Endo-Diabetes Flashcards
1
Q
Differentiate Type 1a and Type 1b diabetes
A
Type 1a: autoimmune destruction of beta cells
Type 1b: Non-autoimmune destruction of beta cells
2
Q
Most reliable and convenient tests for identifying DM in asymptomatic individuals
A
HbA1c or FPG
3
Q
Key regulator in insulin secretion
A
Glucose
4
Q
Glucose level that stimulates insulin synthesis
A
> 70mg/dL
5
Q
Rate limiting step that controls glucose-regulated insulin secretion
A
Glucokinase (liver)
Hexokinase(everywhere else)
6
Q
Most potent incretin
A
Glucagon-like peptide 1(GLP-1)
7
Q
Major portion of postprandial glucose utilized by
A
Skeletal muscle
8
Q
Features of diabetes do not become evident until how much beta cells are destroyed?
A
70-80%
9
Q
Major susceptibility gene in T1DM
A
HLA region on chromosome 6
10
Q
Central to the development of T2DM
A
Insulin resistance and abnormal insulin secretion
11
Q
Predominantly accounts for increased FPG levels
A
Increased hepatic glucose output
12
Q
Results in postprandial hyperglycemia
A
Decreased peripheral glucose usage
13
Q
Honeymoon phase
A
Time when glycemic control is achieved with modest doses of insulin
14
Q
Ketone bodies
A
Acetoacetate(excreted in the urine)
B-hydroxybutyrate
Acetone(not used as source of energy)
15
Q
Preferred method for detecting ketones that more accurately reflect the true ketone level
A
Serum or plasma assays for B hydroxybutyrate
16
Q
Preferentially detected by a commonly used ketosis detection reagent (nitroprusside)
A
Acetoacetate
17
Q
Consistent finding in DKA and distinguishes it from simple hyperglycemia
A
Ketonemia
18
Q
Etiology of hyperglycemic hyperosmotic state(HHS)
A
Relative insulin deficiency & inadequate fluid intake
19
Q
Prominent features of both HHS and DKA
A
Volume depletion and hyperglycemia
20
Q
Confirm a patient’s need for insulin
A
Low c-peptide level
21
Q
Symptoms of diabetes usually resolve when glucose is
A
<200mg/dl
22
Q
Standard of care in diabetes management
A
Self monitoring of blood glucose
23
Q
Standard method for long term glycemic control
A
Measurement of Hba1c
24
Q
Most serious complication of therapy of DM
A
Hypoglycemia
25
Microvascular manifestations of DM
Retinopathy, neuropathy, nephropathy
26
Macrovascular manifestations of DM
CAD, PAD, CVD
27
Leading cause of blindness between ages 20 and 74
DM retinopthy
28
Non-proliferative DM retinopathy
Retinal vascular microaneuryms, blot hemorrhages, and cotton wool spots
29
Hallmark of proliferative DM retinopathy
Neovascularization in response to retinal hypoxia
30
Most effective therapy for DM retinopathy
Prevention
31
Treatment of proliferative retinopathy
Panretinal laser photocoagulation
32
Treatment of macular edema
Focal laser photocoagulation
33
Optimal therapy for DM nephropathy
Prevention by control of glycemia
34
Preferred therapy for DM nephropathy
Renal transplantation from a living related donor
35
Most common site of foot ulcers
Great toe or metatarsophalangeal(MTP) areas
36
Optimal therapy for foot ulcers and amputation
Prevention
37
Most common site of ulceration
Plantar surface of foot
38
Most common form of diabetic neuropathy
Distal symmetric polyneuropathy(commonly sensory)
39
Most commonly involved nerve in mononeuropathy
CN III(heralded by diplopia)
40
Most prominent GI symptoms in DM
Delayed gastric emptying and altered small- and large-bowel motility
41
Most common pattern of DM dyslipidemia
Hypertryglyceridemia and reduced HDL
42
Type 1 DM
```
usually <30 yo
autoimmune cause
DKA is the most common complication
HLA-DR3, -DR4
Depleted beta cells
Islet leukocytic infiltrate
```
43
Type 2 DM
Strong polygenic genetic predisposition
| Islet amyloid deposit
44
Defense against hypoglycemia
1st line: decreased insulin
2nd line: increased glucagon
3rd line: increased epinephrine
45
Compromises physiologic defense against hypoglycemia
Defective glucose counterregulation
46
Compromises behavioral defense against hypoglycemia
Hypoglycemia unawareness
47
Hypoglycemia in non-beta cell tumors is due to
Overproduction of insulin like growth factor II
48
Prototypical cause of endogenous hyperinsulinism
Insulinoma
49
Ingestion of an insulin secretagogue
Hypoglycemia with increased C-peptide levels
50
Exogenous insulin
Causes hypoglycemia with low C-peptide levels
51
Hormones derived from proopiomelanocortin(POMC)
MSH, ACTH, B-lipoprotein, B-endorphin
52
Main site of ADH/Vasopressin synthesis
Supraoptic nuclei of the anterior hypothalamus
53
Main site of oxytocin synthesis
Paraventricular nuclei of the anterior hypothalamus
54
Site of oxytocin and ADH/vasopressin storage and secretion
Posterior pituitary
55
3 parts of the adrenal cortex
