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PNCE > Endo > Flashcards

Endo Flashcards

1
Q

cortisol causes

A 
BP regulation
glucose metabolism
immune fxn 
inflammatory response 
insulin release
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2
Q

aldosterone causes

A

normally low K

inc Na, blood volume and pressure

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3
Q

androgens causes

A

produced DHEA

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4
Q

ACTH causes

A

release of cortisol from cortex (outer part) of adrenal gland

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5
Q

Addisons dz Patho

A

primary adrenal insufficiency
deficiency of aldosterone, cortisol, and androgen
zona fasciculata
problem w/ adrenal glands

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5
Q

Addisons dz Patho

A

primary adrenal insufficiency
deficiency of aldosterone, cortisol, and androgen
zona fasciculata
problem w/ adrenal glands

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6
Q

acute cause of primary adrenal insufficiency

A

massive adrenal hemorrhage

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7
Q

secondary adrenal insufficiency due to problem w/

A

pituitary

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8
Q

tertiary adrenal insufficiency due to problem w/

A

CRH secretion –> adrenal glands won’t product cortisol

head trauma or intracranial tumors

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9
Q

primary adrenal insufficiency labs

A 
adrenal 
CRH: high
ACTH: HIGH
cortisol: LOW
CRH stim response: inc ACTH
aldosterone: low 
renin: high
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10
Q

secondary adrenal insufficiency labs

A 
pituitary 
CRH: high
ACTH: LOW
cortisol: LOW
CRH stim response: no/dec ACTH
aldosterone: low 
renin: normal/low
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11
Q

tertiary adrenal insufficiency labs

A 
hypothalamus  
CRH: low
ACTH: low
cortisol: low
CRH stim response: exaggerated/prolonged 
aldosterone: low 
renin: normal/low
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12
Q

adrenal crisis sx and labs

A

hypotension or shock, vomiting, abd pain
F, AMS
from withdrawal of steroids
dec Na, inc K, dec glu

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13
Q

primary adrenal insufficiency sx

A 
hyperpigmentation (inc ACTH)
salt craving (dec aldosterone) 
hypoNa, orthostatic hypoTN (dec aldosterone) 
kyperK, metabolic acidosis (dec aldosterone)
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14
Q

secondary and tertiary adrenal insufficiency has normal

A

aldosterone levels

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15
Q

adrenal insufficiency BIT

A

AM serum cortisol level

low cortisol = adrenal insufficiency

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16
Q

adrenal insufficiency confirmation test

A

cosyntropin stimulation test (ACTH stim)

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17
Q

adrenal insufficiency tx

A

glucocorticoid and mineralocorticoid replacement: hydrocortisone/dexamethasone and fludrocortisone (primary only)
ER w/ hypoTN: IV fluids and IV hydrocortisone
secondary: glucocorticoid

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18
Q

cushings syndrome MOA

A

high cortisol levels in blood

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19
Q

cortisol function

A

circadian rhythm
rise in AM to help us wake up, and decreases in PM to help go to sleep
maintain BP
dec inflammatory and immune response

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20
Q

MCC Cushing disease

A

pituitary adenoma

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21
Q

MCC Cushing syndrome

A

exogenous steroid use

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22
Q

Cushing BIT

A

overnight low dose dexamethasone test
24h free urine cortisol
suppression= Cushing
no suppression= adrenal/ectopic ACTH secreting tumor

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23
Q

GLP1 AE

A

“-tide”

pancreatitis

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24
Q

SGLT2 AE

A

“-flozin”
UTI
yeast infx

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25
Q

metformin AE

A

lactic acidosis
no IV contrast
macrocytic anemia, renal impairment
GI issues, metallic taste

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26
Q

type I DM pathophys

A

autoimmune pancreatic islet beta cell destruction and GAD abs

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27
Q

DMT1 labs

A 
A1c > 6.5
fasting glucose >126 on 2 occasions 
random glucose >200 
OGTT 2h >200 
ABSENT C PEPTIDE
islet leukocytic infiltrate
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28
Q

rapid insulin

A

lispro

aspart

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29
Q

short acting insulin

A

regular

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30
Q

intermediate acting insulin

A

NPH

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31
Q

long acting “basal” insulin

A

glargine
Lantus
Levemir

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32
Q

dawn phenomenon

A

hyperglycemia between 3AM and 8AM

increase night insulin

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33
Q

somogyi effect

A

nocturnal hypoglycemia at 3AM
high glucose levels by 7AM
decrease night insulin

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34
Q

DMT2 criteria labs

A 
A1c >6.5
fasting glucose >126 on 2 occasions 
random glucose >200
OGTT 2h >200 
ELEVATED C PEPTIDE
amyloid polypeptide deposits in pancreas
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35
Q

DM screening

A

adult w/ BMI >25 and triglycerides >250 or HDL <35
starting at 45yo
repeat every 3yrs if normal

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36
Q

metformin CI if

A

GFR <45

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37
Q

hyperosmolar hyperglycemic state MC in pts w/

A

DMT2

infection

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38
Q

hyperosmolar hyperglycemic state sx

A

polyuria, dehydration, lethargy, seizures, coma, death
gradual onset, blurred vision, slurred speech, weakness,
hypotension, AMS

