
Q

What are common findings in cushings?

A

Truncal obesity, moon facies, buffalo hump, purple striae abd, thin extremities, progressive weight gain, acne, UE/LE weakness

32
Q

Pts who have episodic HTN, HA, tachycardia and sweating should be evaluated for?

A

Pheochromocytoma- a tumor in the adrenal gland
Lab: 24hr urine (elevated catecholamines, metanephrines and Cr)
+UA: CT abd w & w/o oral/IV contrast

33
Q

FSH stimulates what?

A

Ovarian growth of egg and production of estrogen

34
Q

LH (luteinizing hormone) stimulates what?

A

Ovulation, production of progesterone (by corpus luteinizing)
Males- stimulates testicular production of testosterone

35
Q

GH (growth hormone) stimulates what?

A

Somatic growth

36
Q

ACTH stimulates what?

A

Adrenal glands, production of glucocorticoids (cortisol) and mineralcorticoids (aldosterone)

37
Q

Prolactin stimulates what?

A

Lactation and milk production

38
Q

What gland produces melatonin?

A

Pineal

39
Q

What are the two anti-thyroid drugs and which one is safe in pregnancy?

A

Methimazole (tapazole)- teratogenic

Propylthiouracil (PTU)- may be used in pregnancy

3P/Certification Exam (14 decks)

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