```
From outer to inner: (GFR)
Zona glomerulosa(aldosterone secretion)
Zona fasciculata(cortisol secretion)
Zona reticularis(weak androgen secretion)
```
56
2 products of the adrenal medulla
Epinephrine (80%)
| Norepinephrine (20%)
57
Decreases Ca2+ & phosphate excretion but increases urinary Ca2+; increases intestinal Ca2+ absorption
Vitamin D
58
Stimulated by LH, releases the "libido" hormone testosterone
Leydig cells
| Mnemonic: LLL: LH, Leydig, Libido Hormone
59
Stimulated by FSH, nurse cell for sperm
Sertoli cells
| Mnemonic: SSS: FSH, Sertoli cells, Sperm
60
Increases blood glucose, has direct and indirect effects (via IGF-1)
GH
| GHRH -> GH -> IGF-1
61
CRH -> ACTH ->
Cortisol
| ZF (largest area in the AC)
62
Weak androgens
DHEA, androstenedione (ZR, AC): significantly only in females
63
Source: beta cells, islets of Langerhans, endocrine pancreas
Insulin
64
Insulin 2nd messenger
Tyrosine kinase
65
Insulin precursor
Proinsulin(splits into Insulin and C peptide)
66
Increases well-fed state pathways: glycolysis, lipid and protein synthesis
Increases K influx in other cells
Insulin
67
Only insulin mediated transporter
GLUT-4
68
Insulin counter regulatory hormone
Glucagon(alpha cells)
69
Most common functioning pituitary adenoma
Prolactinoma
70
Second most common pituitary adenoma
Somatotroph adenoma
71
Postpartum necrosis of anterior pituitary gland presenting as sudden cessation of lactation
Sheehan syndrome
72
Headache, diplopia and hypopituitarism caused by hemorrhage into the pituitary adenoma
Pituitary apoplexy
73
Most reliable criterion to diagnose pituitary adenoma
Metastases (CSF/Systemic)
74
Most common type of thyroid malignancy; good prognosis
| Orphan Annie nuclei
Papillary Thyroid CA
75
Thyroid malignancy with capsular and vascular invasion
Follicular Thyroid CA
76
Thyroid malignancy derived from C cells, MEN-associated, amyloid deposition
Medullary Thyroid CA
77
Thyroid malignancy with giant cells and highly pleomorphic cells
poor prognosis
Anaplastic Thyroid CA
78
Most common cause of hypothyroidism in iodine sufficient areas; with germinal centers, fibrosis, and Hurthle cell change
Hashimoto's Thyroiditis
79
Most common cause of hypothyroidism worldwide
Iodine deficiency
80
Condition where normal thyroid tissues are replaced by fibrous tissue
Reidel thyroiditis
81
Hyperthyroidism, ophthalmopathy, dermopathy
Grave's disease
82
Histopathologic finding of Grave's disease
Diffuse thyroid hypertrophy and hyperplasia
83
Most common primary thyroid cancer in adults and children
Papillary thyroid cancer
84
Associated disease with PSaMMoma Bodies
Papillary Thyroid Cancer;
Serous Cystadenoma of the ovaries;
Mesothelioma;
Meningioma (in general, cancers with papillary architecture
85
Most common cause of primary hyperparathyroidism
Parathyroid adenoma
86
Elevated PTH, normal calcium levels
Pseudohypoparathyroidism/Tertiary hyperparathyroidism
87
Elevated PTH occurring in CKD patients
Secondary hyperparathyroidism
88
Difficult to treat hypertension associated with hypokalemia
Hyperaldosteronism
89
Most common cause of primary hyperaldosteronism
Bilateral idiopathic hyperaldosteronism
90
Adrenals are converted to sacs of clotted blood, which virtually obscures all underlying detail
Waterhouse-Friderichsen Syndrome(causes acute adrenal insufficiency)
91
Common cause of Waterhouse Friderichsen Syndrome
Neisseria meningitidis
Other causes:
GABHS, GBS, Pseudomonas Staphylococcus
92
Neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones
Pheochromocytoma
93
~75% parenchymal loss of the pituitary
Hypopituitarism
94
Tropic hormone failure associated with pituitary compression or destruction usually occurs in this sequelae
GH > FSH > LH > ACTH > Prolactin
95
Most common presentation of tropic hormone failure in childhood
Growth retardation
96
Earliest symptom of tropic hormone failure in the adult
Hypogonadism
97
Most common cause of hypopituitarism in children associated with WNT signaling pathway
Craniopharyngioma
98
Most common cause of hyperpituitarism
Pituitary adenoma
99
Cut-off size for microadenoma
<10mm diameter
100
Most common mechanism where suprasellar extension can lead to bitemporal hemianopsia
compression of the optic chiasm
101
Early sign of optic tract pressure
loss of red perception
102
Surgical approach for most pituitary tumors
Transphenoidal surgery
103
Treatment of choice for prolactinomas
Dopamine agonists(cabergoline and bromocriptine)
104
Most common pituitary hormone hypersecretion syndrome in both sexes
Hyperprolactinemia
105
Hallmarks of hyperprolactinemia
Amenorrhea, galactorrhea, infertility
106
