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[2a] A ⼀ Step 2 OD USLME > DM & Endocrine > Flashcards

DM & Endocrine Flashcards

1
Q

Goal HbA1C and BP for DM pts

A

< 7% ; <140/90(also BP goal for CKD pts)

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2
Q

When is Metformin contraindicated?

A

Creatinine > 1.5

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3
Q

Microalbuminuria is an indicator of (⬜3)

________________

What lab value is used to detect Microalbuminemia?

________________

what are the values for normal, micro and macro?

A
  1. DM
  2. HTN
  3. PSGN

Urine [Albumin Creatinine Ratio];

_________________

normal = < 30

micro = 30-300

MACRO = >300

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4
Q

How often should eye exams be done for DM pts

A

yearly

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5
Q

for IDDM, how much daily insulin should be prescribed?

A
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6
Q

What things cause HYPERKalemia? -6

A
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7
Q

What are the opthalmological complications of DM-3; what causes them?

A
  1. Retinopathy (from ⬆︎VEGF –> abnormal angiogenesis)
  2. Glaucoma (⬆︎ Sorbitol eye pressure)
  3. Cataracts (Glycation of Ocular lens
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8
Q

A: Clinical Manifestations of DiGeorge Syndrome (5)

B: Genetic Cause

C: Embryologic cause

A

“CATCh 22 & Pa3”

Cardiac (Tetralogy of Fallot + Aortic Arch abnormalitites)

Abnormal face (Bifid Uvula/low set ears)

Thymus Aplasia (Thymic shadow in image) –> Virus/Fungal infection

Cleft Palate

[hypOcalcemia from PTH deficiency] may–> Carpopedal Spasms

22q.11.2 deletion

Pharyngeal arch - 3rd/4th both fail to develop

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9
Q

How does hypOthyroidism affect Neuro system - 4

A
  1. it causes ⬇︎ in DTR
  2. ⬇︎ motor relaxation phase
  3. Mood ∆
  4. Dementia
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10
Q

Obesity w/Hyperphagia + Retardation should raise suspicions for what disorder?

A

Prader Willi Syndrome

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11
Q

Common s/s of HYPERthyroidism -9

A

TT Feels ARCHED

  1. [Tremor & Tachycardia]
  2. Fatigue
  3. Appetite ⬆︎ but Wt ⬇︎
  4. Reflexes ⬆︎
  5. Cardio (Tachycardia, Palpitations,Exertional SOB)
  6. Heat intolerance –> SWEATING
  7. Exopthalmous with lid lag
  8. Diarrhea w/ possible dyspepsia

Older pts may only have Fatigue and Cardio sx!

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12
Q

S/S of hypOthyroidism is mostly opposite of Hyperthyroidism

What are 4 symptoms specific to only hypOthyroidism?

A

Mosty opposite of TT Feels ARCHED but may also have…

  1. Diastolic HF
  2. Depression
  3. Menorrhagia
  4. Pedal Edema

BOTH HAVE FATIGUE AND HTN

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13
Q

What type of radioiodine uptake do you see in [Silent Painless thyroiditis]?

this is a variant of Hashimoto chronic lymphocytic thyroiditis

A

low radioiodine uptake

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14
Q

What happens to [total thyroid hormone] serum level when drugs displace thyroid hormone?

________________

Which drugs do this?-3

A

[free hormone displacement] ➜ [Thyroid production ⬇︎] –> ⬇︎TOTAL thyroid levels but normal free hormone levels

  1. ASA
  2. Furosemide
  3. Heparin
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15
Q

Precocious puberty occurs in [girls less than ⬜ years old] and [boys less than ⬜ years old]

________________

How do you work this up?

A
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16
Q

Precocious puberty occurs in [girls

________________

A pt has just been diagnosed with [Gonadotropin Dependent Central Precocious Puberty]

What are the major causes of this?-2

A

IDIOPATHIC > Pituitary tumor

ALL PTS WITH THIS SHOULD UNDERGO CONTRAST BRAIN MRI REGARDLESS OF +/- HA/VISION SX. Precocious Puberty may be the first sign before the tumor

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17
Q

Danazol MOA

________________

Indication

A

testosterone derivative with progestin effects

________________

endometriosis

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18
Q

Teenage boy comes in with gynecomastia

How do you work this up?

A

YOU DONT! - Pubertal gynecomastia is seen in up to 66% of teenage boys mid-late puberty. It can be uL, BL and/or painful

Tx = self-limited to ≤2 years

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19
Q

How long does it take radioiodine therapy to treat Hyperthyroidism? ; How does radioiodine therapy actually worsen Graves ophthalmopathy?

