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COMLEX 3 > Endo > Flashcards

Endo Flashcards

1
Q

How calculate total daily insulin requirement?

A

Cr >1.5 + age>65 + glucose<180 –> 0.3u/kg

Otherwise –> 0.5u/kg

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2
Q

how much of total daily insulin administer as basal and bolus?

A

50% basal + 50% bolus

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3
Q

how much of total daily insulin administer as mixed insulin?

A

2/3 in AM + 1/3 in PM

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4
Q

glucose check –> goal level?

A

100-150

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5
Q

DM –> dx?

A
  • fasting glucose >126
  • random glucose >200
  • 2hr glucose >200
  • A1c >6.5%
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6
Q

DM –> glycemic goal?

A

A1c <7%

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7
Q

HLA-DR3 and HLA-DR4 are associated with what 2 conditions?

A
  • juvenile DM1

- autoimmune hepatitis

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8
Q

autoimmune hepatitis is associated with what antibody?

A

anti-smooth muscle Ab

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9
Q

72M –> insomnia, fatigue, irregular pulse –> dx?

A

Afib from hyperthyroid

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10
Q

pheochromocytoma –> rule of 10s

A 
10% extra-renal
10% familial
10% bilateral
10% malignant
10% in children
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11
Q

what is alopecia areata

A

autoimmune –> patchy hair loss

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12
Q

TSH: low
T4: high
US: diffuse enlargement of thyroid
Radioactive iodine uptake scan: diffusely decreased uptake

condition?

A

autoimmune thyroiditis (acute hyperthyroid phase):

  • Hashimoto’s thyroiditis
  • DeQuervain’s granulomatosis thyroiditis (subacute painful thyroiditis)
  • silent autoimmune thyroiditis (subacute painless thyroiditis)
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13
Q

silent autoimmune thyroiditis (subacute painless thyroiditis) –> risk factors (3)

A
  • spontaneously
  • post-infection
  • postpartum
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14
Q

Hashimoto’s thyroiditis –> Ab

A
  • thyroglobulin Ab

- thyroid peroxidase Ab (TPO)

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15
Q

differentiate: Hashimoto’s vs De Quervain’s granulomatous thyroiditis

A

Hashimoto:

  • painless
  • lymphocytic infiltrate

De Quervain’s:

  • painful
  • granulomatous response
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16
Q

TSH: low
T4: high
US: diffuse enlargement of thyroid
Radioactive iodine uptake scan: diffusely increased uptake

condition?

A

Graves disease

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17
Q

TSH: low
T4: high
US: normal
Radioactive iodine uptake scan: diffusely decreased uptake

condition?

A
  • exogenous ingestion of T4

- stroma ovarii

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18
Q

TSH: low
T4: high
US: irreg heterogenous nodules
Radioactive iodine uptake scan: focal areas of increased uptake

condition?

A
  • toxic multinodular goiter

- toxic adenoma

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19
Q

Graves disease –> pathophys

A

autoimmune –> TSH receptor Ab –> increase thyroglobuin production

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20
Q

how differentiate bw exogenous ingestion of T4

vs stroma ovarii

A

sestamibi scan

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21
Q

thyroid storm –> tx

A
  • cool IVF, cool blankets

1) propranolol –> decrease autonomic ssx
2) PTU or methimazole
3) steroid: prevent T4 convert to more active T3

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22
Q

active thyroid nodules –> trt w surgery or radioactive iodine ablation?

A

radioactive iodine ablation

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23
Q

TSH elevated –> but no hypothyroid ssx –> dx

A

subclinical hypothyroid

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24
Q

subclinical hypothyroid –> when treat?

A
  • TSH >10

- get ssx

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25
Q

myxedema coma –> tx

A
  • warm IVF, warm blanket
  • T4/T3
  • IV hydrocortisone
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26
Q

Graves dz –> tx

A

PTU or methimazole

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27
Q

Graves dz –> patient has already developed exophthalmos and pretibial myxedema –> tx

A

surgery + steroids

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28
Q

exogenous intake of T4 –> thyroglobulin is low or high? why?

A

thyroglobulin low

Thyroglobulin is only elevated with T4 if T4 came from thyroid

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29
Q

atropine –> SE: mydriasis –> fixed with no response to accomodation or there is response to accomodation?

A

muscarinic antagonist –> fixed with no response to accomodation

30
Q

phenylephrine –> SE: mydriasis –> fixed with no response to accomodation or there is response to accomodation?

A

adrenergic agent –> there is response to accomodation

31
Q

renal artery stenosis –> hypokalemia or hyperkalemia? MOA?

A

activate renin-angiotension-aldosterone system –> hypoK, hyperNa

32
Q

myxedema coma –> trt w T4 & hydrocortisone –> why steroid?

