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Endo Fun Flashcards

0
Q

What hormones are produced by the posterior pituitary?

A

ADH, oxytocin

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1
Q

What hormones are produced by the anterior pituitary?

A

TSH, prolactin, FSH, LH, GH, ACTH

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2
Q

If you think there is an excess of an hormone order what test?

A

Suppression

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3
Q

If you think there is a lack or decrease of a hormone order what test?

A

Stimulation

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4
Q

What stimulates synthesis of thyroid hormones and is inhibited by T3 and T4?

A

TSH

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5
Q

What hormone prepares for breast feeding?

A

Prolactin

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6
Q

What inhibits prolactin?

A

Dopamine

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7
Q

What stimulates ovulation and sperm genesis?

A

FSH

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8
Q

What inhibits FSH

A

Inhibin

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9
Q

What develops the corpus leuteum, releases oocyte and produces estrogen?

A

LH

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10
Q

What inhibits LH?

A

Testosterone

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11
Q

What stuns bone growth and protein synthesis?

A

GH

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12
Q

What inhibits GH?

A

Somatostatin

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13
Q

What synthesizes secretion of adrenal cortical hormones?

A

ACTH

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14
Q

What inhibits ACTH?

A

Cortisol

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15
Q

What increases water resorption by kidneys?

A

ADH

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16
Q

What is hyperparathyroidism?

A

Excess secretion of PTH causing increased absorption of calcium from bones, kidneys, GI

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17
Q

What is the patient complaints of hyperparathyroidism?

A

Bones, stones, groans, moans.

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18
Q

Primary hyperparathyroidism?

A

Middle aged woman, hyper functioning benign parathyroid adenoma 85%

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19
Q

Secondary causes of hyperparathyroidism?

A

Chronic renal dz, METASTATIC dz, multiple myeloma, sarcoidosis.

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20
Q

Clinical presentation of hyperparathyroidism?

A

Anorexia, N,v,constipation, fatigue, weakness, confusion. Polyuria, polydipsia, bone pain, kidney stones, abdominal pain

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21
Q

Causes of hypoparathyroidism?

A

Follows thyroid surgery, autoimmune, congenital

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22
Q

Acute and chronic sx of hypoparathyroidism?

A

Acute: circumoral tingling, tetany, muscle cramps, irritability
Chronic: lethargy, personality changes, blurry vision, mental retardation

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23
Q

Hypoparathyroidism on physical exam.

A

Positive chvosteks sign, pos trousseaus test, prolonged QT on EKG

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24
Q

Chvosteks test?

A

Tap face and get facial muscle spasm, hypoparathyroidism

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25
Q

Trousseaus test.

A

Carpal spasm with BP cuff, hypoparathyroidism

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26
Q

Treatment for hypoparathyroidism?

A

Calcium, vit D if tetany then IV calcium gluconate

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27
Q

Hyperthyroid disease 2?

A

Thyroiditis, graves dz (+ on grave)

Decreased TSH, increased T4

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28
Q

Hypothyroid disease 2?

A

Thyroiditis, hashimotos

Increased TSH, decreased T4

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29
Q

MC cause of hyperthyroidism?

A

Graves dz, autoimmune causes 90%, increased T4 and decreases TSH

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30
Q

Hyperthyroidism on exam?

A

Exophthalmos, per tibial myxedema, goiter WITH bruit

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31
Q

Goiter with bruit,

A

Graves dz

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32
Q

MC drug causing graves dz hyperthyroidism.

A

Amiodarone

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33
Q

What are the signs and symptoms of graves dz?

A

Increase in: appetite, exertional SOB, diarrhea, fatigue, hA, heat intolerance, weight loss, irritability, nervousness, palpitations, sweating, tremor, weakness

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34
Q

Graves dz tx?

A

Methimazole or propythiouracil to inhibit hormone synthesis
PTU in pregnancy
Radioactive iodine
Beta blocker for sx

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35
Q

Give s/s for thyroid crisis / thyroid storm.