A

1-4 mo ; radioiodine eventually –> hypothyroidism –>⬆︎ thyroid stimulating autoantibodies –> orbital tissue expansion from orbital fibroblast stimulation

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20
Q

Tight blood glucose control in DM pts mostly ⬇︎ their risk for what?

A

microvascular complications (retinopathy, neprhopathy)

we dont know if it has an effect on MACROvascular disease such as MI or stroke

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21
Q

Riedel thyroiditis MOD

A

progressive fibrosis of thyroid gland and surrounding tissue (that looks like CA)

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22
Q

cp for HyperParathyroidism - 4

A

Painful Bones (to include Pseudogout), Renal Stones, Abdominal Groans (includes constipation), Psychic Moans

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23
Q

MEN-Multiple Endocrine Neoplasia 1 cp - 3

A
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24
Q

MEN-Multiple Endocrine Neoplasia 2A cp - 3

A
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25
MEN-Multiple Endocrine Neoplasia 2B cp - 4
26
In [Hashimoto chronic lymphocytic Thyroiditis], which antibodies are responsible for the attack on the thyroid gland?
Anti**T**hyroid**P**er**O**xidase ## Footnote *AntiTPO is also a/w miscarriage!!*
27
Acromegaly cp - 13
heart = concentric LVH
28
Acromegaly Dx
GH stimulates IGF1 secretion most of the day --\> acromegaly sx
29
cp of hypopituitarism - 5
FLAT PiG 1. FSH/LH ⬇︎ --\> **Amenorrhea, testicular atrophy** 2. ACTH ⬇︎ --\> **⬇︎Cortisol BUT NOT ALDOSTERONE --\>** hypotension from ⬇︎arterial resistance 3. TSH⬇︎ --\> **Fatigue/hypOthyroidism** 4. Prolactin⬇︎ --\> **LACTATION FAILURE (1ST SIGN OF SHEEHAN!)** 5. GH⬇︎ --\> **Anorexia**
30
What are all the functions of [Glucocorticoid Cortisol] - 6
**BIG FIB** 1. ⬆︎**B**lood pressure (⬆︎a1 receptors) 2. ⬆︎**I**nsulin resistance --\> DM 3. ⬆︎**G**luconeogenesis 4. ⬇︎**F**ibroblast --\> striae 5. ⬇︎**I**mmune system (*WHITE*) 6. ⬇︎**B**one formation by ⬇︎osteoBlast
31
How does immobilization affect Ca+ levels
**INCREASES** Immobilization --\> ⬆︎osteoclast activity --\> ⬆︎serum Ca+
32
, Acute Rhabdomyolysis causes Ca+ to (⬜ [increase/decrease]) because of what?
DECREASE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ release of Ca+ and Phosphorous from damaged muscles --\> CaPhosphate precipitation --\> drops free serum Ca+ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *HYPERcalcemia and HYPERphosphatemia can occur later during the **re**mobilization phase during recovery*
33
How does albumin levels affect ionized Ca+ levels?
IT DOESNT! - albumin only affects TOTAL ca+ levels and will NOT cause calcium-related symptoms
34
etx of PCOS \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What are the primary effects of this etx?-5
DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> 1. Androgen characteristics (acne, balding, hirsutism) 2. menstrual irregularities from Anovulation 3. PCOS on US from Follicular atresia 4. Infertility from Anovulation 5. ⬆︎Estrogen (from Androgen conversion) --\> Endometrial ADC *tx = Wt loss ➜ **SOCK***
35
Tx for PCOS - 5
[Wt loss--\> **SOCK**] ## Footnote **S****OCK**:**S**pironolactone,**O**CP (1st line after wt loss),**C**lomiphene for infertility,**K**etoconazole \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *etx: DM/Obesity--\>Hyperinsulinemia which --\> ⬆︎⬆︎⬆︎LH secretion --\> ⬆︎ovarian theca Androgen secretion --\> Sx*
36
What level of prolactin indicates a Prolactinoma
\>200 ## Footnote Prolactin inhibits LH release
37
Which CA is known for producing calcitonin?
Medullary Thyroid Carcinoma ## Footnote also produces ACTH and VIP *associated with MEN2A and 2B*
38
Why should pts with [Medullary Thyroid Carcinoma] have a fractionated metanephrine assay ordered?
Screen them for Pheochromocytoma ## Footnote *MTC and Pheochromocytoma are associated with MEN2A and 2B*
39
How do you treat Papillary Thyroid Carcinoma - 3
Surgical Resection --\> +/- radioiodine ablation and suppressive doses of thyroid hormone (in pts with risk of recurrence)
