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Sam: Endocrine > Clin Med > Flashcards

Clin Med Flashcards

1
Q

Nervous system for ______ homeostasis responses

A

quick

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2
Q

Endocrine system for _______ homeostasis responses

A

long

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3
Q

Endocrine system is mostly _______ hormones (transferred via the blood).

A

trophic

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4
Q

Epinephrine, dopamine, T3 and T4 are examples of?

A

Amines (modified amino acids)

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5
Q

Aldosterone, cortisol, estradiol, and testosterone are examples of?

A

Steroid hormones

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6
Q

There are two big groups of hormones – ones that come from ________ and ones that come from ________.

A

amino acids

cholesterol (aka amines/peptides and steroids)

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7
Q

How do modes of action differ between polar and non-polar molecules?

A

Polar bind to membrane receptors/cell surface receptors and non-polar pass through the membrane and bind to intracellular receptors.

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8
Q

All the lipid soluble molecules are derived from ________.

A

cholesterol

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9
Q

________ comes from the cortex and the adrenal gland. _________ and _________ come from the adrenal medulla.

A

Cortisol

Norepinephrine and Epinephrine

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10
Q

Growth hormone stimulates the liver to produce what hormone?

A

IGF-1

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11
Q

What hormone inhibits the anterior pituitary?

A

Somatostatin

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12
Q

When is growth hormone secreted and what/when is it inhibited?

A

Secreted: hypoglycemia, fasting, starvation, stress

Inhibited: increased glucose levels, free fatty acid release, obesity, cortisol

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13
Q

Growth hormone excess before puberty is known as?

Growth hormone after puberty is known as?

A

Gigantism

Acromegaly

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14
Q

Gigantism effects what type of bones?

Acromegaly effects what type of bones?

A

Long bones

Bones in the extremities

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15
Q

What inhibits intestinal calcium absorption, inhibits osteoclasts, and stimulates osteoblast activity in bones?

A

Calcitonin

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16
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s (in the US) but i’m pretty sure it’s iodine deficiency world wide

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17
Q

Most common cause of hyperthyroidism?

A

Graves Disease

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18
Q

What increases catabolism of fat and muscle tissues, free fatty acids and their use for energy, gluconeogenesis, and blood glucose level?

A

Cortisol

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19
Q

Hypotension, high CRH levels, and hypoglycemia are all symptoms of?

A

Addison’s

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20
Q

What element is essential for manufacture of thyroid hormones?

A

Iodine

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21
Q

What are the most informative tests of thyroid function?

A

TSH (extremely sensitive) and free T4

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22
Q

What is a normal range of thyroid hormone?

A

0.27-4.2 mU/L

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23
Q

Thyroid stimulating hormone receptor antibodies will be elevated in 80% of patients with ____________.

A

Graves Disease

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24
Q

What is the definitive test for evaluating thyroid nodules and is essential for diagnosing thyroid cancer?

A

Fine needle aspiration

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25
Q

What disease will have elevated levels of TPO and Tg antibodies?

A

Hashimoto’s

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26
Q

Cold intolerance, constipation, dry skin, and hair loss are symptoms of?

A

Hashimoto’s

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27
Q

What drug do we use to treat hypothyroidism?

A

Levothyroxine

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28
Q

Is it essential to detect congenital hypothyroidism to prevent?

A

Cretinism

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29
Q

If you’re trying to determine between a thyroid nodule and Graves disease, what test can we do?

A

Do a radioactive isotope scan – if there’s a nodule involved, only the nodule will light up

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30
Q

Can we as PA’s treat Graves?

A

Nah. Have to refer to endooooo

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31
Q

What is a clinical syndrome associated with excessive levels of thyroid hormone?

A

Thyrotoxicosis

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32
Q

What do we mean by “factitious” hyperthyroidism?

A

Someone has hyperthyroidism by taking too much thyroid hormone

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33
Q

Hyperactivity, irritability, restlessness, and anxiety are symptoms of?