Most abundant anterior pituitary hormone and major determinant of hepatic IGF-I synthesis
GH
107
Most validated test to distinguish pituitary-sufficient patients from AGHD
Liver
108
Confirmed by demonstrating failure of GH suppression to <0.4 g/L within 1-2h of a 75g oral glucose
Acromegaly
109
Most common cause of GHRH-mediated acromegaly
Chest or abdominal carcinoid tumor
110
Most significant cause of mortality with acromegaly
Cardiovascular
111
Provides a useful screening measure when clinical features raise the possibility of acromegaly
IGF-I
112
Initial treatment for most patients with acromegaly
Surgical resection of GH-secreting adenomas
113
Drug that acts by competitve inhibition of GH
Pegvisomant
114
Features that make pathologic causes of hypercortisolism more likely
Central redistribution of fat
Thin skin with striae and bruising
Proximal muscle weakness
115
Primary cause of death in Cushing's syndrome
Cardiovascular disease
116
Size of most ACTH-secreting pituitary tumors
<5mm in diameter(half undetectable by MRI)
117
Origin of most nonfunctioning adenomas
Gonadotrope cells
118
Most important, if not the only, physiologic action of AVP
Reabsorb water and promote concentration of water
119
Syndrome characterized by abnormally large volumes of dilute urine (24hr urine >50mL/kg body weight and osmolarity <300mosmol/L)
Diabetes insipidus
120
Excessive urination from insensitivity of renal tubules to ADH
Nephrogenic DI
121
Excessive urination secondary to lack of ADH
Central DI
122
Differentiates central vs peripheral DI
Fluid deprivation test
123
Most common cause of preventable mental retardation
Iodine deficiency
124
Hypothyroidism in infancy or early childhood
Cretinism
125
Method of choice in determining thyroid size accurately
Ultrasound
126
First test in the approach of thyroid testing
TSH levels
127
There is no convincing evidence for a role of infection in autoimmune hypothyroidism, except
Congenital rubella syndrome
128
Thyroid cell destruction in autoimmune thyroiditis is primarily mediated by
CD8+ cytotoxic T cells
129
Major role in pathogenesis in myxedema coma, leading to hypoxia and hypercapnia
Hypoventilation
130
Indication for external warming in hypothermia of myxedema
Temperature <30C
131
Major etiologies of hyperthyroidism
Graves disease
Toxic multinodular goiter
Toxic adenoma
132
Apathetic thyrotoxicosis in elderly present as
Fatigue and weight loss
133
Most common cardiovascular manifestation of hyperthyroidism
Sinus tachycardia(associated with palpitations)
134
Earliest manifestations of Grave's ophthalmopathy
Sensation of grittiness, eye discomfort, and excess tearing
135
Most serious manifestation of Grave's ophthalmopathy
Compression of optic nerve at apex of the orbit
136
Most frequent site of of thyroid dermopathy
Anterior or Lateral aspects of lower leg( pretibial myedema)
137
Time of major risk of relapse in Graves disease in pregnancy
Postpartum period
138
Duration of carbimazole or methimazole - free period prior to radioiodine therapy
At least 2 days before
139
Duration of PTU free period prior to radioiodine therapy
several weeks before
140
Absolute contraindications to radioiodine
Pregnancy and breast feeding
141
Most common cause of acute thyroiditis in children and young adults
Presence of a pyriform sinus(predominantly left-sided)
142
Most common clinically apparent cause of chronic thyroiditis
Hashimoto thyroiditis
143
Major cause of sick euthyroid syndrome
release of cytokines
144
Most common pattern of sick euthyroid syndrome
Decrease in total and unbound T3 levels(low T3 syndrome) with normal levels of T4 and TSH
145
Venous distention over the neck and difficulty breathing especially when the arms are raised(in large retrosternal goiters)
Pemberton sign
146
Most frequent cause of acquired hypoparathyroidism in the past
Surgery for hyperthyroidism
147
Hypoparathyroidism now usually occurs after
Surfery for hyperparathyroidism
148
Sonographic characteristics of thyroid nodules suggestive of malignancy
Microcalcifications, hypoechogenicity, increased vascularity
149
Most common malignancy of the endocrine system
Thyroid CA
150
Most common type of thyroid cancer
Papillary thyroid carcinoma
151
More common in iodine-deficient regions
Follicular thyroid carcinoma
152
Surgical treatment in almost all patients with well-differentiated cancer
Near-Total thyroidectomy
153
Most common type of thyroid lymphoma
Diffuse large-cell lymphoma
154
Provides a marker of residual or recurrent disease in medullary thyroid carcinoma
Elevated serum calcitonin
155
Primary management of medullary thyroid carcinoma
Surgery
156
Size of most palpable thyroid nodules
>1cm
