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Clin Med 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

hyperaldosteronism is caused by increased ___ production

A

aldosterone

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2
Q

necrotizing skin and soft tissue infections are surgical ___

A

emergencies

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3
Q

primary hyperaldosteronism can be caused by (3)

A
  1. idiopathic
  2. adrenal adenoma
  3. adrenal carcinoma
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4
Q

lab values in hyperaldosteronism

A
  1. uncontrolled hypertension
  2. hypokalemia
  3. hypernatremia
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5
Q

most common presentation of hyperaldosteronism

A

vision impairment

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6
Q

2 tests to dx hyperaldosteronism

A
  1. plasma aldosterone concentration (PAC); plasma renin concentration (PRA)
  2. PAC/PRA ratio
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7
Q

pharm for hyperaldosteronism

A

Spironolactone

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8
Q

imaging for hyperaldosteronism

A

CT scan

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9
Q

in hypoaldosteronism, potassium will be

A

high

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10
Q

hypoaldosteronism causes metabolic

A

acidosis

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11
Q

pharm for hypoaldosteronism

A

Florinef (corticosteroid)

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12
Q

Adrenal Insufficiency is also called

A

Addison’s Disease

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13
Q

what hormone stimulates coritsol release

A

ACTH

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14
Q

4 symptoms of Addison’s Disease

A
  1. hyperpigmentation of the skin
  2. weakness
  3. fatigue
  4. hypoglycemia
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15
Q

Addison’s is differentiated from secondary/tertiary Adrenal Insufficiency by

A
  1. hyperpigmentation
  2. hyperkalemia
  3. dehydration

none of these are seen in secondary/tertiary

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16
Q

2 diagnostic tests for Adrenal Insufficiency

A
  1. simplified cosyntropin test (ACTH stimulation test)

2. 8 am plasma cortisol level + plasma ACTH

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17
Q

tx for Addisonian crisis

A

glucocorticoid: high dose 100 mg IV bolus over 24 hours

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18
Q

chronic tx for Adrenal Insufficiency

A

mineralocorticoid and glucocorticoid replacement + long acting predinosine/dexamethasone

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19
Q

pheochromocytoma triad

A
  1. HA
  2. sweating
  3. tachycardia
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20
Q

tests for pheochromocytoma

A
  1. fractionated metanphrines
  2. CT or MRI
  3. if normal –> repeat during spell
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21
Q

pheochromocytoma tx

A

in this order:

  1. alpha blocker
  2. beta blocker
  3. liberalize salt intake
  4. surgical resection
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22
Q

MEN 1 involves

A
  1. parathyroid
  2. AP
  3. pancreas
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23
Q

MEN 1 pruritis improves with __ and worsens with __

A

sun; stress

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24
Q

Men 2 - aka Sipple involves

A
  1. parathyroid
  2. pheochromocytoma
  3. medullary thyroid carcinoma
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25
Q

MEN 2b - aka MEN 3 involves

A
  1. marfanoid habitus
  2. pheochromocytoma
  3. medullary thyroid carcinoma
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26
Q

MEN 4 involves

A
  1. parathyroid adenomas
  2. pancreatic neuroendocrine tumors
  3. gonadal tumors
  4. adrenal tumors
  5. renal tumors
  6. thyroid tumors
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27
Q

Congenital Adrenal Hyperplasia is caused by

A

21-hydroxylase deficiency

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28
Q

CAH is characterized by increased __ and accumulation of __ precursors

A

ACTH; cortisol

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29
Q

3 symptoms of CAH

A
  1. skin hyperpigmentation
  2. ambiguous genitalia
  3. hyponatremia
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30
Q

CAH can cause a ___ crisis

A

salt wasting

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31
Q

tx for CAH

A
  1. crisis: hydrocortisone and fluids

2. chronic: cortiosteroids + mineralocorticoids for life

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32
Q

most common cause of Cushing’s Syndrome

A

iatrogenic –> prolonged steroid use

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33
Q

primary Cushing’s is caused by

A

adrenal adenoma or carcinoma

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34
Q

most common cause of secondary Cushing’s

A

SCLC

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35
Q

work up for Cushing’s

A 
1. low dose dexamethasone test 
(DST)
2. late night salivary cortisol 
3. 24 hr urinary free cortisol excretion 
4. plasma ACTH
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36
Q

