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Endocrinology > Clin Med Buzzwords and Highlights > Flashcards

Clin Med Buzzwords and Highlights Flashcards

1
Q

Lytic lesions

A

Paget’s disease

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2
Q

Elevated alkaline phosphatase

A

Paget’s disease

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3
Q

Increase in head size

A

Paget’s disease

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4
Q

Tx for Paget’s disease

A

IV bisphosphonates (ex: Zoledronate) after ensuring GFR > 35 and Vitamin D is adequate

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5
Q

Hyperpigmentation

A

Occurs with primary adrenal insufficiency

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6
Q

Presence of 21-hydroxylase antibodies

A

Addison’s disease

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7
Q

Tx for Addison’s disease

A
  • Hydrocortisone if pt can manage 2-3 doses/day
  • Prednisone for less compliant patients
  • Flurdrocotrisone if mineralcorticoid deficiency is present
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8
Q

Buffalo hump

A

Cushing’s syndrome

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9
Q

Exopthalamos

A

Grave’s

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10
Q

BMI criteria for screening pts for DM

A

> 25 or
23 in Asian pt

+ one additional risk fx
(FHx; CVD/HTN/PCOS Hx; inactivity)

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11
Q

A1c Levels for pre/DM

A

> 5.7% = preDM

>/= 6.5% = DM

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12
Q

Diagnostic BG levels for DM

A

Fasting: >126
Random w/sx: >200
2 hour OGTT: > 200

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13
Q

Diagnostic BG levels for preDM

A

Fasting: 100-125
Random: 140-199
2 hour OGTT: 140-199

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14
Q

Lab for dx DM1

A

GAD65 (antibodies vs. B-cell proteins- may be negative in DM1 patient so cannot r/o, use only to confirm)

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15
Q

Adult with new onset DM and positive GAD65 test

A

Latent autoimmune DM in adulthood (LATA)

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16
Q

Glycemic targets for gestational DM

A

Fasting: 60-99

Post-prandial: 100-129

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17
Q

Rash/ulcer on front of shins

A

Diabetes (necrobiosis lipoidica)

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18
Q

Where is the location of dysfunction in secondary adrenal insufficiency?

A

Pituitary gland

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19
Q

Where is the location of dysfunction in tertiary adrenal insufficiency?

A

Hypothalamus

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20
Q

Loss libido; amenorrhea and loss of axillary and pubic hair in women

A

Adrenal insufficiency

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21
Q

Lab findings in adrenal insufficiency

A 
Low Na
High K
High Ca
Anemia
Hypoglycemia
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22
Q

What is the gold standard diagnostic test for adrenal insufficiency?

A

Cosyntropin stimulation test

Cosyntropin mimics the actions of ACTH and other corticotropic agents may be used.

Levels <18 ug/dL at 30/60 minutes indicate adrenal insufficiency

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23
Q

ACTH 2x or more upper range of normal plus low cortisol

A

Primary adrenal insufficiency

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24
Q

ACTH <5 and low cortisol

A

Secondary adrenal insufficiency (pituitary problem)

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25
Q

Indications for stress dosing during glucocorticoid treatment for adrenal insufficiency

A

Illness with fever/critical illness; surgery; delivery; adrenal crisis

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26
Q

Purple striae/easy bruising

A

Cushing’s

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27
Q

Moon face

A

Cushing’s syndrome

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28
Q

Treatment-resistant HTN, possible endocrine cause

A

Hyperaldosteronism

Most common curable cause of HTN

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29
Q

S/s of hypokalemia

A

Muscle weakness/cramping/tetany

Palpitations/arrhythmias

Polyuria/nocturia

Lethargy/diminished concentration/mood disorders

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30
Q

HTN + signs of hypokalemia

A

Suspicious for primary hyperaldosteronism

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31
Q

HTN + sleep apnea

A

Screen for hyperaldosteronism

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32
Q

Red face when raising arms

A

“Pemberton’s Sign” –> big ass thyroid nodule (mass effect)

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33
Q

Imaging when patient is in hypo- or euthyroid state

A

Ultrasound

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34
Q

High-risk characteristics of thyroid nodules

A 
Taller than wide
Hypoechoic (looks solid)
Irregular margins or "fingers"
Microcalcification
Hypervascularity
> 4 cm
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35
Q

Imaging when patient has hyperthyroidism

A

Radioactive iodine uptake

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36
Q

You find a thyroid gland mass in your patient. Are you more concerned if your patient has hypo- or hyperthyroidism?