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39
Q

hyperosmolar hyperglycemic state tests

A 
glu 600-2400
high serum osmolality (>320)
glycosuria, inc BUN/Cr
negative ketones
hyponatremia
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40
Q

hyperosmolar hyperglycemic state tx

A

agressive IV fluids w/ NS
replete electrolytes (K)
IV insulin after fluids

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41
Q

diabetic ketoacidosis causes

A

insulin non compliance
new diabetic dx
MCC infection

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42
Q

diabetic ketoacidosis sx

A

abd, N/V, dehydration, fruity breath

kussmaul respiration

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43
Q

diabetic ketoacidosis labs

A 
ketonuria
random glucose 250-600
metabolic acidosis 
total body K dec 
high anion gap 
leukocytosis
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44
Q

diabetic ketoacidosis tx

A

IV fluids
K replacement before insulin
IV insulin
bicarb for severe acidosis

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45
Q

metabolic syndrome criteria

A

waist circumference: >40in (M), >35in (F)
glucose >100 or tx of hyperglycemia
HDL: <40 M, <50 F or tx HDL
BP: >135 systolic or >85 diastolic or tx HTN
triglyceride: >150 or tx triglyceride

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46
Q

klinefelter sx

A

boy w/ gynecomastia

small testicles

47
Q

Turner syndrome sx

A

girl w/ webbed neck

short stature

48
Q

kallman syndrome sx

A

anosmia
absent breast development
uterus present
syndactyly

49
Q

MEN1

A

3Ps
primary hyperparathyroidism: hypercalcemia, inc intact PTH, dec P, inc 24h urine calcium
pancreatic tumor: ZES, gastronome, insulinoma
pituitary adenoma: prolactinoma MC

50
Q

MEN2A

A

1M and 2Ps
medullary thyroid cancer
pheochromocytoma
primary hyperparathyroidism

51
Q

MEN2B

A 
3Ms and 1P
medullary thyroid cancer
pheochromocytoma
marfanoid body habits 
mucosal neuromas
52
Q

pheochromocytoma rule of 10

A 
bilateral
familial
pediatric
malignant
extra adrenal
MEN2A/2B
53
Q

pheochromocytoma sx

A

triad: episodic HA, HTN, diaphoresis
5Ps: pressure (HTN), pain (HA), perspiration, palpitation, pallor

54
Q

pheochromocytoma BIT

A

24h urinary metanephrine and catecholamines: inc metanephrines and inc vanillylmandelic acid

55
Q

pheochromocytoma MAT

A

CT/MRI adrenals

56
Q

pheochromocytoma tx

A

surgical resection

preop: 1st alpha blockage (phenoxybenzamine) control BP then propranolol

57
Q

primary hyperaldosteronism vs secondary hyperaldosteronism

A

primary: renin independent. adrenal hyperplasia, conns (adrenal aldosteronoma)
secondary: increased renin. renal artery stenosis

58
Q

Conns syndrome pathology

A

aldosterone secretion independent from RAAS

59
Q

MCC conn syndrome

A

adrenal adenoma

60
Q

Conns syndrome sx

A

refractory HTN
muscle weakness (hypoK), palpitations, arrhythmias
polyuria/polydipsia, N/V/abd dist
dec DTR, dec Mg

61
Q

Conns syndrome tests

A

screening: plamsa aldosterone to plasma renin if HTN (+ if inc ratio)
definitive: saline infusion test
hypernatremia, hypoK, metabolic alkalosis

62
Q

conns syndrome tx

A 
tx underlying (adrenalectomy) 
1st line spironolactone or eplerenone
63
Q

SIADH med causes

A 
narcotics
SSRI, NSAIDS
carbamazepine
TCA, HCTZ
ecstasy
64
Q

increased ADH secretion results in

A 
concentrated urine (increased urine osmo)
water retention (dec serum osmo) 
increased edema and increased ICP --> hyponatremia
65
Q

ectopic ACTH secretion commonly from

A

small cell lung cancer

66
Q

SIADH sx

A

hyponatremia, muscle weakness,, confusion, N/V/HA

severe: seizures, AMS from cerebral edema

67
Q

SIADH tests

A

hyponatremia (isovolemic hypotonic)
inc urine osmo, dec serum osmo
inc plasma ADH
dec uric acid, dec BUN

68
Q

S|ADH tx

A

asx: fluid restriction and inc salt intake
sx: hypertonic saline, ICU, furosemide
demeclocycline, IV conivaptan/PO tolvaptan

69
Q

medullary thyroid carcinoma produces

A

calcitonin

70
Q

hyperparathyroidism sx

A 
dec DTR
moans: not feeling well
groans: abd pain, GERD
stones: kidney
bones: bone pain
psych overtonesL depression
71
Q

primary hyperparathyroidism labs

A

inc Ca
Inc PTH
dec P
shortened QT

72
Q

hyperparathyroidism tx

A

IV fluids
loop diuretics
parathyroidectomy: if asx, can be candidate if T score <-2.5 or younger than 50yo

