Deja - Internal - Endocrinology Flashcards
1
Q
What is the histologic description of Mucor?
A
Non septate hyphae with branching at 90 degrees (looks like the letter M).
2
Q
What are the diagnostic criteria for diabetes?
A
Both types of diabetes are diagnosed based on the same criteria.
A. Fasting glucose over 126 two separate times.
B. Random glucose over 200 with symptoms of diabetes.
C. Glucose tolerance test (2-hour test with 75g glucose load) over 200.
3
Q
Lispro (Humalog) - Peak and duration?
A
Peak: 30-90min.
Duration: 3-5h.
4
Q
Aspart (NovoLog) - Peak and duration:
A
Peak: 40-50min.
Duration: 3-5h.
5
Q
Regular insulin - Peak and duration?
A
Peak: 2-5h.
Duration: 5-8h.
6
Q
NPH - Peak and duration:
A
Peak: 4-12h.
Duration: 18-24h.
7
Q
Lente - Peak and duration:
A
Peak: 3-10h.
Duration: 18-24h.
8
Q
Lantus - Peak and duration:
A
Peak: No peak.
Duration: 20-24h.
9
Q
Levemir - Peak and duration:
A
Peak: 6-8h.
Duration: Up to 24h.
10
Q
Ultralente - Peak and duration:
A
Peak: 10-20h.
Duration: 20-36h.
11
Q
Somogyi effect:
A
Nocturnal hypoglycemia causing elevated morning glucose due to release of counterregulatory hormones.
Treat with less insulin.
12
Q
Dawn phenomenon:
A
Early morning hyperglycemia secondary to nocturnal GH release.
13
Q
In what patients would metformin be absolutely contraindicated?
A
In patients who have compromised kidney function because of concern for lactic acidosis.
14
Q
How do we believe metformin works?
A
Increase sensitivity to insulin.
15
Q
What medication slows the progression of nephropathy in diabetes?
A
ACEIs and ARBs.
16
Q
DKA signs and symptoms:
A
- Severe hyperglycemia (>500).
- Ketoacidosis
- Hyperkalemia
- Fruity breath
- Slow deep breaths.
- Abdominal pain.
- Dehydration.
- Lethargy.
17
Q
What is the most important treatment in DKA?
A
IV fluid hydration - usually with normal saline.
18
Q
What are the most severe complications of DKA treatment?
A
Cerebral edema or cardiac arrest due to hyperkalemia.
19
Q
Hyperosmolar hyperglycemic nonketotic (HHNK) coma - Signs and symptoms:
A
- Hypovolemia.
- Hyperglycemia (glucose can be >1000).
- NO KETOACIDOSIS.
- Renal failure.
- Altered mental status.
- Seizure.
- DIC.
- Often precipitated by acute stress such as trauma or infection.
20
Q
DKA and HHNK coma - Difference?
A
There is NO ketoacidosis.
21
Q
HHNK - Treatment:
A
- Mortality is >50% - Treatment is urgent.
- Rapid IV fluid resuscitation.
- Insulin and K are usually needed earlier than in DKA because the intracellular shift of plasma K during therapy is accelerated in the absence of acidosis.
22
Q
What are the 2 mechanisms by which a prolactinoma causes symptoms?
A
- Endocrine effect: due to hyperprolactinemia.
2. Mass effect: Prepare of the tumor on surrounding tissues.
23
Q
What CN can be affected by a prolactinoma?
A
CN III
24
Q
How is prolactinoma diagnosed?
A
MRI or CT.
25
How is acromegaly diagnosed?
1. MRI/CT demonstrating pituitary tumor.
2. Nonsuppressibility of GH after an oral glucose challenge.
3. Elevated IGF-1.
26
What malignancy are patients with acromegaly at increased risk for?
Colon cancer.
27
What is another name for toxic multinodular goiter?
Plummer disease.
28
How is Plummer disease diagnosed?
Radioactive iodine uptake tests show "hot" nodules with the rest of the gland being "cold".
Also, clinically, nodules can sometimes be felt.
29
What is the treatment for de Quervain thyroiditis?
Usually self-limiting, but ASPIRIN and steroids may be indicated to control inflammation.
30
What are the treatment options for a hyperthyroid state?
1. Medication: PTU or methimazole.
2. Radioactive iodine ablation.
3. Surgery: subtotal thyroidectomy.
31
1st-line treatment for Graves:
Radioactive iodine ablation except in children and pregnant women.
32
Possible side effects of radioactive iodine ablation:
1. Hypothyroidism
| 2. Thyrotoxic crisis
33
What can induce thyroid storm?
1. Infection
2. Surgery
3. Trauma
4. Abrupt stop of antithyroid meditation
5. Serious acute problems - MI and stroke.
34
What is the mortality rate of thyroid storm?
