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Endo Flashcards

1
Q

Most common cause of primary hyperCa?

A

Primary hyperpara (outpatient)

Malignancy (inpatient)

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2
Q

1st step in hyperCa?

A

Parathyroid hormone level

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3
Q

Androgen insensitivity syndrome classic.

A

Male genotype with female characteristics (breast, sparse armpit and pubic hair)
No uterus
No periods
Infertility

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4
Q

Incomplete androgen insensitivity?

A

Partial fusion of vaginal lips
Enlarged clitoris
Blind ending vagina

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5
Q

Aspartame sugar is metabolized to?

A

Aspartic acid

Phenylalanine

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6
Q

Aspartame sweetener in contraindicated in which patients?

A

Phenylketonuria

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7
Q

Euthyroid sick syndrome labs?

A

Low T3

Normal T4 + TSH

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8
Q

What should be done before starting metfoemin?

A

Creatinine clearance > 70

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9
Q

Drug causes hyperCa?

A

Lithium

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10
Q

Diuretic used to Rx hyperCa?

A

Furosemide

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11
Q

Testosterone supplant SE?

A

Erythrocytosis

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12
Q

HyperCa in hyperpara vs renal failure vs milk alkali vs sarcoidosis.

A

Hyperpara: normal PTH + high Ca.

Renal: high PTH + High Ca

Milk alkali: overdose of Ca supplement + low PTH

Sarcoidosis: low PTH

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13
Q

Complications of acromegaly?

A 
arthritis 
Amenorrhea 
HTN
Cardiomegaly 
Carpel tunnel syndrome
DM
Renal failure 
Colonic polyps
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14
Q

Most common cause of death in acromegaly?

A

Cardio

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15
Q

Most common cause of 1ry hyperpara? Rx

A

Adenoma

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16
Q

Normal Anion Gap?

A

10-14

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17
Q

How to calculate Baseline anion gap?

A

0.25 x (44-albumin)

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18
Q

Pathophysiology of Cushing’s

A

High corticosteroids

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19
Q

Types of Cushing’s

A

ACTH dependent

ACTH independent

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20
Q

Dx of Cushing’s

A

DXM suppression test

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21
Q

Pager disease pathophysiology?

A

Increase bone remodeling (resorption, formation and mineralization)

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22
Q

Association between pages and multiple myeloma?

A

None

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23
Q

Rx of paget disease

A

Bisphosphonate

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24
Q

Effect of H-blocker / PPl on Ca absorption?

A

Decrease Ca carbonate

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25
Q

Patient on long term PPi / H-blocker what Ca formula should be started?

A

Ca citrate.

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26
Q

Anti-psychotic causing DM?

A

Risperidone
Clozapine
Olanzapine
Quetiapine

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27
Q

Most common cause of high K in healthy?

A

Lysis of RBC during phlebotomy.

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28
Q

What level of High K causes cardiac changes?

A

> 6 miles/L

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29
Q

Rx of hyperthyroidism in pregnancy?

A

PTU > MMI

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30
Q

Most important feature in

  1. Insulin
  2. Sulfonylurea
  3. Glitazone
A
  1. Most effective
  2. Least expensive
  3. No risk of hypoglycemia
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31
Q

Sulfonylurea SE?

A

Hypoglycemia

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32
Q

Metformin SE?

A

Lactic acidosis

GI upset

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33
Q

Metformin effect on weight?

A

Reduction

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34
Q

Rx of hyperK?

A
  1. Ca gluconate to stabilize cardiac cells.
  2. Sodium bicarbonate
  3. Glucose with insulin
  4. Albuterol
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35
Q

HypoPO4 classic?

A

Acute low PO4 in malnourished patients with refeeding syndrome at 2-3 day of improved nutrition

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36
Q

Sx hypoPO4?

A 
Weakness 
Confusion 
Arrhythmia
Low PB
HypoK
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37
Q

Pathophysiology of refeeding syndrome?

A

Refeeding increases insulin > uptake of phosphate > sever low PO4

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38
Q

Rx of uncontrolled DM in friable elderly?

A

Insulin

1. Diet is not recommended in elderly friable.

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39
Q

Contraindication to pioglitazone?

A

Heart Failure

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40
Q

Monitor LFT with statin. High LFT.

A

Only stop statin if LFTs are 3x increased.

No need for dose adjustment in <3x increase.

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41
Q

Effect of tight blood sugar control in post-op?

A

Improve morbidity and mortality.