40
When is a thyroid Radionuclide scan indicated?
pts with low TSH evaluates for HOT nodules (which are usually benign)
41
When is a thyroid Fine needle aspirations indicated? - 3
pts with HIGH TSH who have: 1. cold nodules 2. thyroid CA fam hx 3. suspicious thyroid US findings
42
How is Mg associated with Ca+ levels
low Mg+ (especially in alcoholics) --\> ⬇︎PTH hormone release and PTH resistance ---\> ⬇︎serum Ca+ **AND low serum K+** ## Footnote serum Phosphorous levels are NOT affected by this phenomena!
43
What are the distinguishing features of Pancreatic VIPoma - 5
1. **Tea colored** watery secretory diarrhea 2. hypOkalemia 3. hypOchlorhydria (from ⬇︎gastric acid) 4. HYPERcalcemia from ⬆︎bone resorption 5. Facial flushing ## Footnote *tx = octreotide for diarrhea*
44
Osteomalacia etx -2
VitD deficiency --\> [⬇︎GI Ca+ and Phosphate absorption] ➜ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. [inability of osteoBlast to fill bone cavities (created by osteoclast) with [Ca+Phosphate-laden osteoid] = [**defective mineralization of bone matrix]** and 2. secondary hyperparathyroidism --\> ⬆︎ALP
45
Most common causes of Osteomalacia - 5
usually Vitamin D deficiency from ... 1. Malabsorption 2. RYBG 3. Celiac sprue 4. Chronic liver disease 5. Chronic Kidney disease
46
Pts with untreated Hyperthyroidism are at risk of developing what conditions? - 2
1. Bone loss from ⬆︎osteoclast activity 2. cardiac tachyarrhythmias ## Footnote Hyperthyroidism = Graves \> toxic adenoma \> multinodular goiter
47
[Subacute DeQuervain Thyroiditis] presents as ____ --\> **PAINFUL HYPERthryoid**--\> hypOthyroid from \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx?-2
URI ; releasing preformed thyroid hormone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. BBlockers 2. NSAIDs *You may see ⬆︎inflammatory markers in this condition*
48
What is the most common side effect of AntiThyroid drugs (i.e. Methimazole, PTU)
agranulocytosis ## Footnote * Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!* * Radioactive Iodine tx can --\> worsening ophthalmopathy*
49
In HYPERthyroidism, what is the mechanism for why pts have HTN?
⬆︎Myocontractility and HR
50
Diabetic Gastroparesis cp-2 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Tx-2?
1. **early satiety** 2. postprandial fullness Tx = Metoclopramide or Erythromycin
51
A pt comes in with hypOcalcemia \< 8.4 Describe your full work up
52
Why are pts who receive \> 1 unit of pRBC/blood transfusion at risk for hypOcalcemia?
pRBC and whole blood **CONTAIN CITRATE** and citrate chelates Ca+ AND Mg --\> paresthesias, Chvostek, Trousseau, Hyperreflexia Leukoreduction ⬇︎risk of Febrile Nonhemolytic Reaction in trasfusion patients
53
What is the most beneficial therapy to ⬇︎ the progression of DM nephropathy?
BP control \< 130/80 ## Footnote *do not push HbA1C \< 7%*
54
what type of abd pain does DKA pts have
DIFFUSE
55
A Pt with Hyperthyroid pt develops Sore throat and Fever after being started on Methimazole What should you assess for?
agranulocytosis D/C the drug! * Pt on AntiThyroid drugs who develop **sore throat with fever** should have WBC checked!* * Radioactive Iodine tx can --\> worsening ophthalmopathy*
56
Dx for Addison's Primary Adrenal Insufficiency - 2
[8 AM serum cortisol and plasma ACTH levels] --\> ACTH stimualtion test for confirmation
57
A woman starts to rapidly develop facial and body hair What test do you order first to determine etiology? - 2
DHEA and Testosterone ## Footnote Hyperandrogenism suggest androgen secreting CA of ovary or adrenal glands so these test will help to determine that
58
Potassium Iodide Indication - 2
1. PreOp tx for Thyroidectomy in Graves 2. Thyroid Storm
59
In the context of thyroid disease, what is the indication for CTS - 3
1. Thyroid Storm 2. Type 2 amiodarone-induced thyrotoxicosis 3. SEVERE DeQuervain Subactue Thyroiditis
60
What are the two definitive treatments for thyroid disease
1. Radioactive Iodine 2. Thyroidectomy
61
Describe Euthyroid Sick Syndrome
