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INTERNAL MED IP/OP > ENDO > Flashcards

ENDO Flashcards

1
Q

What regulates Ca homeostasis?

A

Parathyroid hormone

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2
Q

What stimulates the release of PTH?

A

Low Ca levels

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3
Q

What can often occur after having neck surgery or surgery for thyroid cancer?

A

Hypoparathyroidism

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4
Q

If a pt is having significant muscle spasm, paresthesia, and tetany -dx?

A

Hypoparathyroidism

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5
Q

What two things can you look for on PE for hypoparathyroidism?

A

Chvostek sign (tapping on the face that causes facial twitching), or trousseau sign (inflating the BP cuff causes tetany)

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6
Q

How do you dx hypoparathyroidism?

A

Decreased PTH, Serum Ca, and increased Phosphorus

EKG – prolonged QT interval

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7
Q

How do you treat hypoparathyroidism?

A

replace Ca and Vit D, check Mg

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8
Q

If you elevated PTH and serum Ca, and low phosphate – dx?

A

HYperparathyroidism

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9
Q

What is the MC cause hyperparathyroidism?

A

Single parathyroid gland adenoma

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10
Q

If a pt has renal stones, nausea, constipation, and decreased bone mineral density – dx?

A

Hyperaparthyroidism

“Bones, stones, and groans”

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11
Q

What will you see on EKG with hyperparathyroidism?

A

short QT interval

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12
Q

If PTH is low with elevated Ca – dx?

A

Need to think of other causes (aka malignancy)

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13
Q

How do you treat hyperparathyroidism?

A

Surgery for symptomatic patients

Asymptomatic + serum Ca over 1.0, reduced CrCl, osteoporosis, and under 50 – go to surgery

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14
Q

What type of symptoms would we see in a pt with hyperparathyroidism?

A

proximal muscle weakness, gait disturbance, atrophy, and hyperreflexia

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15
Q

What would secondary hyperparathyroidism be caused from? Tx?

A

Chronic renal failure and Vit D deficiency

Tx – Replace Vit D or dietary phosphate restriction

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16
Q

How do we treat acute hypercalcemic crisis?

A

IV hydration and bisphosphonates, furosemide can help calcium excretion

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17
Q

What’s more common, hyper or hypothyroidism?

A

Hypothyroidism

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18
Q

Hashimoto’s is associated with what?

A

Hypothyroidism

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19
Q

What is grave’s disease associated with?

A

Hyperthyroidism

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20
Q

If a pt has constipation, weight gain, fatigue, hair loss, and cold intolerance – dx?

A

Hypothyroidism

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21
Q

What would the labs show for hypothyroidism?

A 
TSH = High
T4 = Low
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22
Q

How do we treat hypothyroidism?

A

Levothyroxine (take on an empty stomach and wait 4 hours before taking Ca or Fe)

Levothyroxine replaces T4 (which is then converted to T3)

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23
Q

What else could cause hypothyroidism?

A

Iodine deficient diet, lithium!, and amiodarone

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24
Q

What are the causes of hyperthyroidism?

A

Grave’s Dz (autoimmune that leads to TSH receptor antibodies)

Subacute Thyroiditis = post-infectious, tender thyroid

Silent thyroiditis = occurs post-partum

Toxic nodular goiter – nodular felt on exam

Pituitary adenoma – nothing in particular in Hx or exam

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25
Q

What’s the most common cause of a painful thyroid?

A

Subacute thyroiditis

Also suppurative thyroiditis (rare) MC caused by staph aureus

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26
Q

If a pt has heat intolerance, weight loss, palpitations, hyper defication, and anxiety – dx?

A

Hyperthyroidism

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27
Q

What is thyrotoxicosis?

A

excess circulating T3 and T4

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28
Q

What sxs are more specific to Graves dz?

A

Upper eyelid retraction, lid lag with downward gaze, protrusion and buldging og the eyes

29
Q

What will the labs look like with hyperthyroidism?

A

TSH – suppressed

T3 and T4 – elevated

30
Q

What if free T3 is also elevated, along with T4, and TSH is suppressed – what should you do?

A

Pituitary adenoma – get an MRI

31
Q

How do you treat a thyroid storm?

A

PTU or methimazole

32
Q

How do you treat an adenoma?

A

surgical resection

33
Q

How do we treat the palpitations in someone with hyperthyroidism?

A

Propranolol

34
Q

How do you treat someone who is preggo with hyperthyroidism?

A

PTU in 1sttri, methimazole in 2ndand 3rd

35
Q

What’s the definitive treatment for hyperthyroidism?

A

Radioactive iodine – used if prior PTU or MMI failure

  • Methimazole can lead to leukopenia/agranulocytosis
  • PTU can cause hepatotoxicity
36
Q

After any thyroid medication is initiated, when so we re-check TSH levels?

