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IM Plat 3rd - Correlates > Endo-Diabetes > Flashcards

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

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2
Q

Most reliable and convenient tests for identifying DM in asymptomatic individuals

A

HbA1c or FPG

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3
Q

Key regulator in insulin secretion

A

Glucose

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4
Q

Glucose level that stimulates insulin synthesis

A

> 70mg/dL

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5
Q

Rate limiting step that controls glucose-regulated insulin secretion

A

Glucokinase (liver)

Hexokinase(everywhere else)

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6
Q

Most potent incretin

A

Glucagon-like peptide 1(GLP-1)

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7
Q

Major portion of postprandial glucose utilized by

A

Skeletal muscle

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8
Q

Features of diabetes do not become evident until how much beta cells are destroyed?

A

70-80%

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9
Q

Major susceptibility gene in T1DM

A

HLA region on chromosome 6

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10
Q

Central to the development of T2DM

A

Insulin resistance and abnormal insulin secretion

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11
Q

Predominantly accounts for increased FPG levels

A

Increased hepatic glucose output

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12
Q

Results in postprandial hyperglycemia

A

Decreased peripheral glucose usage

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13
Q

Honeymoon phase

A

Time when glycemic control is achieved with modest doses of insulin

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14
Q

Ketone bodies

A

Acetoacetate(excreted in the urine)
B-hydroxybutyrate
Acetone(not used as source of energy)

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15
Q

Preferred method for detecting ketones that more accurately reflect the true ketone level

A

Serum or plasma assays for B hydroxybutyrate

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16
Q

Preferentially detected by a commonly used ketosis detection reagent (nitroprusside)

A

Acetoacetate

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17
Q

Consistent finding in DKA and distinguishes it from simple hyperglycemia

A

Ketonemia

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18
Q

Etiology of hyperglycemic hyperosmotic state(HHS)

A

Relative insulin deficiency & inadequate fluid intake

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19
Q

Prominent features of both HHS and DKA

A

Volume depletion and hyperglycemia

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20
Q

Confirm a patient’s need for insulin

A

Low c-peptide level

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21
Q

Symptoms of diabetes usually resolve when glucose is

A

<200mg/dl

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22
Q

Standard of care in diabetes management

A

Self monitoring of blood glucose

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23
Q

Standard method for long term glycemic control

A

Measurement of Hba1c

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24
Q

Most serious complication of therapy of DM

A

Hypoglycemia

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25
Q

Microvascular manifestations of DM

A

Retinopathy, neuropathy, nephropathy

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26
Q

Macrovascular manifestations of DM

A

CAD, PAD, CVD

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27
Q

Leading cause of blindness between ages 20 and 74

A

DM retinopthy

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28
Q

Non-proliferative DM retinopathy

A

Retinal vascular microaneuryms, blot hemorrhages, and cotton wool spots

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29
Q

Hallmark of proliferative DM retinopathy

A

Neovascularization in response to retinal hypoxia

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30
Q

Most effective therapy for DM retinopathy

A

Prevention

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31
Q

Treatment of proliferative retinopathy

A

Panretinal laser photocoagulation

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32
Q

Treatment of macular edema

A

Focal laser photocoagulation

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33
Q

Optimal therapy for DM nephropathy

A

Prevention by control of glycemia

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34
Q

Preferred therapy for DM nephropathy

A

Renal transplantation from a living related donor

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35
Q

Most common site of foot ulcers

A

Great toe or metatarsophalangeal(MTP) areas

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36
Q

Optimal therapy for foot ulcers and amputation

A

Prevention

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37
Q

Most common site of ulceration

A

Plantar surface of foot

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38
Q

Most common form of diabetic neuropathy

A

Distal symmetric polyneuropathy(commonly sensory)

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39
Q

Most commonly involved nerve in mononeuropathy

A

CN III(heralded by diplopia)

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40
Q

Most prominent GI symptoms in DM

A

Delayed gastric emptying and altered small- and large-bowel motility

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41
Q

Most common pattern of DM dyslipidemia

A

Hypertryglyceridemia and reduced HDL

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42
Q

Type 1 DM

A 
usually <30 yo
autoimmune cause
DKA is the most common complication
HLA-DR3, -DR4
Depleted beta cells
Islet leukocytic infiltrate
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43
Q