*Euthyroid Sick (low T3) Syndrome* syndrome characterized by **ISOLATED low T3** that can occur anytime the body is "sick"
62
When would you say a pt has subclinical hypothyroidism
elevated TSH but normal T4 and T3 ## Footnote *T3 remains normal until late stages of hypothyroidism*
63
What are the two most common thyroid CA
Papillary \> Follicular
64
Which microscopic finding is associated with Papillary Thyroid CA?
Psammoma bodies (large lamellated calcifications with ground glass cytoplasm)
65
Why can't Follicular Thyroid CA be evaluated with fine needle biopsy?
FTC involves **invasion of the tumor capsule** and/or blood vessels which can only be examined via surgical excision This is also the reason FTC has the tendency to hematogenously spread
66
When is screening for DM (fasting bg or oral glucose tolerance test) recommended?
\>45 yo with BP\>135/80 ## Footnote *and those with additional DM risk factors*
67
Tx for Prolactinoma \>1cm or Symptomatic - 3
1. Cabergoline dopamine agonist OR 2. Bromocriptine dopamine agonist 3. Transsphenoidal resection if refractory
68
Tx for Prolactinoma \>3cm
Transsphenoidal resection
69
How does Hyperthyroidism affect muscle function?
HYPERthyroidism AND hypOthyroidism can both cause myopathy characterized as proximal muscle weakness ***S**tatins **P**robably* ***H****urt **M**uscles*
70
Graves Ophthalmopathy etx \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ risk factors?-2
Activated T cells and **Thyrotropin Autoantibodies** both stimulate retroorbital fibroblast --\> orbital tissue expansion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Smoking, Female
71
explain how DM destroys nerves
deposition of [glycosylation products], [oxidative stress] and [microvascular injury] all --\> small nerve AND Large nerve-length dependent axonopathy
72
cp for DM [LARGE nerve fiber] damage \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ cp for DM [small nerve fiber] damage
LARGE nerves --\> negative sx = loss of 2TVP, [ankle reflexes⬇︎] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ small nerves --\> positive sx = pain, paresthesias
73
What is the most common cause of primary hypogonadism in males?
Klinefelter XXY
74
cp for [Klinefelter XXY] ?-5
1. small phallus 2. hypOgonads (small testes) 3. hypOspadia 4. gynecomastia 5. Cryptochidism
75
Why do pregnant patients or patients started on OCPs require increased doses of levothyroxine if they're taking it
Estrogen --\> ⬇︎clearance of Thyroid Binding Globulin --\> additional TBG binds up all the free T4 --\> ⬇︎free T4
76
What would you expect Radioactive iodine uptake to be in [DeQuervain Subactue Thyroiditis]
Decreased ## Footnote The hyperthyroid phase (which eventually becomes hypothyroid) is caused by release of preformed thyroid hormone
77
Thyroid Toxic Adenoma hyperthyroidism MOD
autonomous production of thyroid hormones from hyperplastic thyroid follicular cells ## Footnote *if multiple uptake present, consider multinodular goiter*
78
How does looking at Thyroglobulin levels help determine etiology of thyroid disease?
Thyroglobulin is the base needed to make thyroid hormone. If thyroid hormone is elevated...and Thyroglobulin is also elevated then Thyroid is naturally producing a lot of thyroid hormone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ If thyroid hormone is elevated ...but Thyroglobulin is low then that means thyroid hormone must had been exogenousouly given
79
What is Conn's syndrome
Primary Hyperaldosteronism
80
List the ophthalmoscopy findings for simple Diabetic Retinopathy - 3 ; What procedure prevents this?
1. microhemorrhages 2. retinal edema 3. exudates Argon laser photocoagulation
81
What are the precipitants of Pheochromocytoma?-3 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ which medication should be given prior to these precipitants?
*Don't **GAS** a Pheochromocytoma* 1. **G**eneral Beta Blockers (allows unopposed [α] stimulation) 2. **A**nesthesia 3. **S**urgery Phenoxybenzamine (irreversible general alpha blocker)
82
PTHrelatedProtein is associated with Cancer (Humoral Hypercalcemia of Malignancy) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ What is the major mechanism difference between PTHrP and PTH