A

This is life threatening hyperthyroidism. High ver, tachycardia, vomiting, diarrhea, dehydration, delirium, congestive heart failure.

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36
Q

What causes thyroid storm?

A

Stress, infections, surgery or trauma

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37
Q

How can you treat thyroid storm?

A

Treat underlying cause. PTU, propranolol which only tx sx

AVOID ASA

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38
Q

Most common cause of hypothyroidism?

A

Hashimotos, autoimmune

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39
Q

Painless goiter?

A

Hashimoto’s thyroiditis

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40
Q

Sx of Hashimoto’s thyroiditis?

A

Cold intolerance, decrease appetite, weight gain, constipation, depression, dry skin, fatigue, lethargy, paresthesias, muscle cramps

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41
Q

PE of Hashimoto’s ?

A

Dry skin, thinning of lateral eyebrows, slow DTR, bradycardia, thin nails, thinning hair

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42
Q

Tx for hypothyroidism?

A

Synthroid, start low in elderly/CAD. Check TSH every 6 wks till euthyroid then 2/yr.

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43
Q

Describe subacute thyroiditis?

A

Woman in 40’s with acute painful glandular enlargement with dysphagia. Gland is hard and tender.

Tx with ASA for pain and inflammation and BBlocker for thyroid sx.

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44
Q

Describe suppurative thyroiditis.

A

Rare, caused by pyogenic bacteria. Very painful tender, red, asymmetric swelling go thyroid. Tx. Abx and surgical drainage.

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45
Q

Patient presents to clinic with a painless single hard mass on thyroid, dysphagia and hoarseness

A

Thyroid cancer.

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46
Q

Thyroid cancer is liked to what other disease?

A

MEN IIa and IIb

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47
Q

Adrenal gland outer most layer?

A

Zona glumerulosa produces aldosterone, controlled by renin

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48
Q

Adrenal middle layer?

A

Zona fasiculate producing cortisol and controlled by ACTH

49
Q

Adrenal innermost layer?

A

Zona reticularis producing DEHA controlled by androgen stim factor

50
Q

Lab test to checkm for adrenal hypo function?

A

ACTH stimulation test

51
Q

Lab test to check for adrenal hyper function?

A

Dexamethasone suppression test

52
Q

What is Cushing syndrome and its causes?

A

Too much cortisol! From excess steroid use, pituitary hypothalamus dys, adenoma, adrenal neoplasia

53
Q

What does Cushing syndrome present with?

A

Apple obesity, buffalo hump, thin skin, acne, hirsutism, amenorrhea, fatigue, proximal muscle meekness, pigmented striae, HTN.

54
Q

What Is the #1 test for Cushing syndrome?

A

Increase free cortisol in urine over 125/24 hrs

55
Q

Tx for Cushing syndrome?

A

Transphenoidal resection and replacement therapy if tumor. Radiation therapy. Meds not OK alone:ketoconazole, metyrapone

56
Q

What is Addison’s disease?

A

Primary corticoadrenal insufficiency.

57
Q

MC cause of Addison’s dz?

A

Autoimmune inflammation of the adrenal cortex, TB infection, trauma, mets

58
Q

Patient presents to clinic with weakness, easy fatigue ability, ortho static hypotension, anorexia, n,v, diarrhea, wt loss, hyper pigmentation?

A

Addison’s disease

59
Q

Screening test for Addison’s disease?

A

Plasma cortisol 30-60 min after cosyntropin IM or IV

60
Q

If screening lab for Addison’s produces high ACTH?

A

Primary dz

61
Q

If screening lab for Addison’s produces low ACTH?

A

Secondary dz

62
Q

Treatment for Addison’s dz?

A

Oral cortisone and mineral cortocoid. IV if crisis.

63
Q

What is a pheochromocytoma?