Type 2 DM

A

Strong polygenic genetic predisposition

Islet amyloid deposit

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44
Q

Defense against hypoglycemia

A

1st line: decreased insulin
2nd line: increased glucagon
3rd line: increased epinephrine

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45
Q

Compromises physiologic defense against hypoglycemia

A

Defective glucose counterregulation

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46
Q

Compromises behavioral defense against hypoglycemia

A

Hypoglycemia unawareness

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47
Q

Hypoglycemia in non-beta cell tumors is due to

A

Overproduction of insulin like growth factor II

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48
Q

Prototypical cause of endogenous hyperinsulinism

A

Insulinoma

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49
Q

Ingestion of an insulin secretagogue

A

Hypoglycemia with increased C-peptide levels

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50
Q

Exogenous insulin

A

Causes hypoglycemia with low C-peptide levels

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51
Q

Hormones derived from proopiomelanocortin(POMC)

A

MSH, ACTH, B-lipoprotein, B-endorphin

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52
Q

Main site of ADH/Vasopressin synthesis

A

Supraoptic nuclei of the anterior hypothalamus

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53
Q

Main site of oxytocin synthesis

A

Paraventricular nuclei of the anterior hypothalamus

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54
Q

Site of oxytocin and ADH/vasopressin storage and secretion

A

Posterior pituitary

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55
Q

3 parts of the adrenal cortex

A 
From outer to inner: (GFR)
Zona glomerulosa(aldosterone secretion)
Zona fasciculata(cortisol secretion)
Zona reticularis(weak androgen secretion)
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56
Q

2 products of the adrenal medulla

A

Epinephrine (80%)

Norepinephrine (20%)

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57
Q

Decreases Ca2+ & phosphate excretion but increases urinary Ca2+; increases intestinal Ca2+ absorption

A

Vitamin D

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58
Q

Stimulated by LH, releases the “libido” hormone testosterone

A

Leydig cells

Mnemonic: LLL: LH, Leydig, Libido Hormone

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59
Q

Stimulated by FSH, nurse cell for sperm

A

Sertoli cells

Mnemonic: SSS: FSH, Sertoli cells, Sperm

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60
Q

Increases blood glucose, has direct and indirect effects (via IGF-1)

A

GH

GHRH -> GH -> IGF-1

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61
Q

CRH -> ACTH ->

A

Cortisol

ZF (largest area in the AC)

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62
Q

Weak androgens

A

DHEA, androstenedione (ZR, AC): significantly only in females

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63
Q

Source: beta cells, islets of Langerhans, endocrine pancreas

A

Insulin

64
Q

Insulin 2nd messenger

A

Tyrosine kinase

65
Q

Insulin precursor

A

Proinsulin(splits into Insulin and C peptide)

66
Q

Increases well-fed state pathways: glycolysis, lipid and protein synthesis
Increases K influx in other cells

A

Insulin

67
Q

Only insulin mediated transporter

A

GLUT-4

68
Q

Insulin counter regulatory hormone

A

Glucagon(alpha cells)

69
Q

Most common functioning pituitary adenoma

A

Prolactinoma

70
Q

Second most common pituitary adenoma

A

Somatotroph adenoma

71
Q

Postpartum necrosis of anterior pituitary gland presenting as sudden cessation of lactation

A

Sheehan syndrome

72
Q

Headache, diplopia and hypopituitarism caused by hemorrhage into the pituitary adenoma

A

Pituitary apoplexy

73
Q

Most reliable criterion to diagnose pituitary adenoma

A

Metastases (CSF/Systemic)

74
Q

Most common type of thyroid malignancy; good prognosis

Orphan Annie nuclei

A

Papillary Thyroid CA

75
Q

Thyroid malignancy with capsular and vascular invasion

A

Follicular Thyroid CA

76
Q

Thyroid malignancy derived from C cells, MEN-associated, amyloid deposition

A

Medullary Thyroid CA

77
Q

Thyroid malignancy with giant cells and highly pleomorphic cells
poor prognosis

A

Anaplastic Thyroid CA

78
Q

Most common cause of hypothyroidism in iodine sufficient areas; with germinal centers, fibrosis, and Hurthle cell change