A

Graves Disease

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34
Q

Proptosis/exophthalmos and “lid-lag” are symptoms of?

A

Graves Disease

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35
Q

What drugs do we use to treat hyperthyroidism?

A

Propylthiouracil (PTU) or Methimazole

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36
Q

What is common side effect of Thiourea drugs?

A

Pruritis

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37
Q

Important to monitor patients for signs and symptoms of _____ ______ during the initial 6 months of thiourea use

A

liver injury

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38
Q

Methimazole or PTU is associated with birth defects?

A

Methimazole

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39
Q

What is the treatment of choice for Graves?

A

Radioactive Iodine

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40
Q

What is the treatment of choice for Graves in children or hyperthyroidism during pregnancy when symptoms can’t be controlled with drugs?

A

Thyroid surgery

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41
Q

What does the prognosis look like for Graves patients?

A

Recurrences common if only treatment is thioureas

42
Q

If we have a toxic thyroid nodule, how do we treat it?

A

If the patient is younger than 40 years old surgery is preferred over RAI. If older than 40 RAI is preferred over surgery.

43
Q

What is the most common type of thyroid cancer?

A

Papillary

44
Q

What is a risk factor for thyroid cancer?

A

Prior head and neck radiation or radiation exposure.

45
Q

Aldosterone is secreted from where in the kidney?

A

Outer layer of adrenal cortex

46
Q

Cortisol is secreted from where in the kidney?

A

Middle and inner adrenal cortex

47
Q

Is Cushing’s syndrome more commonly associated with endogenous or exogenous sources?

A

Exogenous –> glucocorticoid administration

48
Q

What is the difference between Cushing’s Disease and Cushing’s syndrome?

A

Cushing’s disease is a tumor on the pituitary secreting excessive ACTH and Cushing’s syndrome is a tumor on the adrenal gland.

Note: there are other causes of cushing’s syndrome –

49
Q

What are some signs and symptoms of Cushing’s Disease?

A

“moon facies”, abdominal protuberance, “buffalo hump”, supraclavicular fact.

Hypertension, oligomenorrhea, osteopenia and osteporosis

50
Q

What tests do we do to diagnose Cushing’s?

A

Dexamethasone suppression test

can also do a 24 hour urine free cortisol/creatinine

51
Q

If you have a patient with fatigue, weakness, and hypotension – what must you keep in your DDx?

A

Adrenal insufficiency

52
Q

What patients are at risk for adrenal insufficiency?

A

those taking exogenous corticosteroids

53
Q

Chronic adrenal insufficiency —- you think of?

A

Addison’s disease

and JFK. my he RIP.

54
Q

Signs and symptoms of Addison’s?

A

Weakness, fatigue, wt. loss, myalgias – symptoms are very non-specific.

Low BP, orthostasis, hyperpigmentation of skin

55
Q

Low AM cortisol level – think of?

A

Addison’s

56
Q

What is a diagnostic test we can do for Addison’s?

A

Cosyntropin (synthetic ACTH) stimulation test – provides measure of renal reserve

57
Q

What is the name of a tumor of the adrenal medulla that releases excessive amounts of norepineprhine/epinephrine into the circulation?

A

Pheochromocytoma

58
Q

What is the hallmark of Hypoparathyroidism?

A

Low ionized Ca

59
Q

What is the hallmark of hyperparathyroidism?

A

elevation of serum total and ionized Ca

60
Q

Does hyperparathyroidism cause chronic trabecular or cortical bone resorption?

A

Cortical

61
Q

If i say “moans, groans, stones, and bones” you say?

A

Hyperparathyroidism

62
Q

What has to be on you DDx with hypercalcemia?

A

Malignancy – tumor mets to bone (breast, lung, pancreas, kidney)

63
Q

What is the most common metabolic bone disease?

A

Osteoporosis

64
Q

Osteoporosis leads to breakdown of trabecular or cortical bone more?

A

Trabecular

65
Q

What drug is the best at rebuilding bone density?

A

Teriparatide

66
Q

What percentage of Trabecular bone is lost over 10 years?