A

Rare tumor rising for the chromaffin cells of sympathetic nervous system. Can cause HTN.

64
Q

Presentation of pheochromocytoma?

A

HA, sweating, palpitations, anxiety, tremor, abdominal pain, HTN.

65
Q

What labs should you order if you suspect pheochromocytoma?

A

Urine catecholamines, plasma catecholamines, MRI/CT for adrenal tumor

66
Q

Treatment for pheochromocytoma?!

A

Treatment is surgery BUT remember to give alpha blocker FiRST before beta blocker or blood pressure will rise more

67
Q

What is insufficientroduction of thyroid hormone at birth?

A

Congenital hypothyroidism or creatinism

68
Q

Signs and symptoms of congenital hypothyroidism?

A

Sluggish, constipation, large tongue, umbilical hernia, hypothermia, bradycardia, enlarged fontanelle, jaundice, scaly dry skin, brittle hair, inability to feed.

69
Q

How do children present with Cushing syndrome.

A

Growth arrest, obesity, precocious puberty, easy bruising, and difficulty standing for a crouch.

70
Q

What is the leading cause of death in diabetes?

A

Myocardial infarction

71
Q

Cause of primary hyperthyroidism?

A

Thyroid making too much hormone

72
Q

Cause of secondary hyperthyroidism?

A

Pituitary making too much TSH

73
Q

A patient presents with amenorrhea and galactorrhea in the absence of pregnancy?

A

Pituitary adenoma

74
Q

Number one treatment of pituitary adenoma?

A

Dopamine agonist, carbegoline or bromocriptine

75
Q

Nerve damaged during thyroidectomy causing hoarseness.

A

Recurrent laryngeal nerve

76
Q

Risk of pituitary surgery?

A

Diabetes insipidus. Treat with desmopressin

77
Q

Hungry bone syndrome.

A

When hyperthyroidism is corrected surgically the patient needs extra calcium because the damaged bone be absorbs it quickly.

78
Q

What do most pituitary adenomas secrete?

A

Prolactin

79
Q

How dose primary hyper aldosteronism present.

A

HTN, polyuria, polydipsia, muscle weakness, fatigue, NO edema.

80
Q

Treatment for primary hyper aldosteronism?

A

Spironolactone (blocks aldosterone) and surgery of tumor.

81
Q

What is acromegaly?

A

Excess GH from anterior pituitary. Usually fo

Rom an GH secreting pituitary macro adenoma.

82
Q

Clinical presentation of increase on glove and hat size, space between teeth, DM, kidney stones, HA?

A

Acromegaly

83
Q

Screening test for acromegaly?

A

Increase in insulin like GF and confirm with oral glucose suppression test and MRI

84
Q

Describe familial short stature.

A

Growth curves at or below 5% by age 2, healthy and normal PE, normal bone age and puberty.

85
Q

Describe constitutional delay of growth.

A

At or below 5%, delay in puberty! skeletal imaturation, likely to be expected height

86
Q

What is achondroplasia?

A

Dwarfism, short limbs, long torso, big head, prominent brow, delayed milestones (motor), normal intelligence, bowing of legs, frequent ear infections

87
Q

What is diabetes insipidus and the causes?

A

Decrease of ADH. Central: decreased production of vasopressin from post pituitary from tumor, surgery, basal skull fx
Nephrogenic: decreased renal response to vasopressin from chronic renal dz

88
Q

Sx are polyuria, polydipsia, polyphagia?

A

Diabetes insipidus

89
Q

Treatment of DI?

A

Central: desmopressin
Nephrogenic: thiazides , monitor sodium levels

90
Q

What are some causes of hyperprolactinemia?

A

Exercise, pregnancy, suckling, seizure, Meds, pituitary adenoma

91
Q

Clinical presentation in men/women with hyperprolactinemia?

A

Men: ED, gynecomastia, decreased libido
Women: oligomenorrhea, amenorrhea, galactorrhea, infertility

92
Q

If prolactin over 100 think?

