Endo Flashcards
Which diabetic pts should be on a statin
All, provided they are over 40 and have at least one other cv rf
Bp management in diabetics
Strict control to <140/80, first line aceis and arbs
Which diabetic pts should get the pneumonia vaccine
All above age 19
In hhs, glucose is above
600
Serum osmolality in hhs is
> 320 mosm/kg
Is there acidosis in hhs
No
Tx of hhs
Aggressive fluids, electrolyte replacement, insulin
What do you see on biopsy in a pt with diabetic nephropathy
Kimmelstein wilson nodules
Most Common cause of death in diabetic patients
Cv dz
Tx diabetic gastroparesis with
Metoclopramide or erythromycin
Criteria for metabolic syndrome
Weighht- need three out of five
Waist Expanded Impaired Glucose Htn Hdl decreased Tgs increased
Can tbg be elevated in pregnancy and estrogen admin
Yes
Difference between hyperthyroid and thyrotoxicosis
Hyperthyroid-increased synthesis of t3/t4
Thyrotox-increased levels of t3/t4
Graves is the __ form of hyperthyroidism. ___ increase synth of t3/t4
Autoimmune
Thyroid stimulating antibodies
Thyroid storm is a life threatening form of ___ that may cause ___, ___ and ___
Thyrotoxicosis
Af, fever, delirium
Tx of thyroid storm
Antithyroid drugs (methimazole, propylthiouracil), then iodine, iv esmolol and steroids and admit to icu
Symptomatic tx of hyperthyroid
B blocker
As blood sugars decrease to 250-300 in tx of dka, what should you add
5% dextrose to decrease risk of hypoglycemia
___ tbg levels in pregnancy lead to ___ free t3/t4 levels and __ tsh
Increased
Decreased
Increased
What should you do to levothyroxine dose in preggos
Increase
Hashimoto thyroiditis is associated with what antibodies
Antithyroglobulin and antithyroid peroxidase (anti-tpo)
What kind of hernia can you see in congenital hypothyroid
Umbilical
What lipid abnormalities can you see in hypothyroid
High ldl
High tgs
In asymptomatic hypothyroid treat with levothyroxine if tsh is above
10 mU/L
Increased serum alk phos level with normal ggt level points to what etiology
Bone, not liver
Bone pain and hearing loss, think
Paget’s disease
Low serum phosphorus feedback loop
Low serum phosphorus converts 25 vit D to 1,25 vit D, which causes release of phosphate from bone matrix and increased intestinal reabsorption
Lab values in paget dz of bone (alk phos, calcium, phosphate)
High serum alk phos, normal calcium and phosphate
Pth works on what two organs to increase calcium
Renal tubular cells to reabsorb calcium and bone to stimulate calcium release
Parathyroid hormone stimulates production of 1,25 vit d, which causes calcium reabsorption from the
Gut
Stones, bones, moans, groans and psychic overtones indicate what
Hypercalcemia
Tx of hypercalcemia
Fluids then loop diuretics and iv bisphosphonate
Pth ___ phosphorus
Decreased
Primary hyperparathyroidism reveals __calcemia, __phosphotemia, and ___calciuria
Hyper
Hypo
Hyper
In secondary hyperparathyroidism, If etiology is renal failure what is phosphate level
High
What is familial hypocalciuric hypercalcemia
Inherited disorder due to mutations in calcium sensing receptor present in parathyroid and kidney. Have normal pth, hypercalcemia and hypocalciuria. Asymptomatic and no tx necessary
What is cinacalcet
Lowers serum pth levels and is used for hyperparathyroidism due to pts with renal failure or who can’t undergo surgery
What is Sheehan syndrome
Pituitary infarction secondary to postpartum hemorrhage
Most common cause of Cushing syndrome
Prolonged tx with exogenous corticosteroids
Difference between Cushing syndrome and Cushing diseAse
Syndrome: too much cortisol
Disease: too much cortisol from acth producing pit adenoma
Dx of Cushing syndrome
Dexamethasone suppression of plasma cortisol, or measure 24h urinary free cortisol
How to determine if Cushing syndrome is due to adrenal tumor or acth dependent Cushing syndrome
Measure plasma acth and cortisol after dexamethasone suppression test. If acth is suppressed, it’s an adrenal tumor
Water deprivation test: what happens in psychogenic polydipsia
More concentrated urine
