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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
Indications for stress dosing during glucocorticoid treatment for adrenal insufficiency
Illness with fever/critical illness; surgery; delivery; adrenal crisis
26
Purple striae/easy bruising
Cushing's
27
Moon face
Cushing's syndrome
28
Treatment-resistant HTN, possible endocrine cause
Hyperaldosteronism | Most common curable cause of HTN
29
S/s of hypokalemia
Muscle weakness/cramping/tetany Palpitations/arrhythmias Polyuria/nocturia Lethargy/diminished concentration/mood disorders
30
HTN + signs of hypokalemia
Suspicious for primary hyperaldosteronism
31
HTN + sleep apnea
Screen for hyperaldosteronism
32
Red face when raising arms
"Pemberton's Sign" --> big ass thyroid nodule (mass effect)
33
Imaging when patient is in hypo- or euthyroid state
Ultrasound
34
High-risk characteristics of thyroid nodules
``` Taller than wide Hypoechoic (looks solid) Irregular margins or "fingers" Microcalcification Hypervascularity > 4 cm ```
35
Imaging when patient has hyperthyroidism
Radioactive iodine uptake
36
You find a thyroid gland mass in your patient. Are you more concerned if your patient has hypo- or hyperthyroidism?
Hypothyroidism + mass is more suspicious for cancer than hyper
37
What is the most specific lab to order if Hashimoto's Thyroiditis is suspected?
TPO antibodies
38
What is the most specific lab to order if Grave's disease is suspected?
TSI (TRab)
39
What is the cut-off size for a thyroid nodule fine needle aspiration?
1 cm (aspirate anything over this size)
40
Headache + vision changes
Pituitary mass (most common = pituitary adenoma; concern for MEN if other tumors are present)
41
Imaging for suspected pituitary mass
MRI
42
Tx for pituitary adenoma
Transsphenoidal microadenomectomy
43
Hypoaldosteronism does not occur with ___ adrenal insufficiency
Secondary (adrenal gland is fine; aldosterone is primarily regulated by renin-angiotensin system)
44
Important to remember when patient needs both levothyroxine and steroids
Always administer steroids first
45
What must be done before dx Cushing's Disease?
R/o exogenous glucocorticoid use with 1+ test - late PM salivary cortisol - 24 hr urine collection - Overnight dexamethasone suppression test
46
Tx for Cushing's Disease
Transphenoidal microadenomectomy
47
Cushing's Disease vs Syndrome
``` Disease = pituitary mass Syndrome = effects of too much glucocorticoids ```
48
When suspicious of a problem with GH, what lab should be ordered?
IGF-1: GH is pulsatile so IGF-1 is a better measure
49
What is the usual cause of gigantism?
Hypothalamic GHRH excess | Very rarely a pituitary problem
50
Dx of gigantism?
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
Risks associated with acromegaly
Increased risk of colon, esophagus, stomach, and melanoma cancers
52
Dx of acromegaly
- Elevated IGF-1 - GH suppression test (administer glucose) failed (somatostatin does not inhibit GH) - MRI
53
Tx for acromegaly
Transphenoidal microadenomectomy - Somatostatin can be administered
54
Dx of GH deficiency
- 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
Galactorrhea
Hyperprolactinemia Often from prolactinoma on pituitary Consider MEN I
56
Tx for hyperprolactinemia
Dopamine agonist such as cabergoline or bromocriptine
57
Workup for patient with suspected low LH/FSH pituitary production
Check TSH and prolactin Do NOT work up if menses are regular!