A

25-30%

67
Q

What percentage of Cortical bone is lost over 10 years?

A

10-15%

68
Q

What is first line therapy for osteoporosis?

A

Calcium and Vitamin D

69
Q

What bones does a DEXA scan look at?

A

Spinal bone, proximal femur, and other bones risk for fracture

70
Q

How do bisphosphonates work?

A

They inhibit osteoclastic bone resporption

71
Q

When we prescribe Fosamax what instructions do we have to give?

A

Take 30 minutes before AM meal with eight ounces of water and remain upright for 30 minutes to prevent esophagitis and do the chicken dance and chug a PBR.

72
Q

Serum IGF-1 5x normal is associated with?

A

Acromegaly

73
Q

How do we treat acromegaly?

A

Transsphenoidal microsurgery

74
Q

What is the most common cause of hyperprolactinemia?

A

Pituitary microadenoma

75
Q

In resting state, muscle energy is supplied by?

A

Fatty acids

76
Q

Circulating _______ will prevent ketosis not hyperglycemia?

A

insulin

77
Q

What is a major factor in insulin resistance?

A

Central/visceral obesity

78
Q

What range of A1c is considered pre-diabetes?

A

5.7-6.4%

79
Q

Why do we put diabetics on aspirin?

A

Because they have abnormal platelet function

80
Q

What are the ABC’s of diabetes?

A
  1. Aspirin
  2. Blood pressure
  3. Cholesterol
81
Q

What drug do we use as adjunct therapy to metformin, and has adverse effects such as hypoglycemia and weight gain?

A

Second generation Sulfonylureas – Glipizide

82
Q

What drug to treat diabetes causes flatulence and diarrhea and 60% of people d/c the drug because of these problems?

A

Alpha-Glucosidase Inhibitors (acarbose)

83
Q

What drugs act primarily on peripheral tissues, decrease insulin resistance and increase insulin sensitivity?

A

TZD’s (pioglitazone)

84
Q

Is hypoglycemia associated with TZDs? Is weight gain?

A

No hypoglycemia, but yes weight gain

85
Q

What oral diabetic agent causes weight loss?

A

SGLT2-inhibitors (Canaglifozin, Dapaglifozin)

86
Q

Are GLP-1 Receptor Agonists an oral medication?

A

No! Injection – alternative to insulin. Do not cause weight gain and show to have a decreased incidence of hypoglycemia.

87
Q

What is the best way to prevent retinopathy?

A

Tight glycemic control

88
Q

Nephropathy develops as a result of chronic ________ and uncontrolled _________.

A

hyperglycemia, hypertension

89
Q

What is the test of choice for Nephropathy?

A

Spot AM urine for albumin/Cr

90
Q

If our patient is only losing a teeny tiny bit of protein in their urine do we have to start an ACE?

What if their BP is normal, do we still start an ACE?

A

YUP

YEAH DOG

91
Q

Decreased sensation in “stocking glove” distribution should make you think of?

A

Neuropathy

92
Q

What happens to your lipids with hyperthyroidism?

A

Low HDL and high total triglycerides

93
Q

“Fruity breath” should make you think of?

A

DKA

94
Q

DKA will result in ________ acidosis with an _________ anion gap.

A

Metabolic, increased

95
Q

When referring to glycemic control in type 2 diabetes, we want their postprandial plasma glucose to be less than….

A

180

96
Q

When referring to glycemic control in type 2 diabetes, we want their preprandial plasma glucose to be between…

A

80 and 130

97
Q

What drug decreases hepatic glucose production and increase insulin sensitivity?

A

Metformin

98
Q

What class of drugs increase insulin sensitivity, glucose uptake, and improves metabolism?

A

TZD’s

which is confusing because modest weight gain is associated with TZDs

99
Q

What kind of patients can we not use TZD’s in?

A

Those with CHF and hepatic disease

100
Q

Fluid retention should make you think of what class of drugs?

A

TZD’s

Sam: Endocrine (3 decks)

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