Up to 50%.
35
What is the initial treatment for thyroid storm?
It is an EMERGENCY, so think of the ABCs:
Airway stabilization
Breathing/O2 administration
Circulation (check pulse/BP and start IV fluids).
36
After primary stabilization of the patient, what is the medical management of thyroid storm?
The goal of therapy is to decrease circulating thyroid hormone and treat patient's symptoms:
1. Prevent hormone synthesis - PTU, methimazole.
2. Prevent hormone release - cold iodine (about 2 hours after PTU to prevent worsening symptoms).
3. Prevent conversion of T4 to T3: Glucocorticoids and beta-blockers.
4. Symptomatic treatment: beta-blockers and Tylenol (for fever).
37
What lab results can help diagnose Hashimoto thyroiditis?
Elevated antithyroglobulin and antimicrosomal antibody titers.
38
How can Graves disease and Hashimoto thyroiditis be distinguished?
Radioactive iodine uptake is INCREASED with Graves and DECREASED with Hashimoto.
39
What are some examples of secondary hypothyroidism?
1. Sheehan syndrome
2. Pituitary neoplasm
3. TB
40
What is an example of tertiary hypothyroidism?
Hypothalamic radiation.
41
Other than TSH, TRH, T3, T4 what other abnormal lab tests may be found in a hypothyroid patient?
1. Elevated serum cholesterol (TG, LDL, total cholesterol).
2. UP AST and ALT.
3. Anemia.
4. Hyponatremia.
42
What are the signs and symptoms of myxedema coma?
1. Severe lethargy or coma.
2. Hypothermia.
3. Areflexia.
4. Bradycardia.
43
What causes myxedema coma?
1. Prolonged cold exposure.
2. Infection
3. Sedatives
4. Narcotics
5. Trauma
6. Surgery
44
Treatment for myxedema coma?
```
This is an EMERGENCY!
Start with ABCs (airway, breathing, circulation).
1. IV fluids
2. Steroids
3. Levothyroxine
4. Treat any precipitating causes
```
45
What is the initial appropriate workup of a thyroid mass?
Fine-needle biopsy and TSH.
46
What can be used to monitor medullary carcinoma?
Calcitonin, because it is a calcitonin-secreting tumor.
47
Which thyroid carcinoma often has metastasis to the bone and lungs?
Follicular
48
MEN 1 - Wermer syndrome:
1. Prolactinoma (pituitary tumor)
2. Parathyroid
3. Pancreas
49
MEN 2A - Sipple syndrome:
1. Pheochromocytoma
2. Medullary thyroid
3. Parathyroid
50
MEN 2B:
1. Pheo
2. Medullary
3. Mucocutaneous neuromas
51
What EKG finding could you expect with hyperparathyroidism?
Shortened QT, because of hypercalcemia.
52
How is hyperparathyroidism diagnosed?
1. Hypercalcemia
2. Hypophosphatemia
3. Hypercalciuria
4. PTH level
53
DDX with hypercalcemia, besides hyperparathyroidism?
1. Neoplasm
2. Sarco
3. Thiazides
4. Paget
5. VitD intoxication
6. Milk alkali syndrome
7. Myeloma
54
What are the MC complications of parathyroidectomy?
1. Hoarseness because of damage of the recurrent laryngeal nerve.
2. Hypocalcemia.
55
Causes of hypoparathyroidism?
1. Idiopathic
2. DiGeorge
3. Hypomagnesemia
4. 2o to neck radiation or surgery
56
Why does hypomagnesemia lead to hypoparathyroidism?
Because Mg is necessary for the parathyroid to secrete PTH.
57
In what conditions is low Mg seen?
1. SIADH
2. Pancreatitis
3. Alcoholism
58
What EKG findings could you expect in hypoparathyroidism?
Prolonged QT interval because of the hypocalcemia.
59
How is hypoparathyroidism treated?
Emergently treat with IV calcium, then treat with vitD and oral Ca for maintenance treatment.
60
What is the most likely etiology of Addison in the USA?
Autoimmune destruction of the gland.
61
Besides autoimmune, mention other causes of Addison disease?
1. TB
2. Amyloidosis
3. Sarco
4. HIV
5. Adrenal hemorrhage 2o to W-F syndrome.
6. Congenital adrenal hyperplasia
7. Metastasis to the adrenals
62
What is the most likely cause of secondary adrenal insufficiency?
Hypothalamic-pituitary axis disturbance, usually by sudden cessation of exogenous steroids, which leads to decreased ACTH secretion.
63
What kind of metabolic disturbance is seen in primary adrenal insufficiency?
Metabolic ACIDOSIS due to aldosterone and cortisol deficiency an, therefore, lack of secretion of hydrogen ions.