tx for secondary Cushing’s

A

transsphenoidal resection or irradiation

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37
Q

pharm for Cushing’s

A

Mitotane
Metyrapone
Ketoconazole

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38
Q

Cushing’s Disease (Secondary Cushing’s) is specifically caused by

A

ACTH secreting pituitary tumor

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39
Q

T1DM work up

A

OGTT

A1C

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40
Q

tx for hypoglycemia

A

15-20 g glucose or simple CHO –> recheck after 15 min

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41
Q

BG < 50 tx

A

glucagon injxn in buttocks, arm, thigh, or nasal spray

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42
Q

onset of hypoglycemia occur at what level

A

60-70

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43
Q

cognitive impairment is seen w. hypoglycemia at what level

A

50

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44
Q

criteria for T2DM dx

A
  1. FBG < 126
  2. A1C greater than or equal to 6.5
  3. random plasma BG 200 or higher

confirmation w. at least 2 tests

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45
Q

indications for insulin

A
  1. A1C > 10%
  2. BC 300 or higher
  3. complications (ex CAD)
  4. serum BG not met w. oral meds
  5. markedly symptomatic
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46
Q

ABCs of DM goals

A
  1. A1C
  2. blood pressure <140/90; CVD risk 130/80
  3. Cholesterol
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47
Q

DM insulin regimen

A
  1. stable baseline: basal insulin –> long acting OR short term via pump PLUS pre-meal short acting
  2. intermediate insulin at bedtime OR long acting insulin in the AM or at bedtime
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48
Q

testing for gestational diabetes should occur

A

24-48 weeks gestation –> A1C OGTT

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49
Q

metabolic syndrome includes (5 things)

A
  1. elevated TG
  2. low HDL
  3. HTN
  4. abdominal obesity
  5. insulin resistance
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50
Q

what is an insulinoma

A

tumor of pancreas that produces excess insulin

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51
Q

insulinoma presentation

A

healthy appearing person w. fasting hypoglycemia

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52
Q

DKA triad

A
  1. hyperglycemia
  2. ketosis
  3. metabolic acidosis
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53
Q

tx for DKA

A

IV insulin + glucose

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54
Q

Charcot Foot can be a complication of

A

DM ch

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55
Q

acne is caused by (4 things)

A
  1. androgens
  2. keratin and sebum plug hair follicle
  3. C acnes
  4. inflammation
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56
Q

tx for acne

A
  1. topical retinoid
  2. benzoyl peroxide
  3. +/- abx
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57
Q

acne morphologies

A
  1. comedomes
  2. inflammatory
  3. nodulocystic
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58
Q

Actinic keratosis can turn into

A

SCC

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59
Q

indurated lesions w. a scale are suggestive of

A

SCC

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60
Q

tx for AK

A
  1. liquid nitrogen cryotherapy
  2. Diclofenac
  3. Ingenol Mebutate
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61
Q

which gene is most altered tumor suppressor gene in SCC and AK

A

p53

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62
Q

SCC originates in

A

keratinocytes

63
Q

work up for SCC

A

tangential shave bx

64
Q

tx for SCC

A

mohs micrographic surgery

65
Q

staging for melanoma

A

Breslow depth

66
Q

warts are caused by what virus

A

HPV

67
Q

molluscum contagiousum is caused by what virus

A

pox virus

68
Q

HPV __ and __ have higher risk for malignancy

A

16; 18

69
Q

only FDA approved tx for warts

A

Imiquimod

70
Q

HPV prevention

A

Ceravix; Gardasil; Gardasil-9

71
Q

endemic goiter is caused by

A

low iodine diet e

72
Q

most endemic goiters reflect __ thyroid hormone levels

A

euthyroid

73
Q

pharm for endemic goiter

A

Levothyroxine

74
Q

primary cause of hypothyroidism

A

Hashimoto’s

75
Q

TSH nl

A

0.5-5.0

76
Q

is serum T3 used to dx hypothyroidism

A

no!

77
Q

pharm for hypothyroid

A
  1. Levothyroxine

2. Armour thyroid: T3 and T4 from pig

78
Q

most common thyroid d.o in US

A

Hashimoto’s

79
Q

Hashimoto’s is an ___ disorder

A

autoimmune

80
Q

tx for Hashimoto’s

A
  1. AI –> abs
  2. antithyroperoxidase
  3. antithyroglobulin
81
Q

myxedema can be a complication of

A

untreated hypothyroidism

82
Q

painful subacute thyroiditis (deQuervain’s) often a

A

viral URI

83
Q

tx for deQuairvan’s

A
  1. ASA
  2. Propranolol
  3. Iodinated contrast agent for elevated T3
  4. Ipodate sodium/iopanoic acid for elevated T4
84
Q

labs in hypothyroidism

A

TSH: high

T3/T4: normal to low

85
Q

Graves Disease is a type of autoimmune

A

hyperthyroidism

86
Q

3 PE symptoms of hyperthyroidism

A
  1. Afib
  2. exophthalmos
  3. myxedema
87
Q 
labs in hyperthyroidism: 
TSH:
FT4:
T4:
FT3:
T3:
A

