Brian's Endocrinology Flashcards
What is the first line treatment for a patient who presents with palpitations and nervousness secondary to hyperthyroidism?
-Beta blockers
What is Hashimoto’s disease?
-an autoimmune cause of hypothyroidism
How does levothyroxine work?
-It is a synthetic T4
What is the most common thyroid cancer?
-Papillary, makes up about 80% of all thyroid cancers.
In a patient with hyperthyroidism will TSH most likely be elevated or decreased?
-Decreased
How do fibrates work to affect the lipid profile?
-They inhibit synthesis of VLDL and elevate lipoprotein lipase
What medication might you use prior to thyroidectomy in a patient with hyperthyroidism?
-Methimazole or propylthiouracil (PTU)
What is included in Whipple’s triad of hypoglycemia?
- Hx of previous hypoglycemia
- serum glucose of < 40
- immediate recovery upon administration of glucose
Positive antithyroid peroxidase and antithyroglobulin antibodies should make you think of what diagnosis?
-Hashimoto’s
What is the treatment for Myxedema?
-Levothyroxine and slow warming
What is the most common cause of hypoparathyroid?
-Post thyroidectomy with the complication of parathyroidectomy.
What is Chvostek’s sign?
-Tap on facial nerve and get a twitch with low Ca.
Cortical adrenal insufficiency is also know as what disease?
-Addison’s disease
What is Trousseau’s sign?
-Inflate BP cuff and hold for 3 minutes. Patient with low Ca will get carpel tunnel symptoms.
What is the most common cause of hyperparathyroidism?
-Single parathyroid adenoma in 80% of cases.
In Cushing’s disease is ACTH elevated or decreased?
-Elevated
What is Grave’s disease?
-The most common cause of hyperthyroidism. It is an autoimmune disease.
What specific breathing pattern is associated with diabetic ketoacidosis?
-Kussmaul respirations, a deep and labored breathing pattern
What is the least aggressive thyroid cancer?
-Papillary
Name two tests you might use to rule out Cushing’s syndrome?
-24 hour free cortisol urine test and dexamethasone suppression test
List two ectopic tumors that may produce ACTH and give a patient Cushing’s syndrome?
- Small cell lung cancer
- pancreatic islet cells
- thymomas
What is the treatment for Addison’s disease?
-Hydrocortisone or prednisone
What is the test to begin if you suspect a pheochromocytoma?
-24 hour urine for catecholamines
Exophthalmos should make you think of what diagnosis?
-Hyperthyrodism
What percentage of diabetes in the US is Type II ?
- 80-90 %
HLA-DR gene is a marker for what endocrine disorder?
-DM type 1
What is the main function of parathyroid hormone?
-Increase serum Ca
List four diagnostic criteria for diabetes?
- Random glucose > 200
- fasting glucose >126
- two hour postprandial glucose >200
- HgA1c > 6.5%
Moans, groans, stones, and bones describe symptoms of what endocrine problem?
-Hyperparathyroid
Stocking glove anesthesia should make you think of what diagnosis?
-Diabetic neuropathy and B12 deficiency neuropathy
Fruity breath should make you think of what diagnosis?
-Diabetic ketoacidosis
As it relates to diabetics, what is the dawn phenomenon?
-Reduced insulin response between 5 and 8 am.
What is the most common cause of hypopituitarism?
-Tumor
How does metformin work? (trade name Glucophage)
-Decreases the hepatic glucose production and increases peripheral glucose uptake
How do sulfonylureas work?
-They stimulate the production of insulin.
What class of medications does piogliazone (Actos) fall into?
-Thiazolidinediones also known as glitazones.
What is the suffix associated with sulfonylureas?
-ide is the suffix. Examples: glipizide, tolbutamide, tolazamide.
Typically what is the first medication started in type 2 DM?
-Metformin
How often should a diabetic’s HgbA1c be checked and what lever should it be?
-Every three months (remember the life of an RBC is 90-120 days) and it should be below 6.6%
What are the 5 criteria for metabolic syndrome?
- HDL < 40 men, BP 135/85
- Triglycerides > 150
- Fasting glucose > 100
- Waist > 40 inches in men, > 35 inches women
What class of medications is the first line treatment for lowering LDL?
-Statins
Which lipid medication may cause flushing?
-Niacin
What life threatening side effect do statins have?
-Rhabdomyolysis
Does niacin increase or decrease HDL?
-increase
What medication class does metformin (Glucophage) fall into?
-Biguanide
List the 5 insulins in order of peak efficasy?
- Lispro 1-2 hours
- Regular 2-4 hours
- NPH 5-7 hours
- Lente 4-8 hours
- Ultralente 8-14 hoursj
Is metformin indicated or contraindicated in renal failure?
-Contraindicated
What is the most common cause of DM type 1?
-Autoimmune destruction of the islet cells in the pancreas.
List 4 physical exam findings for Cushing’s syndrome?
- Moon face
- buffalo hump
- purple striae
- central obesity
- supraclavicular fat pads
- easy bruising
Propranolol belongs to what class of medication?
-Beta blockers
During pregnancy which is the preferred treatment of hyperthyroidism – PTU or methimazole?
-PTU
List 4 thyroid cancers?
- Papillary
- Follicular
- Medullary
- Anaplastic
What endocrine complication is relevant to endocrinology?
-Adrenal infarct leading to a Cushing’s syndrome.
How does nicotinic acid work to affect the lipid profile?
-It inhibits secretion of VLDL.
Hyper pigmentation of the skin along creases should make you think of what diagnosis?
-Addison’s disease
Which thyroid cancer is the most aggressive?
-Anaplastic