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42
Q

Rx of post-op hyperglycemia

A

Insulin infusion

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43
Q

Causes of dyslipidemia?

A

DM
Hypothyroid
Obstructive liver disease
CKD

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44
Q

Rx of hypoNa from SIADH?

A

3% saline at 100 ml/Hr Q2-4 hr.

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45
Q

When to Rx SIADH with fluid restriction?

A

If no neuro sx

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46
Q

Hyperosmolar hyperglycemic state HHS classic?

A 
Plasma glucose > 33
Blood osmolality 320
Blood PH > 7.3 
HCO3 > 15
Dehydration 
Altered consciousness 
\+/- Ketonuria
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47
Q

Predisposing cause of HHS?

A

T2DM with infection
Alcohol
CVS
Renal

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48
Q

Rx of HHS?

A
  1. R/o MI by ECG
  2. Correct Na calculated and 9-10L NaCl should replaced.
  3. Stop metformin
  4. 2L should be given in 1st hour.
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49
Q

Pre-DM fasting glucose level?

A

6.1 - 6.9

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50
Q

Dx DM?

A
  1. Sx + Random 11.1
  2. Sx + FPG 7
  3. 2hr GTT 11.1
  4. HgbA1c > 6.6
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51
Q

Addison’s Disease?

A 
Low PB
Hyper pigmentation
Low Na + high K
Weakness + fatigue 
GI symptoms
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52
Q

Dx of addison’s?

A

Cosyntropin (ACTH analogue)

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53
Q

Feature of exenatide?

A

No risk of hypoglycemia
Given in combination.
No studies on children.

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54
Q

Hypoglycemia not related to insulin triad?

A

whippes triad:

  1. Neuro sx of low glucose
  2. Low plasma glucose
  3. Relief of Sx with glucose
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55
Q

Cushing’s triad?

A

Head injury

  1. Low HR
  2. Low RR
  3. HTN
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56
Q

Samter’s triad?

A

Nasal polyp
Asthma
Aspirin sensitivity

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57
Q

Virchows triad?

A

Stasis
Hyper coagulable state
Vessel injury

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58
Q

Beck’s triad?

A

Muffled heart sound
Distended neck veins
Hypotension

In cardiac tamponade

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59
Q

Niacin in statin patient?

A

Increases risk of rhabdomyolysis

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60
Q

Vitamin produced endogenously?

A

Vit D + K

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61
Q

Dx DI?

A
  1. Water deprivation fails to concentrate urine.

2. Exogenous ADH (vasopressin) to differentiate central from nephrogenic

62
Q

Primary Polynesia Dx?

A

Concentrate urine with water deprivation test.

63
Q

Sub clinical thyroid?

A

Abnormal TSH

Normal T4

64
Q

Subclinical thyroid dz association

A
  1. High TSH: high LDL

2. Low TSH: A-FIB , low bone density , cardiac disease.

65
Q

Investigation of hypertrichosis + regular periods.

A

Free testosterone

66
Q

Drugs contraindicated in pheochromocytoma?

A
  1. Diuretics => worsen pressure diuresis and volume depletion.
67
Q

Causes of SIADH?

A
  1. Drugs esp Vincrstine
  2. CNS
  3. Lung esp. SCLC
68
Q

Known endocrinological SE of lithium?

A

Hypothyroid

69
Q

What dose of steroids suppresses ACTH?

A

Late evening dose.

70
Q

Acceptable range of glucose in critically ill patients?

71
Q

Vit D deficiency Sx?

A

Bone metabolism abnormality

72
Q

Vit C deficiency?

A

Scurvy => bleeding gums

73
Q

Thiamine deficiency?

A

High out put HF
Dermatitis
Neuropathy

74
Q

Niacin deficiency?

A

Diarrhea
Dermatitis
Dementia

75
Q

Dx pheochromocytoma?

A

Urine catecholamine products

76
Q

Sx of low PO4?

A

Rhabdomyolysis at <0.3

77
Q

Lab findings in pheochromocytoma

A

High glucose

High Ca

Erythrocytosis

78
Q

Importance of 7-day half life of thyroxin?

A

If you miss the does for 1 week pts remain asymptomatic.

79
Q

High Vit D labs?

A

High Vit D
High Ca
High PO4

80
Q

Rx subacute thyroiditis

A

NSAIDs

High dose steroids

81
Q

Good glycemic control doesn’t affect which diabetic complication?

82
Q

Endocrinological disease ass with vitiligo?

A

Graves’ disease

Hashimoto’s

83
Q

Mechanism of action of DPP-4?