A

Hypothyroidism + mass is more suspicious for cancer than hyper

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37
Q

What is the most specific lab to order if Hashimoto’s Thyroiditis is suspected?

A

TPO antibodies

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38
Q

What is the most specific lab to order if Grave’s disease is suspected?

A

TSI (TRab)

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39
Q

What is the cut-off size for a thyroid nodule fine needle aspiration?

A

1 cm (aspirate anything over this size)

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40
Q

Headache + vision changes

A

Pituitary mass (most common = pituitary adenoma; concern for MEN if other tumors are present)

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41
Q

Imaging for suspected pituitary mass

A

MRI

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42
Q

Tx for pituitary adenoma

A

Transsphenoidal microadenomectomy

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43
Q

Hypoaldosteronism does not occur with ___ adrenal insufficiency

A

Secondary (adrenal gland is fine; aldosterone is primarily regulated by renin-angiotensin system)

44
Q

Important to remember when patient needs both levothyroxine and steroids

A

Always administer steroids first

45
Q

What must be done before dx Cushing’s Disease?

A

R/o exogenous glucocorticoid use with 1+ test

  • late PM salivary cortisol
  • 24 hr urine collection
  • Overnight dexamethasone suppression test
46
Q

Tx for Cushing’s Disease

A

Transphenoidal microadenomectomy

47
Q

Cushing’s Disease vs Syndrome

A 
Disease = pituitary mass
Syndrome = effects of too much glucocorticoids
48
Q

When suspicious of a problem with GH, what lab should be ordered?

A

IGF-1: GH is pulsatile so IGF-1 is a better measure

49
Q

What is the usual cause of gigantism?

A

Hypothalamic GHRH excess

Very rarely a pituitary problem

50
Q

Dx of gigantism?

A

GH suppression test
(Administer glucose, measure GH response: glucose should trigger release of somatostatin to inhibit GH; in someone with excess GH, somatostatin doesn’t raise to a sufficient level to do this)

51
Q

Risks associated with acromegaly

A

Increased risk of colon, esophagus, stomach, and melanoma cancers

52
Q

Dx of acromegaly

A
  • Elevated IGF-1
  • GH suppression test (administer glucose) failed (somatostatin does not inhibit GH)
  • MRI
53
Q

Tx for acromegaly

A

Transphenoidal microadenomectomy

  • Somatostatin can be administered
54
Q

Dx of GH deficiency

A
  • Low IGF-1
  • ->

GH stimulation test:
Give insulin or glucagon
- this should trigger less somatostatin release
- If GH levels do not increase = GH deficiency

–> MRI of pituitary

55
Q

Galactorrhea

A

Hyperprolactinemia

Often from prolactinoma on pituitary

Consider MEN I

56
Q

Tx for hyperprolactinemia

A

Dopamine agonist such as cabergoline or bromocriptine

57
Q

Workup for patient with suspected low LH/FSH pituitary production

A

Check TSH and prolactin

Do NOT work up if menses are regular!

58
Q

Considerations when administering estrogen

A

If given to patient with a uterus, MUST administer progesterone with estrogen

59
Q

Considerations when administering testosterone

A

Monitor CBC and PSA
Can cause rise in hematocrit
Can cause existing prostate cx to grow
Do not use in pt with hx of heart disease

60
Q

Cause of DI

A

Central: Decrease in ADH release from posterior pituitary

Nephrogenic: Decreased sensitivity to ADH in kidney

61
Q

> 3 L/day urine production

A

DI

62
Q

Desmopressin administration -> concentrated urine

A

DI dx

63
Q

Tx for DI

A

Desmopressin

Monitor BNP

64
Q

Metabolic Syndrome Dx criteria

A

3+ of following:

Waist circumference > 102 (male) or >88 cm (female)

(^ Applicable for Caucasians only; lower standards for pts of other origins)

TG > 150

HDL <40 (male) or <50 (female)

HTN

Fasting BG > 110

65
Q

Considerations when using Phentermine + Topiramate for weight loss

A

Caution in pts with cardiac hx (perform EKG first)

Can cause insomnia

Can increase libido

TERATOGENIC

66
Q

Considerations when using Bupropion + Naltrexone for weight loss

A

Do not use pts with hx of eating disorders

Naltrexone with make opioids (including pain meds) ineffective

67
Q

Considerations when using Liraglutide for weight loss

A

Contraindicated in patients with hx of medullary thyroid cancer or pancreititis

Can cause nausea- start low and titrate up

68
Q

Considerations when using orlistat for weight loss

A

Don’t use with fat-soluble meds such as coumadin

69
Q

Which weight loss meds are approved in pregnancy?