64
How Cushing syndrome different from Cushing disease?
Cushing disease refers to a type of Cushing syndrome caused specifically by ACTH hypersecretion by the pituitary.
65
What is the MCC of endogenous hypercortisolism?
Cushing disease (pituitary hypersecretion of ACTH).
66
What tests are used to diagnose hypercortisolism?
1. 24h urine free cortisol
2. Dexamethasone suppression tests.
3. ACTH levels
4. Diurnal cortisol variation.
67
What are some other studies to consider to localize the lesion in hypercortisolism?
A CT scan can look for an adrenal mass and an MRI can look for a pituitary mass.
68
Signs and symptoms of Conn?
1. HTN
2. Muscle cramps
3. Palpitations
4. Polyuria
5. Polydipsia
6. Hypokalemia
69
Percentage of hypertensives that have Conn?
1-2%.
70
Some ways to diagnose Conn?
1. Captopril stimulation test.
2. Fludrocortisone suppression test.
3. Na loading.
71
What is the captopril stimulation test?
Captopril is administered and then serum renin and aldosterone levels are measured.
--> UP aldosterone and DOWN renin confirm the diagnosis.
72
What is the fludrocortisone suppression test?
Fludrocortisone, a synthetic corticosteroid, is administered to the patient.
--> Serum aldosterone levels are then measured.
In a normal patient it would be expected that aldosterone would be suppressed but not in a patient with Conn syndrome.
73
What is the Na loading test?
Patient is loaded with Na via IV saline and then urinary aldosterone levels are tested.
No decrease in urinary aldosterone confirms diagnosis.
74
What is the renin level in Conn syndrome?
Low renin
75
What other study can help in the diagnosis of Conn?
CT demonstrating an adrenal nodule or hyperplasia.
76
How is secondary hyperaldosteronism diagnosed?
DOWN RENIN!
77
What can be measured to differentiate primary from 2o hyperaldosteronism?
RENIN
78
What is the treatment for 2o hyperaldosteronism?
Treat the HTN with a K-sparing diuretic, a beta-blocker, and treat the underlying cause.
79
Percentage of hypertensives with pheochromocytoma?
0.5%
80
Possible etiologies for pheochromocytoma?
1. MEN2A,2B
2. VHL
3. von Recklinghausen
4. Neurofibromatosis
81
What are the 5 P's of pheochromocytoma?
1. Pain (headache)
2. Pressure
3. Perspiration
4. Palpitation
5. Pallor and HTN
82
Diagnostic test for pheochromocytoma?
Urine screen for elevated VMA (vanillylmandelic acid), a urine catecholamine.
As well as elevated urine and serum epinephrine and norepinephrine levels.
83
What other test can be done to localize a pheochromocytoma?
A CT scan can identify a suprarenal mass (adrenal mass).
84
What are some other laboratory findings in a pheochromocytoma?
1. Hyperglycemia
| 2. Polycythemia
85
Rule of 10s for a pheochromocytoma:
```
10% malignant.
10% Bilateral.
10% Extrarenal.
10% Familial.
10% Children.
10% Multiple.
10% Calcified.
```
86
Why treat with preoperative alpha-blockers and beta-blockers?
To prevent unopposed vasoconstriction, and thus volume depletion.
87
Risk factors for osteoporosis:
1. Female
2. Postmenopausal or low estrogen state
3. Hypercortisolism
4. Hyperthyroidism
5. Ca deficiency
6. Low physical activity
7. Smoking
88
Typical fractures that occur in osteoporosis:
1. Hip
2. Vertebrae
3. Colles' fractures
89
How is osteoporosis diagnosed?
Dual energy X-ray (DEXA) SCAN --> shows low bone density or an incidental fracture in the elderly.
90
What are the treatments for osteoporosis:
1. Bisphosphonates
2. Calcitonin
3. Selective estrogen receptor modulators
4. Calcium
91
What is the calcitonin most useful for?
1. Treating bone pain.
| 2. However, it cannot be used chronically because the effects wear off.
92
What are the signs and symptoms of Paget disease of the bone?
1. Hearing loss (impingement of CN VIII).
2. Multiple fractures.
3. Bone pain.
4. High-output failure.
5. Increased hat size.
93
How is Paget diagnosed?
1. Elevated ALP.
| 2. Sclerotic lesions on bone scans/X-rays.
94
Complications associated with Paget disease of the bone?
1. Pathologic fractures
2. High-output cardiac failure.
3. Hearing loss
4. Kidney stones.
5. Sarcoma
6. Spinal cord compression
95
Paget treatment:
Most patients do NOT need treatment.
| Patients with complications are treated with bisphosphonates as 1st line and calcitonin as 2nd line.
96
What type of fatal fungal infection can diabetics get?
Mucor, especially sinusitis.