Water deprivation test: what happens in central and nephrogenic di
Pts excrete a high vol of inappropriately dilute urine
What will desmopressin do in central di
Decrease urine output and increase urine osmolarity
What will desmopressin do in nephrogenic di
No effect
First line tx of nephrogenic di
Salt restriction and take in water
Thiazides can help
Very common cause of euvolemic hyponatremia
Siadh
If pt is severely hyponatremic (<110) or is symptomatic (seizing, coma), what should you do
Cautiously give hypertonic saline, monitor for central pontine myelonolysis
Tx of siadh
Fluid restrict
Cause of siadh
Persistent adh release independent of serum osmolality
Acth secretion is __ in primary adrenal insufficiency
Increased, this causes the hyperpigmentation
Most common cause of secondary AI
Cessation of long term glucocorticoid tx
Aldosterone is ___ in primary AI, ___ in secondary AI
High
Normal
Acth is ___ in primary AI, ___ in secondary AI
High
Low
Pheochromocytomas are associated with what syndromes
Men 2A and men 2B
Why don’t you do b blockade first in pheochromocytomas
Unopposed a adrenergic stimulation can lead to severe hypertension
Medullary carcinoma is associated with ___ syndromes, so screen for ____, ____ before you remove thyroid
Men 2A/B
Vma and metanephrines
Elevated ___ level is dx of 21 hydroxylase deficiency
17 hydroxyprogesterone
Tx of 21 hydroxylase def
Immediate fluid resus and salt repletion
Pts with hhs or dka have __ levels of serum potassium but __ levels of total body potassium due to ___
Normal or elevated
Low
Due to excessive urinary potassium loss caused by osmotic diuresis
Insulin therapy for hhs can ___ serum potassium levels and cause ___
Lower
Severe hypokalemia
What happens to pituitary gland in Sheehan syndrome
Ischemic necrosis of the gland
Approx 40% of calcium is bound to
Albumin
Serum calcium decreases by ___ with every 1g/dL decrease in serum albumin
0.8 mg/dL
Can myopathy occur with hypothyroidism
Yes
Thyrotoxicosis causes what four cv findings
Tachycardia
Systolic htn
Widened pulse pressure
Afib/glitter
Hyperthyroidism causes a ___ in svr
Decrease
Increased bp in thyrotoxicosis is due to
Increased myocardial contractility
Rapid onset hirsutism suggests very high levels of ___ possibly due to ___. Check __ and ___ levels
Androgen
Androgen-secreting neoplasm
Testosterone and dheas
Androgen producing tumor-where am I?: high testosterone and normal dheas
Ovarian source
Androgen producing tumor-where am I?: high dheas
Adrenal tumor
Hypothyroid can cause ___lipidemia
Hyper
First dx step of hypercalcemia after correcting for albumin
Measure pth level
Clinical features of neonatal thyrotoxicosis
Warm moist skin, tachycardia, poor feeding, irritability, poor weight gain, low birth weight
Cause of neonatal thyrotoxicosis
Transplacental passage of maternal anti-tsh receptor antibodies
Diagnosis of neonatal thyrotoxicosis
Maternal anti-tsh receptor antibodies >500%
Tx of neonatal thyrotoxicosis
Self resolves in three months
Short term can use methimazole and b blockers
Can hashimoto thyroiditis cause recurrent pregnancy loss
Yes
Optimization of glycemic control in dm is associated with reduced risk of micro or macro vascular complications
Micro
Can hypocalcemia cause hyperreflexia
Yes
Tx of acute hypocalcemia
Ivcalcium gluconate/chloride
Carpal spasm, trousseau sign, is a sign of
Hypocalcemia
How does transfused blood cause hypocalcemia
Citrate in transfused blood bonds ionized calcium. If you have liver issues, can’t metabolize citrate.
Porphyria cutanea tarda is associated with what condition primarily
Hep c
Pt with htn and hypokalemia: high renin and high aldosterone
Secondary hyperaldo
Pt with htn and hypokalemia: low renin and high aldo
Primary hyperaldo
Pt with htn and hypokalemia: low renin and low aldo
Non-aldo causes: cah, Cushing for example
Four causes of secondary hyperaldo
Renovascular htn
Malignant htn
Renin secreting tumor
Diuretics
Hyperaldo presents with
Htn, headache, polyuria, muscle weakness
In hyperaldo, labs show ___kalemia and metabolic ____.