true PTH ⬆︎ conversion of [25VitaminD] to [1-25VitaminD] ## Footnote *PTHrP comes from SQC, renal, bladder, breast, ovarian CA*
83
What are the triggers of Thyrotoxicosis - 5
1. iodine contrast 2. infection 3. childbirth 4. surgery 5. trauma
84
What is Milk Alkali Syndrome
HYPERcalcemia from excessive intake of PO Ca+ supplement and absorbable alkali usually in pts taking Ca+ supplement for osteoporosis
85
Refeeding Syndrome etx
surge of insulin after severe starvation --\> VERY LOW **MPK** 1. **M**g 2. **P**hosphorous 3. **K**+
86
What is the best way to monitor a pt being treated for DKA - 2
1. Serum Anion Gap 2. Beta Hydroxybutyrate levels
87
Primary Hyperparathyroidism and Familial hypocalciuric Hypercalcemia both present with serum Ca+ that is _____ (low/high) How do you differentiate the two?
HIGH FHH = urine calcium:creatinine ratio \< 0.01 Primary Hyperparathyroidism = ucc\>0.02
88
Sialadenosis etx
NONinflammatory swelling of the salivary glands caused by liver disease or malnutrition (DM, bulimia)
89
In DKA and HONK management, when do you add dextrose 5% to the IVF replenishment?
glucose≤200
90
Demeclocycline MOA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Indication?
inhibits ADH-mediated renal cortical collecting duct aquaporin insertion \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SIADH
91
Tolvaptan MOA \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Indication?-2
Tol**V**aptan = [**V**2 vasopressin ADH R blocker] ; 1. HF Hypervolemia severe 2. SIADH refractory
92
In pts with Diabetes Insipidus, how do you differentiate between Central and Nephrogenic causes?
Water Deprivation Test ## Footnote give Demopressin AVP after water deprivation and if urine becomes more concentrated = Central DI. If no change = nephrogenic DI. This is ALSO helpful for r/o Primary Polydipsia
93
cp for Primary Hyperparathyroidism
Asymptomatic Hypercalcemia ## Footnote *Hypercalcemia sx: Painful Bones, Renal Stones, Abd Groans and Psychic Moans*
94
Struma Ovarii etx
**RARE** - ovarian teratoma produces thyroid hormone --\> Hyperthyroid state
95
cp for Thyroid Storm - 3
***HHH** needs **PPP*** Hot, Head and Heart 1. **H**ot = Fever 2. **H**ead = CNS dysfunction with tremor 3. **H**eart = Tachycardia, palpitations, HTN, HF \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ tx = **P**ropranolol --\> **P**TU ---(1 hr later)--\> [**P**otassium Iodine and CTS]
96
tx for Thyroid Storm - 3
***HHH** needs **PPP*** **P**ropranolol --\> **P**TU ---(1 hr later)--\> [**P**otassium Iodine and CTS]
97
A DM pt is not well managed on single therapy Metformin Out of the other DM drug classes, which is most effective for inducing weight loss?
GLP1 agonist (exenaitde, liraglutide)
98
A DM pt is not well managed on single therapy Metformin When is it appropriate to consider adding insulin?
HBA1c\>8.5%
99
A DM pt is not well managed on single therapy Metformin Out of the other DM drug classes, which have the potential to actually cause weight gain?-3
1. Insulin 2. Sulfonylurea 3. Meglitinides
100
[McCune Albright] syndrome etx?
*all [McCune Albright] does is **P P P*** etx = autonomous activity of endocrine tissue from defect in cAMP kinase
101
etx for Prader Willi Syndrome ; cp?-4
**PATERNAL** deletion of chromo15q11 thru 13 ; 1. Hyper**P**hagia --\> **P**hat (Obesity), Gastric rupture, DM2 2. hypOtonia 3. short stature 4. Mentally retarded
102
etx for Angelman Syndrome ; cp?-4
**maternal** deletion of chromo15q11 thru 13 ; 1. Frequent s**M**iling/Laughter (Moms make you smile) 2. Hand Flapping 3. short stature 4. mentally retarded
103
What should you suspect in a pt with [Hashimoto chronic lymphocytic Thyroiditis] who develops B-symptoms?
Conversion of Hashimoto to [Thyroid Lymphoma]
104
How is the Thyroid related to Bone homeostasis?
Thyroid hormone ⬆︎osteoclast activity --\> bone loss
105
Normal range for serum Glucose
70 - 120

[2a] A ⼀ Step 2 OD USLME (21 decks)

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