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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
Q

MEN-Multiple Endocrine Neoplasia 2B cp - 4

A
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26
Q

In [Hashimoto chronic lymphocytic Thyroiditis], which antibodies are responsible for the attack on the thyroid gland?

A

AntiThyroidPerOxidase

AntiTPO is also a/w miscarriage!!

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27
Q

Acromegaly cp - 13

A

heart = concentric LVH

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28
Q

Acromegaly Dx

A

GH stimulates IGF1 secretion most of the day –> acromegaly sx

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29
Q

cp of hypopituitarism - 5

A

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
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30
Q

What are all the functions of [Glucocorticoid Cortisol] - 6

A

BIG FIB

  1. ⬆︎Blood pressure (⬆︎a1 receptors)
  2. ⬆︎Insulin resistance –> DM
  3. ⬆︎Gluconeogenesis
  4. ⬇︎Fibroblast –> striae
  5. ⬇︎Immune system (WHITE)
  6. ⬇︎Bone formation by ⬇︎osteoBlast
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31
Q

How does immobilization affect Ca+ levels

A

INCREASES

Immobilization –> ⬆︎osteoclast activity –> ⬆︎serum Ca+

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32
Q

, Acute Rhabdomyolysis causes Ca+ to (⬜ [increase/decrease]) because of what?

A

DECREASE

________________

release of Ca+ and Phosphorous from damaged muscles –> CaPhosphate precipitation –> drops free serum Ca+

________________

HYPERcalcemia and HYPERphosphatemia can occur later during the remobilization phase during recovery

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33
Q

How does albumin levels affect ionized Ca+ levels?

A

IT DOESNT! - albumin only affects TOTAL ca+ levels and will NOT cause calcium-related symptoms

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34
Q

etx of PCOS

________________

What are the primary effects of this etx?-5

A

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

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35
Q

Tx for PCOS - 5

A

[Wt loss–> SOCK]

SOCK:Spironolactone,OCP (1st line after wt loss),Clomiphene for infertility,Ketoconazole

________________

etx: DM/Obesity–>Hyperinsulinemia which –> ⬆︎⬆︎⬆︎LH secretion –> ⬆︎ovarian theca Androgen secretion –> Sx

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36
Q

What level of prolactin indicates a Prolactinoma

A

>200

Prolactin inhibits LH release

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37
Q

Which CA is known for producing calcitonin?

A

Medullary Thyroid Carcinoma

also produces ACTH and VIP

associated with MEN2A and 2B

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38
Q

Why should pts with [Medullary Thyroid Carcinoma] have a fractionated metanephrine assay ordered?

A

Screen them for Pheochromocytoma

MTC and Pheochromocytoma are associated with MEN2A and 2B

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39
Q

How do you treat Papillary Thyroid Carcinoma - 3

A

Surgical Resection –> +/- radioiodine ablation and suppressive doses of thyroid hormone (in pts with risk of recurrence)

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40
Q

When is a thyroid Radionuclide scan indicated?

A

pts with low TSH

evaluates for HOT nodules (which are usually benign)

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41
Q

When is a thyroid Fine needle aspirations indicated? - 3

A

pts with HIGH TSH who have:

  1. cold nodules
  2. thyroid CA fam hx
  3. suspicious thyroid US findings
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42
Q

How is Mg associated with Ca+ levels

A

low Mg+ (especially in alcoholics) –> ⬇︎PTH hormone release and PTH resistance —> ⬇︎serum Ca+ AND low serum K+

serum Phosphorous levels are NOT affected by this phenomena!

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43
Q

What are the distinguishing features of Pancreatic VIPoma - 5

A
  1. Tea colored watery secretory diarrhea
  2. hypOkalemia
  3. hypOchlorhydria (from ⬇︎gastric acid)
  4. HYPERcalcemia from ⬆︎bone resorption
  5. Facial flushing

tx = octreotide for diarrhea

44
Q

Osteomalacia etx -2

A

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

  1. secondary hyperparathyroidism –> ⬆︎ALP
45
Q

Most common causes of Osteomalacia - 5

A

usually Vitamin D deficiency from …

  1. Malabsorption
  2. RYBG
  3. Celiac sprue
  4. Chronic liver disease
  5. Chronic Kidney disease
46
Q

Pts with untreated Hyperthyroidism are at risk of developing what conditions? - 2

A
  1. Bone loss from ⬆︎osteoclast activity
  2. cardiac tachyarrhythmias

Hyperthyroidism = Graves > toxic adenoma > multinodular goiter

47
Q

[Subacute DeQuervain Thyroiditis] presents as ____ –> PAINFUL HYPERthryoid–> hypOthyroid from ______

________________

Tx?-2

A

URI ; releasing preformed thyroid hormone

________________

  1. BBlockers
  2. NSAIDs

You may see ⬆︎inflammatory markers in this condition

48
Q

What is the most common side effect of AntiThyroid drugs (i.e. Methimazole, PTU)

A

agranulocytosis

  • Pt on AntiThyroid drugs who develop sore throat with fever should have WBC checked!*
  • Radioactive Iodine tx can –> worsening ophthalmopathy*
49
Q

In HYPERthyroidism, what is the mechanism for why pts have HTN?