A

Dipeptidyl peptidase-4 inhibitor > inhibits Glucagon like peptide > increase glucagon > insulin release

84
Q

Advantage of PPD-4

A 
No weight gain 
No hypoglycemia (glucose level dependent)
85
Q

Mechanism action of sulfonylurea?

A

Increase insulin release

86
Q

Disadvantage of solfonylurea?

A

Hypoglycemia (increase insulin independent of glucose level)

87
Q

Importance of pancreatic B and a cells.

A

a => Glucagon.

b => insulin

88
Q

Mechanism of action of anti-hyperglycemics

A
  1. DPP-4: increase insulin (b) + decrease glucagon (a)
  2. Sulfonylurea: increase insulin (b)
  3. Repaglinide: insulin (b)
  4. a-Glucosidase inhibitor: inhibits absorption
  5. Pioglitazone: improves glucose uptake by tissues.
89
Q

Serious SE of PTU?

A

Agranulocytosis

90
Q

Effect of nicotinic acid?

A

Lowers cholesterol, LDL, TG, LDL/HDL ratio

91
Q

SE of nicotinic acid

A

High glucose (x DM)
Hepatotoxic
Muscle pain

92
Q

Most common cause of hypoglycemia in well control DM?

A
  1. Chance in diet
  2. Change dose
  3. Renal disease
93
Q

Sojgren Syndrome classic?

A

Dry mouth and eye.

  1. Ocular Sx
  2. Oral Sx
  3. Ocular signs
  4. Focal sialadenitis
  5. Salivary gland involvement
  6. Anti- Ro/La
94
Q

Sjogren association.

A

Autoimmune disorders
Salivary gland Ca
B cell lymphoma

95
Q

Rx sjogren?

A

Pilocarpine for xerostomia

Cyclosporine 0.05% eye

96
Q

Rx worsen ophthalmopathy in graves ?

A

Radioactive iodine

97
Q

What Rx increase risk of rhabdomyolysis with statin?

A

Rx inhibit CYP 3A4 => Ca blockers (verapamil)

98
Q

Non-K sparing?

A
  1. Loop diuretics: furosemide, bumetanide
  2. Thiazide diuretics:
    Chlorothiazide
99
Q

Drug to be stopped before CT contrast?

100
Q

Criteria Dx DM?

A
  1. Hgb A1C > 6.5
  2. Fasting glucose > 7
  3. 2h post prandial > 11.1
  4. Random glucose > 11.1 + symptoms
101
Q

ACEI SE?

102
Q

HyperK with ACEI?

A
  1. Temporarily stop

2. Repeat test

103
Q

Effect of DHEA on muscle?

A

Doesn’t improve strength or performance

104
Q

MEN syndromes

A

MEN I > 3P (pancreas, pituitary, parathyroid)

MEN IIa > parathyroid, medullary thyroid, pheochromocytoma

MEN IIb > medullary thyroid, pheochromocytoma, neuromas.

105
Q

Most sensitive and specific test for pheochromocytoma

A

Metanephrin levels

106
Q

Screen for hyperaldosteronism

A

Aldosterone/Renin ration

> 20:1 (aldosterone > 15)

107
Q

Who should be screened for hyperaldosteronism?

A

HTN + low K

108
Q

Insulin formulas

A
  1. Regular insulin
    Acts > 30-60 min
    Peaks > 2-3 hr
  2. Lispro, asparte
    Act > 15 min
    Peaks > 1hr
109
Q

Stimulants for aldosterone

A
  1. K levels (high > release | low > inhibits)

2. RAAS

110
Q

What should be done before measuring aldosterone:renin ratio?

A

Normalize K levels

111
Q

Conn’s syndrome findings?

A

HTN
High Na
low K

112
Q

Maximum dose of rosuvastatin?

113
Q

Pathophysiology of phenylketonuria

A

Defect in phenylalanine hydroxylase (PAH):

Phenylalanine converted to phenylpyruvate instead of tyrosine > musty odor

114
Q

What’s tetrahydrobiopterin

A

Co-factor for phenylalanine hydroxylase

115
Q

Rx of phenylketonuria

A
  • diet

- replenishing tetrahydrobiopterin

116
Q

Hyperpara vs familial hypocalceuric hypercalcemic?

A

Hyperpara > high urine Ca

FHH > low urine Ca

117
Q

Drugs increase risk of High K?

A

ACEI
BB
NSAIDs
K-sparing

118
Q

Vit D form measured in suspected deficiency ?