A

None

70
Q

Target LDL, DMII pt

A

<100

<70 if CVD is present

71
Q

Target HDL

A

> 40

72
Q

Target TGs

A

< 150

73
Q

Target BG, DM patient

A

70-130 fasting

<180 2 hrs post prandial

74
Q

Normal fasting blood glucose

A

80 - 100 mg/dL

75
Q

Genes associated with Paget’s

A

RANK

SQSTSM1

76
Q

Osteoclasts with ~100 nuclei

A

Paget’s

77
Q

PTH is suppressed by …

A

Hypercalcemia
Vitamin D (increases absorption of Ca in intestine)
FGF-23

78
Q

PTH is increased by …

A

Hypocalcemia

Hyperphosphatemia

79
Q

< 12 mg/dL Ca++

A

Mild hypercalcemia

80
Q

12 - 14 mg/dL Ca++

A

Moderate hypercalcemia

81
Q

> 14 mg/dL Ca++

A

Severe hypercalcemia

82
Q

“Bones, groans, thrones, stones, and psychiatric overtones”

A

Symptoms of hypercalcemia:

Bones: pain
Groans: muscle weakness and bone pain
Thrones: GI symptoms + polyuria
Stones: Kidney stones
Psych overtones: mental status changes
83
Q

Shortened QT intervals

A

Hypercalcemia

84
Q

Hypercalcemia + hypophosphatemia + increased PTH + increased Ca++ in urine

A

Primary hyperparathyroidism

Usually caused by a solitary adenoma; may be associated with MEN I or II

85
Q

Indications for surgery in primary hyperparathyroidism

A
  • Significantly reduced creatinine clearance (>30% reduction)
  • Ca+ in urine > 400 mg/dL
  • T score worse than -2.5
  • Pt younger than 50
  • Any complication
  • Non-traumatic fx
  • Vit D Deficiency <15 ng/ml
  • Pt in perimenopause
86
Q

Tx for primary hyperparathyroidism

A 
Calcium mimetic (cinacalcet)
Bisphosphonates
Vit D replacement
Monitor:
- Ca++
- Bone density
- Renal function
- Urine Ca+
87
Q

Normal Ca+ levels

A

8.9 - 10.3 mg/dL

88
Q

Hypocalcemia
Hyperphosphatemia
Low PTH

A

Hypoparathyroidism

89
Q

Chvostek’s sign

A

Facial muscle twitch in response to tap

Hypocalcemia

90
Q

Trousseau’s sign

A

Spasm caused by inflating BP cuff

Hypocalcemia

91
Q

Prolonged QT

A

Hypocalcemia

92
Q

Numbness, cramps, tetany, broncho/laryngospasm

A

Hypocalcemia

93
Q

< 7.5 mg/dL Ca++

A

Severe hypocalcemia

94
Q

7.5 - 8.5 mg/dL Ca++

A

Mild hypocalcemia

95
Q

T score < 2.5, no fragility fx

A

Osteoporosis

96
Q

T score < 2.5 with fragility fx

A

Severe osteoporosis

97
Q

Normal T score

A

1+

98
Q

Elevated PTH
Elevated ALP
Low Vit D

A

Osteomalacia – bone biopsy is gold std dx

99
Q

Organs associated with MEN I

A

Parathyroid
Pancreas
Pituitary

100
Q

Facial angiofibromas

A

MEN I

101
Q

Rash on lower half of body

A

Associated with glucagonoma; think pancreatic tumor (MEN I)

102
Q

Cutaneous lichen amyloidosis

A

MEN II

103
Q

Medullary thyroid cardinoma

A

MEN II or II

Contraindication for tx of any condition (weight loss or DM) with Liraglutide

104
Q

RET oncogene

A

MEN II

105
Q

Menin gene

A

MEN I

106
Q

Consideration in patient with medullary thyroid carcinoma and high PTH levels

A

Suggests MEN II

  • Prophylactic thyroidectomy by 6 YO
107
Q

Consideration in patient with medullary thyroid carcinoma and mucosal neuromas

A

Suggests MEN III

  • Prophylactic thyroidectomy by 6 months

Endocrinology (6 decks)

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