A

⬆︎Myocontractility and HR

50
Q

Diabetic Gastroparesis cp-2

________________

Tx-2?

A
  1. early satiety
  2. postprandial fullness

Tx = Metoclopramide or Erythromycin

51
Q

A pt comes in with hypOcalcemia < 8.4

Describe your full work up

A
52
Q

Why are pts who receive > 1 unit of pRBC/blood transfusion at risk for hypOcalcemia?

A

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
Q

What is the most beneficial therapy to ⬇︎ the progression of DM nephropathy?

A

BP control < 130/80

do not push HbA1C < 7%

54
Q

what type of abd pain does DKA pts have

A

DIFFUSE

55
Q

A Pt with Hyperthyroid pt develops Sore throat and Fever after being started on Methimazole

What should you assess for?

A

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
Q

Dx for Addison’s Primary Adrenal Insufficiency - 2

A

[8 AM serum cortisol and plasma ACTH levels] –> ACTH stimualtion test for confirmation

57
Q

A woman starts to rapidly develop facial and body hair

What test do you order first to determine etiology? - 2

A

DHEA and Testosterone

Hyperandrogenism suggest androgen secreting CA of ovary or adrenal glands so these test will help to determine that

58
Q

Potassium Iodide Indication - 2

A
  1. PreOp tx for Thyroidectomy in Graves
  2. Thyroid Storm
59
Q

In the context of thyroid disease, what is the indication for CTS - 3

A
  1. Thyroid Storm
  2. Type 2 amiodarone-induced thyrotoxicosis
  3. SEVERE DeQuervain Subactue Thyroiditis
60
Q

What are the two definitive treatments for thyroid disease

A
  1. Radioactive Iodine
  2. Thyroidectomy
61
Q

Describe Euthyroid Sick Syndrome

A

Euthyroid Sick (low T3) Syndrome

syndrome characterized by ISOLATED low T3 that can occur anytime the body is “sick”

62
Q

When would you say a pt has subclinical hypothyroidism

A

elevated TSH but normal T4 and T3

T3 remains normal until late stages of hypothyroidism

63
Q

What are the two most common thyroid CA

A

Papillary > Follicular

64
Q

Which microscopic finding is associated with Papillary Thyroid CA?

A

Psammoma bodies (large lamellated calcifications with ground glass cytoplasm)

65
Q

Why can’t Follicular Thyroid CA be evaluated with fine needle biopsy?

A

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
Q

When is screening for DM (fasting bg or oral glucose tolerance test) recommended?

A

>45 yo with BP>135/80

and those with additional DM risk factors

67
Q

Tx for Prolactinoma >1cm or Symptomatic - 3

A
  1. Cabergoline dopamine agonist OR
  2. Bromocriptine dopamine agonist
  3. Transsphenoidal resection if refractory
68
Q

Tx for Prolactinoma >3cm

A

Transsphenoidal resection

69
Q

How does Hyperthyroidism affect muscle function?

A

HYPERthyroidism AND hypOthyroidism can both cause myopathy characterized as proximal muscle weakness

Statins Probably Hurt Muscles

70
Q

Graves Ophthalmopathy etx

________________

risk factors?-2

A

Activated T cells and Thyrotropin Autoantibodies both stimulate retroorbital fibroblast –> orbital tissue expansion

________________

Smoking, Female

71
Q

explain how DM destroys nerves

A

deposition of [glycosylation products], [oxidative stress] and [microvascular injury] all –> small nerve AND Large nerve-length dependent axonopathy

72
Q

cp for DM [LARGE nerve fiber] damage

________________

cp for DM [small nerve fiber] damage

A

LARGE nerves –> negative sx = loss of 2TVP, [ankle reflexes⬇︎]

________________

small nerves –> positive sx = pain, paresthesias

73
Q

What is the most common cause of primary hypogonadism in males?

A

Klinefelter XXY

74
Q

cp for [Klinefelter XXY] ?-5

A
  1. small phallus
  2. hypOgonads (small testes)
  3. hypOspadia
  4. gynecomastia
  5. Cryptochidism
75
Q

Why do pregnant patients or patients started on OCPs require increased doses of levothyroxine if they’re taking it

A

Estrogen –> ⬇︎clearance of Thyroid Binding Globulin –> additional TBG binds up all the free T4 –> ⬇︎free T4

76
Q

What would you expect Radioactive iodine uptake to be in [DeQuervain Subactue Thyroiditis]

A

Decreased

The hyperthyroid phase (which eventually becomes hypothyroid) is caused by release of preformed thyroid hormone

77
Q

Thyroid Toxic Adenoma hyperthyroidism MOD

A

autonomous production of thyroid hormones from hyperplastic thyroid follicular cells

if multiple uptake present, consider multinodular goiter

78
Q

How does looking at Thyroglobulin levels help determine etiology of thyroid disease?