A

Hashimoto’s Thyroiditis

79
Q

Most common cause of hypothyroidism worldwide

A

Iodine deficiency

80
Q

Condition where normal thyroid tissues are replaced by fibrous tissue

A

Reidel thyroiditis

81
Q

Hyperthyroidism, ophthalmopathy, dermopathy

A

Grave’s disease

82
Q

Histopathologic finding of Grave’s disease

A

Diffuse thyroid hypertrophy and hyperplasia

83
Q

Most common primary thyroid cancer in adults and children

A

Papillary thyroid cancer

84
Q

Associated disease with PSaMMoma Bodies

A

Papillary Thyroid Cancer;
Serous Cystadenoma of the ovaries;
Mesothelioma;
Meningioma (in general, cancers with papillary architecture

85
Q

Most common cause of primary hyperparathyroidism

A

Parathyroid adenoma

86
Q

Elevated PTH, normal calcium levels

A

Pseudohypoparathyroidism/Tertiary hyperparathyroidism

87
Q

Elevated PTH occurring in CKD patients

A

Secondary hyperparathyroidism

88
Q

Difficult to treat hypertension associated with hypokalemia

A

Hyperaldosteronism

89
Q

Most common cause of primary hyperaldosteronism

A

Bilateral idiopathic hyperaldosteronism

90
Q

Adrenals are converted to sacs of clotted blood, which virtually obscures all underlying detail

A

Waterhouse-Friderichsen Syndrome(causes acute adrenal insufficiency)

91
Q

Common cause of Waterhouse Friderichsen Syndrome

A

Neisseria meningitidis
Other causes:
GABHS, GBS, Pseudomonas Staphylococcus

92
Q

Neoplasms composed of chromaffin cells, which synthesize and release catecholamines and in some instances peptide hormones

A

Pheochromocytoma

93
Q

~75% parenchymal loss of the pituitary

A

Hypopituitarism

94
Q

Tropic hormone failure associated with pituitary compression or destruction usually occurs in this sequelae

A

GH > FSH > LH > ACTH > Prolactin

95
Q

Most common presentation of tropic hormone failure in childhood

A

Growth retardation

96
Q

Earliest symptom of tropic hormone failure in the adult

A

Hypogonadism

97
Q

Most common cause of hypopituitarism in children associated with WNT signaling pathway

A

Craniopharyngioma

98
Q

Most common cause of hyperpituitarism

A

Pituitary adenoma

99
Q

Cut-off size for microadenoma

A

<10mm diameter

100
Q

Most common mechanism where suprasellar extension can lead to bitemporal hemianopsia

A

compression of the optic chiasm

101
Q

Early sign of optic tract pressure

A

loss of red perception

102
Q

Surgical approach for most pituitary tumors

A

Transphenoidal surgery

103
Q

Treatment of choice for prolactinomas

A

Dopamine agonists(cabergoline and bromocriptine)

104
Q

Most common pituitary hormone hypersecretion syndrome in both sexes

A

Hyperprolactinemia

105
Q

Hallmarks of hyperprolactinemia

A

Amenorrhea, galactorrhea, infertility

106
Q

Most abundant anterior pituitary hormone and major determinant of hepatic IGF-I synthesis

A

GH

107
Q

Most validated test to distinguish pituitary-sufficient patients from AGHD

A

Liver

108
Q

Confirmed by demonstrating failure of GH suppression to <0.4 g/L within 1-2h of a 75g oral glucose

A

Acromegaly

109
Q

Most common cause of GHRH-mediated acromegaly

A

Chest or abdominal carcinoid tumor

110
Q

Most significant cause of mortality with acromegaly

A

Cardiovascular

111
Q

Provides a useful screening measure when clinical features raise the possibility of acromegaly

A

IGF-I

112
Q

Initial treatment for most patients with acromegaly

A

Surgical resection of GH-secreting adenomas

113
Q

Drug that acts by competitve inhibition of GH

A

Pegvisomant

114
Q

Features that make pathologic causes of hypercortisolism more likely

A

Central redistribution of fat
Thin skin with striae and bruising
Proximal muscle weakness

115
Q

Primary cause of death in Cushing’s syndrome

A

Cardiovascular disease

116
Q

Size of most ACTH-secreting pituitary tumors

A

<5mm in diameter(half undetectable by MRI)