58
Considerations when administering estrogen
If given to patient with a uterus, MUST administer progesterone with estrogen
59
Considerations when administering testosterone
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
Cause of DI
Central: Decrease in ADH release from posterior pituitary Nephrogenic: Decreased sensitivity to ADH in kidney
61
>3 L/day urine production
DI
62
Desmopressin administration -> concentrated urine
DI dx
63
Tx for DI
Desmopressin | Monitor BNP
64
Metabolic Syndrome Dx criteria
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
Considerations when using Phentermine + Topiramate for weight loss
Caution in pts with cardiac hx (perform EKG first) Can cause insomnia Can increase libido TERATOGENIC
66
Considerations when using Bupropion + Naltrexone for weight loss
Do not use pts with hx of eating disorders Naltrexone with make opioids (including pain meds) ineffective
67
Considerations when using Liraglutide for weight loss
Contraindicated in patients with hx of medullary thyroid cancer or pancreititis Can cause nausea- start low and titrate up
68
Considerations when using orlistat for weight loss
Don't use with fat-soluble meds such as coumadin
69
Which weight loss meds are approved in pregnancy?
None
70
Target LDL, DMII pt
<100 | <70 if CVD is present
71
Target HDL
> 40
72
Target TGs
< 150
73
Target BG, DM patient
70-130 fasting | <180 2 hrs post prandial
74
Normal fasting blood glucose
80 - 100 mg/dL
75
Genes associated with Paget's
RANK | SQSTSM1
76
Osteoclasts with ~100 nuclei
Paget's
77
PTH is suppressed by ...
Hypercalcemia Vitamin D (increases absorption of Ca in intestine) FGF-23
78
PTH is increased by ...
Hypocalcemia | Hyperphosphatemia
79
< 12 mg/dL Ca++
Mild hypercalcemia
80
12 - 14 mg/dL Ca++
Moderate hypercalcemia
81
> 14 mg/dL Ca++
Severe hypercalcemia
82
"Bones, groans, thrones, stones, and psychiatric overtones"
Symptoms of hypercalcemia: ``` Bones: pain Groans: muscle weakness and bone pain Thrones: GI symptoms + polyuria Stones: Kidney stones Psych overtones: mental status changes ```
83
Shortened QT intervals
Hypercalcemia
84
Hypercalcemia + hypophosphatemia + increased PTH + increased Ca++ in urine
Primary hyperparathyroidism Usually caused by a solitary adenoma; may be associated with MEN I or II
85
Indications for surgery in primary hyperparathyroidism
- 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
Tx for primary hyperparathyroidism
``` Calcium mimetic (cinacalcet) Bisphosphonates Vit D replacement Monitor: - Ca++ - Bone density - Renal function - Urine Ca+ ```
87
Normal Ca+ levels
8.9 - 10.3 mg/dL
88
Hypocalcemia Hyperphosphatemia Low PTH
Hypoparathyroidism
89
Chvostek's sign
Facial muscle twitch in response to tap Hypocalcemia
90
Trousseau's sign
Spasm caused by inflating BP cuff Hypocalcemia
91
Prolonged QT
Hypocalcemia
92
Numbness, cramps, tetany, broncho/laryngospasm
Hypocalcemia
93
< 7.5 mg/dL Ca++
Severe hypocalcemia
94
7.5 - 8.5 mg/dL Ca++
Mild hypocalcemia
95
T score < 2.5, no fragility fx
Osteoporosis
96
T score < 2.5 with fragility fx
Severe osteoporosis
97
Normal T score
1+
98
Elevated PTH Elevated ALP Low Vit D
Osteomalacia -- bone biopsy is gold std dx
99
Organs associated with MEN I
Parathyroid Pancreas Pituitary
100
Facial angiofibromas
MEN I
101
Rash on lower half of body
Associated with glucagonoma; think pancreatic tumor (MEN I)
102
Cutaneous lichen amyloidosis
MEN II
103
Medullary thyroid cardinoma
MEN II or II Contraindication for tx of any condition (weight loss or DM) with Liraglutide
104
RET oncogene
MEN II
105
Menin gene
MEN I
106
Consideration in patient with medullary thyroid carcinoma and high PTH levels
Suggests MEN II - Prophylactic thyroidectomy by 6 YO
107
Consideration in patient with medullary thyroid carcinoma and mucosal neuromas
Suggests MEN III - Prophylactic thyroidectomy by 6 months

Endocrinology (6 decks)

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