73
Q

hypocalcemia EKG

A

prolonged QT interval

74
Q

hypoparathyroidism sx

A

trousseau (BP cuff)
chvostik sign (facial twitch)
inc DTR, tetany

75
Q

hypoparathyroidism lab triad

A

dec Ca
dec intact PTH
inc P

76
Q

hypoparathyroidism tx

A

sx or Ca <7.6: IV Ca glutinate

Ca >7.6: PO Ca carbonate + VitD supplement

77
Q

acromegaly/gigantism tx

A

transsphenoidal resection

octreotide

78
Q

acromegaly/gigantism MAT

A

OGTT w/ serum GH in 2h

79
Q

acromegaly/gigantism study of choice

A

MRI

80
Q

acromegaly/gigantism BIT

A

inc IGF1 levels

81
Q

acromegaly vs gigantism

A

acromegaly: adult
gigantism: children

82
Q

MC type of DI

A

central

83
Q

rx that causes nephrogenic DI

A

lithium

84
Q

DI labs

A

inc vol urine, dec ADH/vasopressin
dec urine osmo (dilute)
inc serum osmo (concentrated)

85
Q

DI BIT

A

water deprivation test: if inc urine osmo –> psychogenic polydipsia

86
Q

DI tx

A

central: tx underlying, IN DDAVP
nephrogenic: thiazide, amiloride, indomethacin

87
Q

nephrogenic DI CI

A

ahminoglycosides: nephrotoxic

88
Q

dwarfism/achondroplasia patho

A

autosomal dominant: FGFR3

89
Q

tx dwarfism

A

conservative

do not give GH

90
Q

prolactinoma labs

A

dec LH/FSH
dec estrogen
inc serum prolactin

91
Q

prolactinoma MAT

A

snowman appearance on MRI

92
Q

prolactinoma tx

A

BItx: cabergoline/bromocriptine

93
Q

MCC hyperthyroidism

A

graves dz

94
Q

jod basedow phenomenon

A

iodine induced thyrotoxicosis

hyperthyroidism after IV iodine contrast

95
Q

hyperthyroidism tx

A 
methimazole
PTU (pregnancy) 
BB
prednisolone 
severe: thyroidectomy
96
Q

graves triad

A

exophthalmos
orbitopathy (lid lag)
peritibial myxedema

97
Q

thyroid storm sx

A

hyperthyroidism + fever, tachycardia, arrhythmia, and AMS

98
Q

thyroid storm tx

A 
ABC
1st step: BB
2nd: PTU/methimazole 
3rd: iodine and steroids (dexamethasone) 
avoid aspirin
99
Q

hashimotos thyroiditis labs

A 
\+ thyroid ab
thyroid peroxidase 
antimicrosomial
dec RAIU
HLADR3
100
Q

de quervains thyroiditis sx

A

follows flu-like illness

self limiting

101
Q

de quervains thyroiditis phases

A

3 phases
hyperthyroidism
hypothyroidism
return to normal fxn

102
Q

riedel thyroiditis sx

A

chronic condition
firm hard woody nodule
fixed hard painless goiter
tx w/ surgery

103
Q

postpartum thyroiditis

A

up to 1yr after delivery
transient hyperthyroidism then hypothyroidism
self limiting, dont give thyroid meds
+ thyroid ab

104
Q

wolff-chaikoff effect

A

auto regulatory w/ too iodine

105
Q

medications that can cause thyroid issues

A

amiodarone
lithium
sulfonamides

106
Q

silent (lymphocytic) thyroiditis

A

+ thyroid ab
dec RAIU
return to euthyroid in. 12-18mo wo tx
tx w/ aspirin, no thyroid meds

107
Q

hashimotos thyroiditis histology

A

hurtle cells

108
Q

de quervain thyroiditis sx

A

1st: enlarged painful thyroid, jaw pain
2nd: weight gain, pretrial myxedema

109
Q

de quervain thyroiditis tests

A

high ESR
neg thyroid ab
gold standard: RAIU dec

110
Q

de quervain thyroiditis tx

A

self limiting

1st: NSAIDS and BB
2nd: steroids

111
Q

myxedema coma sx

A 
dec mentation
hypothermia 
hypotension 
hyponatremia
old lady w/ long standing hypothyroidism in cold weather
112
Q

myxedema coma tx

A

ABC in ICU
supportive
IV levothyroxine and hydrocortisone

113
Q

Sheehan syndrome

A 
postpartum pituitary infarction 
lactation failure (dec prolactin) 
amenorrhea, hot flashes, vaginal atrophy (dec FSH/LH)
fatigue, bradycardia (dec TSH)
anorexia, WL, hypoTN (dec ACTH)
dec lean body mass (dec GH)
114
Q

diabetic meds that cause hypoglycemia

A

sulfonylureas: glyburide, glipizide
meglitinides: repaglinide, nateglinide
insulin: regular, lispro, aspart, NPH, glargine

PNCE (33 decks)

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