Deja - Internal - Endocrinology Flashcards
What is the histologic description of Mucor?
Non septate hyphae with branching at 90 degrees (looks like the letter M).
What are the diagnostic criteria for diabetes?
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.
Lispro (Humalog) - Peak and duration?
Peak: 30-90min.
Duration: 3-5h.
Aspart (NovoLog) - Peak and duration:
Peak: 40-50min.
Duration: 3-5h.
Regular insulin - Peak and duration?
Peak: 2-5h.
Duration: 5-8h.
NPH - Peak and duration:
Peak: 4-12h.
Duration: 18-24h.
Lente - Peak and duration:
Peak: 3-10h.
Duration: 18-24h.
Lantus - Peak and duration:
Peak: No peak.
Duration: 20-24h.
Levemir - Peak and duration:
Peak: 6-8h.
Duration: Up to 24h.
Ultralente - Peak and duration:
Peak: 10-20h.
Duration: 20-36h.
Somogyi effect:
Nocturnal hypoglycemia causing elevated morning glucose due to release of counterregulatory hormones.
Treat with less insulin.
Dawn phenomenon:
Early morning hyperglycemia secondary to nocturnal GH release.
In what patients would metformin be absolutely contraindicated?
In patients who have compromised kidney function because of concern for lactic acidosis.
How do we believe metformin works?
Increase sensitivity to insulin.
What medication slows the progression of nephropathy in diabetes?
ACEIs and ARBs.
DKA signs and symptoms:
- Severe hyperglycemia (>500).
- Ketoacidosis
- Hyperkalemia
- Fruity breath
- Slow deep breaths.
- Abdominal pain.
- Dehydration.
- Lethargy.
What is the most important treatment in DKA?
IV fluid hydration - usually with normal saline.
What are the most severe complications of DKA treatment?
Cerebral edema or cardiac arrest due to hyperkalemia.
Hyperosmolar hyperglycemic nonketotic (HHNK) coma - Signs and symptoms:
- 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.
DKA and HHNK coma - Difference?
There is NO ketoacidosis.
HHNK - Treatment:
- 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.
What are the 2 mechanisms by which a prolactinoma causes symptoms?
- Endocrine effect: due to hyperprolactinemia.
2. Mass effect: Prepare of the tumor on surrounding tissues.
What CN can be affected by a prolactinoma?
CN III
How is prolactinoma diagnosed?
MRI or CT.
How is acromegaly diagnosed?
- MRI/CT demonstrating pituitary tumor.
- Nonsuppressibility of GH after an oral glucose challenge.
- Elevated IGF-1.
What malignancy are patients with acromegaly at increased risk for?
Colon cancer.
What is another name for toxic multinodular goiter?
Plummer disease.
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.
What is the treatment for de Quervain thyroiditis?
Usually self-limiting, but ASPIRIN and steroids may be indicated to control inflammation.
What are the treatment options for a hyperthyroid state?
- Medication: PTU or methimazole.
- Radioactive iodine ablation.
- Surgery: subtotal thyroidectomy.
1st-line treatment for Graves:
Radioactive iodine ablation except in children and pregnant women.
Possible side effects of radioactive iodine ablation:
- Hypothyroidism
2. Thyrotoxic crisis
What can induce thyroid storm?
- Infection
- Surgery
- Trauma
- Abrupt stop of antithyroid meditation
- Serious acute problems - MI and stroke.
What is the mortality rate of thyroid storm?
Up to 50%.
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).
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:
- Prevent hormone synthesis - PTU, methimazole.
- Prevent hormone release - cold iodine (about 2 hours after PTU to prevent worsening symptoms).
- Prevent conversion of T4 to T3: Glucocorticoids and beta-blockers.
- Symptomatic treatment: beta-blockers and Tylenol (for fever).
What lab results can help diagnose Hashimoto thyroiditis?
Elevated antithyroglobulin and antimicrosomal antibody titers.
How can Graves disease and Hashimoto thyroiditis be distinguished?
Radioactive iodine uptake is INCREASED with Graves and DECREASED with Hashimoto.