117
Q

Origin of most nonfunctioning adenomas

A

Gonadotrope cells

118
Q

Most important, if not the only, physiologic action of AVP

A

Reabsorb water and promote concentration of water

119
Q

Syndrome characterized by abnormally large volumes of dilute urine (24hr urine >50mL/kg body weight and osmolarity <300mosmol/L)

A

Diabetes insipidus

120
Q

Excessive urination from insensitivity of renal tubules to ADH

A

Nephrogenic DI

121
Q

Excessive urination secondary to lack of ADH

A

Central DI

122
Q

Differentiates central vs peripheral DI

A

Fluid deprivation test

123
Q

Most common cause of preventable mental retardation

A

Iodine deficiency

124
Q

Hypothyroidism in infancy or early childhood

A

Cretinism

125
Q

Method of choice in determining thyroid size accurately

A

Ultrasound

126
Q

First test in the approach of thyroid testing

A

TSH levels

127
Q

There is no convincing evidence for a role of infection in autoimmune hypothyroidism, except

A

Congenital rubella syndrome

128
Q

Thyroid cell destruction in autoimmune thyroiditis is primarily mediated by

A

CD8+ cytotoxic T cells

129
Q

Major role in pathogenesis in myxedema coma, leading to hypoxia and hypercapnia

A

Hypoventilation

130
Q

Indication for external warming in hypothermia of myxedema

A

Temperature <30C

131
Q

Major etiologies of hyperthyroidism

A

Graves disease
Toxic multinodular goiter
Toxic adenoma

132
Q

Apathetic thyrotoxicosis in elderly present as

A

Fatigue and weight loss

133
Q

Most common cardiovascular manifestation of hyperthyroidism

A

Sinus tachycardia(associated with palpitations)

134
Q

Earliest manifestations of Grave’s ophthalmopathy

A

Sensation of grittiness, eye discomfort, and excess tearing

135
Q

Most serious manifestation of Grave’s ophthalmopathy

A

Compression of optic nerve at apex of the orbit

136
Q

Most frequent site of of thyroid dermopathy

A

Anterior or Lateral aspects of lower leg( pretibial myedema)

137
Q

Time of major risk of relapse in Graves disease in pregnancy

A

Postpartum period

138
Q

Duration of carbimazole or methimazole - free period prior to radioiodine therapy

A

At least 2 days before

139
Q

Duration of PTU free period prior to radioiodine therapy

A

several weeks before

140
Q

Absolute contraindications to radioiodine

A

Pregnancy and breast feeding

141
Q

Most common cause of acute thyroiditis in children and young adults

A

Presence of a pyriform sinus(predominantly left-sided)

142
Q

Most common clinically apparent cause of chronic thyroiditis

A

Hashimoto thyroiditis

143
Q

Major cause of sick euthyroid syndrome

A

release of cytokines

144
Q

Most common pattern of sick euthyroid syndrome

A

Decrease in total and unbound T3 levels(low T3 syndrome) with normal levels of T4 and TSH

145
Q

Venous distention over the neck and difficulty breathing especially when the arms are raised(in large retrosternal goiters)

A

Pemberton sign

146
Q

Most frequent cause of acquired hypoparathyroidism in the past

A

Surgery for hyperthyroidism

147
Q

Hypoparathyroidism now usually occurs after

A

Surfery for hyperparathyroidism

148
Q

Sonographic characteristics of thyroid nodules suggestive of malignancy

A

Microcalcifications, hypoechogenicity, increased vascularity

149
Q

Most common malignancy of the endocrine system

A

Thyroid CA

150
Q

Most common type of thyroid cancer

A

Papillary thyroid carcinoma

151
Q

More common in iodine-deficient regions

A

Follicular thyroid carcinoma

152
Q

Surgical treatment in almost all patients with well-differentiated cancer

A

Near-Total thyroidectomy

153
Q

Most common type of thyroid lymphoma

A

Diffuse large-cell lymphoma

154
Q

Provides a marker of residual or recurrent disease in medullary thyroid carcinoma

A

Elevated serum calcitonin

155
Q

Primary management of medullary thyroid carcinoma

A

Surgery

156
Q

Size of most palpable thyroid nodules

A

> 1cm

IM Plat 3rd - Correlates (10 decks)

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