A

4-6 weeks

37
Q

A pt presents with a fixed hard mass in the throat, cervical lymphadenopathy, and vocal cord paralysis -dx?

A

Thyroid cancer

38
Q

What’s a risk factor for thyroid cancer?

A

Childhood head and neck irradiation

39
Q

How do you move forward with a thyroid nodule?

A

Always draw a TSH

Do a U/S

40
Q

What If a pt has a thyroid nodule and the TSH is low, what do you do?

A

Do a radionucleotide iodine uptake scan
Non-functioning (cold)BIOPSY
Hyper-functioning (warm)serial ultrasounds

41
Q

When should we always biopsy a thyroid nodule?

A

Solid nodule greater than 1 cm

Cystic nodule greater than 2cm

42
Q

What are some of the risk factors to Type 2 diabetes?

A

Over the age of 45, BMI greater than 25, DM in a 1stdegree relative, sedentary lifestyle, gestational DM, Hx of delivering a child 9lbs or heavier, dyslipidemia, PCOS

43
Q

When do we screen for diabetes?

A

Aged 40-70 with BMI greater than 25, every 3 years

44
Q

What would indicate diabetes?

A

Fasting glucose greater than 126 or
One glucose greater than 200 or
HA1c greater than 6.5 or
Positive 2-hr oral glucose tolerance test

45
Q

Give an example and time frame for a rapid acting insulin:

A

Rapid Acting –lispro, aspart, glulisine (onset 5-15 min; peak 1 hr; lasts 4 hours)

46
Q

Give an example and time frame for a fast acting insulin:

A

Fast Acting – Regular (onset 30-60mins, peaks 2 hours, last 6 hours)

47
Q

Give an example and time frame for a Intermediate acting insulin:

A

Intermediate – NPH – onset 2 hours, peak 6 hours, lasts 14 hours

48
Q

Give an example and time frame for a Long-acting insulin:

A

Long-acting –glargine(onset 1-2 hours, no peak, lasts 24 hours)

49
Q

Where do we start when someone is pre-diabetic or has a slightly positive A1c?

A

Weight loss, proper nutrition, and exercise

50
Q

What is first line medication for diabetes?

A

Metformin

51
Q

What can we add if Metformin is not enough?

A

Sulfonylureas (glipizide and glyburide)

52
Q

If oral’s aren’t working to control diabetes, then what?

A

Basal insulin, can add an rapid acting as well

53
Q

If an A1c is greater than 9%, what do we do?

A

They must start insulin

54
Q

What should a diabetic have done yearly?

A

Eye exam, urine for microalbumin, LDL (statin), BP less than 140/90 (ACE or ARB first line), ASA if 10 year risk is greater than 10% or greater than 30 years of age

55
Q

What are some of the risk factors to hypercholesterolemia?

A

HTN, Smoking, DM, obesity, age over 45 (males; 65 for females), and Family Hx

56
Q

How and when do we screen for hypercholesterolemia?

A

HDL, LDL, total cholesterol, and trigs

High risk males over 25 and females over 35

Non-high risk males over 35 and females over 45

57
Q

How do we treat hypercholesterolemia?

A

Diet, exercise, weight loss, and no tobacco products

LDL is greater than 190 = high statin

DM ages 40-75 with LDL between 70-180 = moderate statin

CVD or DM w/ LDL between 70-189 and a 10year risk of atherosclerotic dz >7.5% = moderate to high statin

58
Q

Why would we treat hypertriglyceridemia?

A

To reduce CV risk

If levels are greater than 1,000 pts at risk of pancreatitis

Use Niacin, Fibric Acids (Gemfibrazil or Fenofibrate), Fish Oil

59
Q

What is occurring in diabetes insipidus?

A

ADH is not made or does not work

60
Q

High intensity statins decrease LDL’s by how much?

A

50%

61
Q

Moderate intensity statins should decrease LDL’s by how much?

A

30-49%

62
Q

A healthy diabetic pt that is 65 or older should have a goal A1c of what?

A

7.5% or under

63
Q

; A complex diabetic pt that is 65 or older should have a goal A1c of what?

A

8% or under

64
Q

A very complex diabetic pt that is 65 or older should have a goal A1c of what?

A

8.5% or under

65
Q

What’s a target BG before eating?

A

80-130

66
Q

What’s a target BG 2 hours after eating?

A

less than 180

67
Q

What’s a target bedtime BG?

A

100-140

68
Q

What would be a weightloss of concern in an elderly patient?

A

more than 2% in 1 month, 10lbs in 6 months, or greater than 4% in a year

INTERNAL MED IP/OP (9 decks)

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