Hypokalemia
Metabolic alkalosis
Refeeding syndrome is due to a surge in ___ after body resumes anabolism
Insulin
What electrolytes are depleted in refeeding syndrome
Phosphate
Mag
Potassium
Because rapid insulin secretion starts glycogen, fat and protein synthesis again, which needs these electrolytes and rapidly depletes already small stores of them
Deficiencies in potassium and magnesium in refeeding syndrome can cause
Cardiac arrhythmia s
Aggressive refeeding with electrolyte repletion can cause __ failure
Cardiopulmonary
Aldosterone escape in hyperaldo limits what two things
Edema and hypernatremia (despite htn and increased blood volume)
Hypomag is very common among hospitalized ___
Alcoholics
How can hypomag cause hypocalcemia
By inducing resistance to pth and decreasing pth secretion
Hyperthyroid causes __ osteoclastic activity and bone ___, resulting in ___calcemia
Increased
Resorption
Hyper
Can you see hypercalciuria in hyperthyroid
Yes, due to neg feedback due to hypercalcemia
Fetal hyperthyroid can be seen in moms who have___, not toxic adenoma causing hyperthyroid
Graves
Do you get high fever in thyroid storm
Yes
Tx of thyroid storm
B blocker, ptu, glucocorticoids
Do you get high ck in thyroid storm
Yes
Most common cause of congenital hypothyroid
Thyroid dysgenesis
Pt with acute serious illness, normal T4 and TSH but low T3 likely has
Euthyroid sick syndrome
Can hyperthyroid cause myopathy
Yes
For primary hyperparathyroid who should get parathyroidectomy
Pts with symptomatic hypercalcemia
Acth deficiency, hypothyroid and infertility + loss of libido in men and amenorrhea in women
Hypopit
Can hashimoto thyroiditis cause vitiligo
Yes
Best markers of resolution of dka
Serum anion gap or beta hydroxybutyrate level
Manifestations of men1 syndrome (three)
Pituitary adenomas, primary hyperparathyroid, pancreatic/gastrointestinal neuroendocrine Tumors (eg gastrinoma, vipoma)
Desmopressin is first line treatment for central or nephrogenic di
Central
Bad side effect of ptu and methimazole
Agranulocytosis
In case of getting exogenous thyroid hormone, thyroglobulin will be
Low
Most androgen producing adrenal tumors overproduce
Dhea
Myopathy in Cushing syndrome is characterized by weakness in the __ muscles and is due to __
Proximal
Direct catabolic effects of cortisol on skeletal muscles leading to muscle atrophy
How do toxic adenomas cause hyperthyroid
Autonomous thyroid production without tsh stimulation
Most common cause of oculomotor (cn iii) nerve palsy in adults
Ischemic neuropathy due to poorly controlled dm
Ischemic cn iii palsy presentation
Ptosis, down and out gaze, preserved pupillary response
Una is __, pt is __volemic, pt is ___tonic and hyponatremic
Gi losses
Una<10
Hypovolemic
Hypotonic
Una is __, pt is __volemic, pt is ___tonic and hyponatremic
Skin losses
Una<10
Hypovolemic
Hypotonic
Una is __, pt is __volemic, pt is ___tonic and hyponatremic
Diuretics
Una>10
Hypovolemic
Hypotonic
Una is __, pt is __volemic, pt is ___tonic and hyponatremic
Cirrhosis, chf, nephrotic syndrome
Una<10
Hypervolemic
Hypotonic
Una is __, pt is __volemic, pt is ___tonic and hyponatremic
Aki
Ckd
Una>10
Hypervolemic
Hypotonic
Urine osmolality is __, pt is __volemic, pt is ___tonic and hyponatremic
Siadh, Addison’s, thyroid
Urine osm>100
Normovolemic
Hypotonic
Urine osmalilty is __, pt is __volemic, pt is ___tonic and hyponatremic
Psychogenic
Urine osmolality<100
Normovolemic
Hypotonic
Two kinds of hypernatremia
Low urine osmolarity (<300)
And
High urine osmolarity (>600)
Nephrogenic di is a __natremic state with __ urine osmolarity
Hyper
Low (100-300)
Central di is a __natremic state with __ urine osmolarity
Hyper
Low (<100)
Na+ gain and extrarenal losses are a __natremic state with __ urine osmolarity
Hyper
High
Go losses due to vomiting causes __chloremia, __kalemia and ____ bicarb
Hypo
Hypo
Elevated
Pt, especially young one, with htn and hypokalemia, suspect
Primary hyperaldo
Best screening test for hyperaldo
Early-morning plasma aldosterone concentration (pac) to plasma renin activity ratio
Estrogen ___ tbg
Increases