A

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
Q

What is Conn’s syndrome

A

Primary Hyperaldosteronism

80
Q

List the ophthalmoscopy findings for simple Diabetic Retinopathy - 3 ; What procedure prevents this?

A
  1. microhemorrhages
  2. retinal edema
  3. exudates

Argon laser photocoagulation

81
Q

What are the precipitants of Pheochromocytoma?-3

________________

which medication should be given prior to these precipitants?

A

Don’t GAS a Pheochromocytoma

  1. General Beta Blockers (allows unopposed [α] stimulation)
  2. Anesthesia
  3. Surgery

Phenoxybenzamine (irreversible general alpha blocker)

82
Q

PTHrelatedProtein is associated with Cancer (Humoral Hypercalcemia of Malignancy)

________________

What is the major mechanism difference between PTHrP and PTH

A

true PTH ⬆︎ conversion of [25VitaminD] to [1-25VitaminD]

PTHrP comes from SQC, renal, bladder, breast, ovarian CA

83
Q

What are the triggers of Thyrotoxicosis - 5

A
  1. iodine contrast
  2. infection
  3. childbirth
  4. surgery
  5. trauma
84
Q

What is Milk Alkali Syndrome

A

HYPERcalcemia from excessive intake of PO Ca+ supplement and absorbable alkali usually in pts taking Ca+ supplement for osteoporosis

85
Q

Refeeding Syndrome etx

A

surge of insulin after severe starvation –>

VERY LOW MPK

  1. Mg
  2. Phosphorous
  3. K+
86
Q

What is the best way to monitor a pt being treated for DKA - 2

A
  1. Serum Anion Gap
  2. Beta Hydroxybutyrate levels
87
Q

Primary Hyperparathyroidism and Familial hypocalciuric Hypercalcemia both present with serum Ca+ that is _____ (low/high)

How do you differentiate the two?

A

HIGH

FHH = urine calcium:creatinine ratio < 0.01

Primary Hyperparathyroidism = ucc>0.02

88
Q

Sialadenosis etx

A

NONinflammatory swelling of the salivary glands caused by liver disease or malnutrition (DM, bulimia)

89
Q

In DKA and HONK management, when do you add dextrose 5% to the IVF replenishment?

A

glucose≤200

90
Q

Demeclocycline MOA

________________

Indication?

A

inhibits ADH-mediated renal cortical collecting duct aquaporin insertion

________________

SIADH

91
Q

Tolvaptan MOA

________________

Indication?-2

A

TolVaptan = [V2 vasopressin ADH R blocker] ;

  1. HF Hypervolemia severe
  2. SIADH refractory
92
Q

In pts with Diabetes Insipidus, how do you differentiate between Central and Nephrogenic causes?

A

Water Deprivation Test

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
Q

cp for Primary Hyperparathyroidism

A

Asymptomatic Hypercalcemia

Hypercalcemia sx: Painful Bones, Renal Stones, Abd Groans and Psychic Moans

94
Q

Struma Ovarii etx

A

RARE - ovarian teratoma produces thyroid hormone –> Hyperthyroid state

95
Q

cp for Thyroid Storm - 3

A

HHH** needs **PPP

Hot, Head and Heart

  1. Hot = Fever
  2. Head = CNS dysfunction with tremor
  3. Heart = Tachycardia, palpitations, HTN, HF

________________

tx = Propranolol –> PTU —(1 hr later)–> [Potassium Iodine and CTS]

96
Q

tx for Thyroid Storm - 3

A

HHH** needs **PPP

Propranolol –> PTU —(1 hr later)–> [Potassium Iodine and CTS]

97
Q

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?

A

GLP1 agonist (exenaitde, liraglutide)

98
Q

A DM pt is not well managed on single therapy Metformin

When is it appropriate to consider adding insulin?

A

HBA1c>8.5%

99
Q

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

A
  1. Insulin
  2. Sulfonylurea
  3. Meglitinides
100
Q

[McCune Albright] syndrome etx?

A

all [McCune Albright] does is P P P

etx = autonomous activity of endocrine tissue from defect in cAMP kinase

101
Q

etx for Prader Willi Syndrome ; cp?-4

A

PATERNAL deletion of chromo15q11 thru 13 ;

  1. HyperPhagia –> Phat (Obesity), Gastric rupture, DM2
  2. hypOtonia
  3. short stature
  4. Mentally retarded
102
Q

etx for Angelman Syndrome ; cp?-4

A

maternal deletion of chromo15q11 thru 13 ;

  1. Frequent sMiling/Laughter (Moms make you smile)
  2. Hand Flapping
  3. short stature
  4. mentally retarded
103
Q

What should you suspect in a pt with [Hashimoto chronic lymphocytic Thyroiditis] who develops B-symptoms?

A

Conversion of Hashimoto to [Thyroid Lymphoma]

104
Q

How is the Thyroid related to Bone homeostasis?

A

Thyroid hormone ⬆︎osteoclast activity –> bone loss

105
Q

Normal range for serum Glucose

A

70 - 120

[2a] A ⼀ Step 2 OD USLME (21 decks)

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