A

Pituitary adenoma

93
Q

Treatment for hyperprolactinemia?

A

Stop Meds. Surgery and dopamine agonists (bromocriptine.)

94
Q

Meds than can cause hyperprolactinemia?

A

Risperidone and SSRI

95
Q

What is hypopitutiarism?

A

Partial or complete loss of anterior pituitary

96
Q

Causes of hypoputiaryism?

A

Pituitary adenoma, infarction of the pituitary, inflammatory dx, vascular dz (Sheehan postpartum necrosis)

97
Q

What is DM type 1?

A

Cause by insulin deficient, autoimmune dz, little or no endogenous insulin

98
Q

What are the sx of DM type 1?

A

Polyuria, polydipsia, polyphagia, blurry vision, fatigue, eight loss

99
Q

Positive labs for DM?

A

Fasting glucose over 126 and random glucose over 200.

100
Q

Treatment measure for DM type I?

A

Cholesterol less than 300 per day, less protein, less saturated fat, less sodium

101
Q

What is diabetic ketoacidosis?

A

Ketones as a result from fat metabolism. From infection, inadequate insulin tx, MI, trauma

102
Q

Patient present to clinic with abdominal pain, N, V, decreased appetite, thirst tachycardia, fruity Oder to breath…..?

A

DKA

103
Q

What is the treatment for DKA?

A

Regular insulin. IV fluids. Treat potassium is less than 5.5. Tx underlying cause.

104
Q

Describe what happens in DM type II.

A

Tissues are resistant to insulin, there is NO deficiency.

105
Q

Lab results confirming DMt2?

A

Fasting glucose over 126, random glucose over 200, elevated HA1C.

106
Q

Treatment for DM type 2?

A

Metformin: decreases hepatic glucose production, decreases body weight, improves lipids. Hold if oral contrast.
Sulfonylureas: glyburide and glipizide

107
Q

Monitoring parameters for DM type 2?

A

HA1C less than 7%, microalbumin, BP target 130/85, lifestyle modification

108
Q

Complications of diabetes?

A

Cataracts, retinopathy, glaucoma, diabetic neuropathy in stocking glove pattern, gastropsresis, impotence

109
Q

What is the honeymoon period in DM?

A

Ketoacidosis followed by a sx free period , no tx required

110
Q

Describe the somogyi effect.

A

Hypoglycemic at night and body’s response overshoots leading to hyperglycemia in the morning

111
Q

What is the dawn phenomena?

A

Early morning rise in glucose requiring increased amounts of insulin to maintain balance

112
Q

If rise in early morning blood sugar check the 3 am glucose and if…. Increased?

A

Dawn phenomonon and increase pm insulin dose

113
Q

If early morning blood sugar is increased check 3 am glucose… If it is decreased…..

A

Somogyi effect and decrease pm insulin.

114
Q

What are the signs and symptoms of hypoglycemia?

A

Sweating, palpitations, hunger, tremor, weakness, lightheaded ness, headache, confusion

115
Q

Hypoglycemia is a glucose below what? And what is the treatment?

A

55, dextrose

116
Q

High LDL increases the risk of?

A

Atherosclerotic dz, less than 100 is optimal

117
Q

High HDL is associated with?

A

Decreased fish of atherosclerotic dz, 40-60

118
Q

Increased triglycerides is associated with?

A

Increased risk of atherosclerotic dz in women and diabetics, keep under 125

119
Q

Hyperlinked is on exam?

A

Xanthomas, lipemic blood sample, abdominal pain, Hepatomegaly,

120
Q

Metabolic syndrome clinical features?

A 
Must have 3:
Abdominal obesity men >40 in women > 35 in
Triglycerides over 150
HDL m<50
BP greater than 130/85
Fasting glucose over 110
121
Q

Treatment for metabolic syndrome?

A

Reduce underlying cause

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