A

25-OH Vit D

119
Q

Use of red yeast rice (Monascus Purpureus)

A 
Herbal supplement (China) 
For dyslipidemia
120
Q

Mechanism of red yeast rice?

A

Active ingredients (monacolin K) > HMG-coA inhibitory effect

Lower cholesterol, LDL, TG

121
Q

Monitoring red yeast rice?

122
Q

Role of MMT / PTU in sub acute thyroiditis?

A

No role

It prevents synthesis of new hormones and in sub acute thyroiditis it’s excessive release from stores not new formed

123
Q

Rx of sever hypoglycemia (+ neuro Sx)

A

Admit
IV 50% Dextrose 50-100 ml bolus

Cont infusion D5NS

124
Q

Characteristic of hypoK from hypoMg?

A

Refractory to replacement until Mg is replaced

125
Q

Does pregnancy or lactation change daily allowance of Vit D?

A

No still 600 IU

126
Q

Maximum Vit D recommended for which age group?

127
Q

Cause of HyperCa on malignancy?

128
Q

Mechanism of action of thiazolidinedione

A

Lower glucose

By decreasing insulin resistance via binding to nuclear peroxisome proliferator-activated response

129
Q

Hyperaldosteronism findings in urine

A

Low Na in urine

Normal - high K (40 mEq)

130
Q

Ca levels in hyperCa

A

Total Ca > 3 (12 mg)

Ionized > 1.5 (6 mg)

131
Q

Rx hyperCa

A
  1. IV fluids
  2. Loop diuretics (furosemide)
  3. PO4 orally.
  4. Calcitonin, prednisone
132
Q

Why isn’t bisphosphonate the 1st line in sever hyperCa?

A

Takes 2 days to work

133
Q

MEN-I tumors

A

Parathyroid > hyperCa
Pancreatic > Zollinger-Ellison syndrome
Pituitary

134
Q

Drugs cause hyperthyroidism?

A

Interferon
IL-2
Amiodrone and

135
Q

Indication of Rx in dyslipidemia?

A

+2 risk factors like:

  1. FHx of heart disease
  2. High LDL
  3. Cholesterol
136
Q

Advantage of low carb diet?

A
  1. Don’t change BP, LDL levels.
  2. More weight loss than low-fat diet.
  3. Reduces TG
  4. Reduce insulin resistance
137
Q

Assessment of antithyroid Rx?

A

Measure free T4

138
Q

Components of caloric expenditure?

A

Basal metabolic rate for metabolic homeostasis 60-70%

Thermogenesis (for digestion) 5-10%

Physical activity 25-35%

139
Q

Would celiac disease cause high TG?

140
Q

Criteria for metabolic syndrome?

A

3 out of 5

  1. Central obesity
  2. TG > 1.70
  3. HDL < 1.29 F or < 0.03 M
  4. Fasting glucose > 6.1
  5. BP > 130/85
141
Q

Goal of lipid Rx in dyslipidemia?

A

NB: of blood glucose > 7 Rx DM first.
If < 7 Rx dyslipidemia
1. Decrease LDL via statin
Then decrease non-HDL cholesterol (total cholesterol - HDL = non-HDL lipids)

142
Q

Causes of 2ry HTN?

A 
CHAPS
Cushing's 
High aldosterone (Conns)
Aorta cortication 
Pheochromocytoma 
Stenosis of renal artery
143
Q

Must do before radioiodine Rx? Why?

A
  1. R/o pregnancy
  2. Stop anti-thyroid meds 3 days before Rx.

> anti thyroids prevent radioiodine uptake by thyroid!

  1. Stop K iodide > competes with radioiodine
144
Q

Function of BNP?

A
  1. Inhibits RAAS
  2. Inhibits endothelin secretion
  3. Inhibits sympathetic activity
145
Q

BNP role in Dx cardiac Dz?

A

< 100 HF unlikely
100-400 not clear
> 400 HF likely

146
Q

Best way to monitor blood glucose at home?

A

Finger tip

3x day

147
Q

Sulfonylurea med

A

Glyburide
Gliclazide
Glimepride

148
Q

Thiazolidinedion med

A

Pioglitazone

Rosiglitazone

149
Q

DPP-4 inhibitors

A

Sitagliptan
Saxagliptan
Linagliptan

150
Q

GLP-1 analogue

A

Exenatide

Liraglutide

151
Q

Total cholesterol

A

150-200 or <5.15

152
Q

Normal LDL

A

<130 or <3.36

CanQB (16 decks)

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