A

myxedema coma –> typically decreased adrenal reserves –> empiric replace adrenal

33
Q

suspect cushing synd –> first step to dx?

A
  • 24hr free cortisol
  • low dose dexamethasone
  • late night serum/salivary cortisol
34
Q

prolactinoma –> presentation in F

A
  • headache
  • oligomenorrhea
  • infertility
  • galactorrhea
35
Q

what 2 lab results indicate SIADH?

A
  • urine osm: up

- urine Na: up

36
Q

what malignancies can cause SIADH?

A
  • small cell lung CA

- brain CA

37
Q

SIADH –> tx

A

water restrict

38
Q

diabetes insipidus –> labs:

  • urine osm
A

urine osm: low

39
Q

polydypsia, polyuria –> normal glucose, no glucose in urine

next step in dx?

A

water deprivation test

40
Q

central DI –> tx

41
Q

nephrogenic DI –> tx

A

gentle diuresis –> HCTZ

42
Q

hypoNa –> hypotonic –> euvolemic

ddx?

A

RATS:

  • renal tubular acidosis
  • Addison’s dz
  • thyroid dz
  • SIADH
43
Q

SIADH –> water restrict & trted underlying dz –> still SIADH –> tx? MOA?

A

demeclocycline –> induce nephrogenic DI

44
Q

low dose dexamethasone suppression test –> fails to suppress

dx?

A

cushing’s synd

45
Q

low dose dexamethasone suppression test –> fails to suppress –> next step in dx?

A

check ACTH level

46
Q

low dose dexamethasone suppression test positive –> ACTH level normal

dx?

A

adrenal tumor –> primary hypercortisol

47
Q

low dose dexamethasone suppression test positive –> ACTH level high

next step in dx?

A

high dose dexamethasone suppression test

48
Q

low dose dexamethasone suppression test positive –> ACTH level high –> high dose dexamethasone suppression test –> suppresses

dx?

A

pituitary tumor –> high ACTH –> high cortisol –> cushing’s dz

49
Q

low dose dexamethasone suppression test positive –> ACTH level high –> high dose dexamethasone suppression test –> fail to suppress

dx? next step?

A

ectopic tumor –> pan-scan

50
Q

what is Addison’s dz?

A

autoimmune or TB –> adrenal dysfx –> primary cortisol/aldosterone def

51
Q

Addison’s dz –> presentation in acute dz

A

low cortisol & aldos:

  • hypotensive
  • N/V
  • coma
52
Q

Addison’s dz –> presentation in chronic dz

A
  • orthostatic hypotension

- hyperpigment (more ACTH production)

53
Q

Addison’s dz –> what electrolyte abnormality?

A

low aldos:

  • hypoNa
  • hyperK
54
Q

suspect Addison’s dz –> first step in dx?

A

check AM cortisol

55
Q

AM cortisol is low

dx?

A

cortisol def

56
Q

AM cortisol is low –> next step in dx?

A

cosyntropin stimulation test –> administer ACTH

57
Q

AM cortisol is low –> cosyntropin stimulation test –> cortisol increase

dx?

A

ant hypopituitarism –> low ACTH –> low cortisol

58
Q

AM cortisol is low –> cosyntropin stimulation test –> cortisol no change

dx? next step?

A

adrenal problem –> CT/MRI

59
Q

AM cortisol is low –> cosyntropin stimulation test –> cortisol increase

tx?

A

give cortisol

60
Q

AM cortisol is low –> cosyntropin stimulation test –> cortisol no change

tx?

A

give cortisol + fludrocortisone

61
Q

what is conn’s synd?

A

adrenal tumor –> hyperAldos

62
Q

hyperAldos –> etiology (2)

A
  • Conn’s synd

- renovascular HTN (fibromuscular dysplasia, renal artery stenosis)

63
Q

hyperAldos –> presentation

A
  • HTN –> refractory –> need 3+ meds

- hypoK

64
Q

suspect hyperAldos –> first step in dx?

A

aldo:renin ratio

65
Q

hyperAldos –> check aldo: renin ratio –> what ratio indicates renovascular etiology?

A

results: aldo high, renin high

high renin –> high aldo

ratio <10

66
Q

hyperAldos –> check aldo: renin ratio –> what ratio indicates Conn’s synd etiology?

A

results: aldo high, renin low

ratio >30

67
Q

hyperAldos –> aldo: renin ratio >30 –> next step in dx?

A

salt suppression test: administer salt –> aldo should decrease (normal)

68
Q

hyperAldos –> aldo: renin ratio >30 –> salt suppression test –> fail to suppress

next step?

A
  • MRI to find adrenal tumor

- adrenal vein sampling

69
Q

Graves –> type of hypersensitivity rxn?

A

type II HSN

70
Q

thyroid cancer –> MC type

A

papillary thyroid cancer

COMLEX 3 (17 decks)

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