TSH: low

FT4, T4, FT3, T3: elevated

88
Q

tx for hyperthyroidism

A
  1. Propranolol
  2. Thiurea (Methimazole, Propylthiouracil) –> safe in pregnancy
  3. Iodinated contrast agents (Iopanoic acid, Ipodate sodium)
  4. Radioactive iodine 131 –> NOT save in pregnancy
89
Q

contraindications for Radioactive iodine 131

A

pregnancy

exophthalmos

90
Q

__% of thyroid nodules are

A

benign

91
Q

work up for thyroid nodules

A
  1. thyroid US

2. fine needle bx

92
Q

tx for thyroid nodule

A
  1. Propranolol

2. Radioactive Iodine 131

93
Q

folliculitis is inflammation of the

A

hair follicle

94
Q

folliculitis is caused by

A

staph>strep

95
Q

tx for folliculitis

A

warm compress

avoid systemic abx!

96
Q

furuncle (aka boil) is caused by what pathogen

A

staph

97
Q

furuncle is an infevtion of the

A

hair follicle AND surrounding soft tissue furu

98
Q

tx for furuncle

A
  1. warm compress

2. I&D

99
Q

if abx for furuncle

A
  1. Doxycycline
  2. 1st gen cephalosporins
  3. Tetracyclines
100
Q

a carbuncle is a coalescence of

A

furuncles

101
Q

carbuncles are caused by which pathogen

A

staph

102
Q

tx for carbuncle

A

systemic abx focused on MRSA:

  1. Tetracyclines
  2. Bactrim
103
Q

cellulitis is caused by what pathogen

A

staph, strep

104
Q

cellulitis is an infection of the

A

epidermis AND subcutaneous CT

105
Q

cellulitis is especially concerning for

A

DM pt

106
Q

cellulitis patients may appear

A

septic

107
Q

cellulitis tx OP setting

A
  1. Penicillins
  2. beta lactam inhibitors
  3. cephalosporins
  4. sulfa
  5. tetracyclines
108
Q

cellulitis tx hospital setting

A
  1. Vancomycin

2. Ancef

109
Q

cellulitis tx DM

A
  1. Bactrim PLUS Keflex
110
Q

what drug is contraindicated in CO for cellulitis

A

Azithromycin

111
Q

erysipelas is caused by what pathogen

A

group A strep

112
Q

erysipelas is an infection of the

A

dermis

113
Q

erysipelas is characterized by

A

very shiny, red, well demarcated erythema

114
Q

erysipelas tx

A
  1. vancomycin

2. daptomycin

115
Q

necrotizing fasciitis is characterized by

A

bullae, crepitus of the skin

116
Q

nectrotizing fascitis is caused by

A

group A strep (Mprotein)

117
Q

___ progresses quickly, destroys subcutaneous fat, but spares ___

A

nectrotizing fasciitis; muscle

118
Q

tx for necrotizing fasciitis

A

urgents surgical consultation

119
Q

Fournier’s Gangrene attacks the

A

penis and scrotum

120
Q

RF for Fournier’s Gangrene

A

DM, etoh, HIV, obesity, malignancy

121
Q

fx for Fournier’s Gangrene

A
  1. urgent surgical consultation!
  2. Vancomycin immediately post surgery
  3. then Piperacillin/Tazo
122
Q

gas gangrene (clostridial myonecrosis) destroys subcutaneous fascia fat, AND

A

muscle

123
Q

gas gangrene is caused by

A

clostridium perfingens

traumatic wounds/perforation of bowel

124
Q

tx for gas gangrene

A

urgent surgical consultation!

125
Q

MRSA is associated with

A

previous hospital stay dt infxn
surgical procedures
enteral feeding
prior abx

126
Q

common complaint associated w. MRSA

A

spider bite

127
Q

tx for MRSA

A

3rd gen Cephalosporins
Fluoroquinolones
Vancomycin

128
Q

Community Acquired MRSA (CA-MRSA) causes atypical symptoms not usually associated w. s. aureus, including

A

necrotizing fasciitis
purpura fulminans
necrotizing PNA
community outbreaks

129
Q

nasal MRSA is associated w. 10% increases risk for skin/soft tissue infxn; what is the tx for nasal MRSA

A

topical intranasal muciporin for 5 days

daily bathing w. antibacterial agent

130
Q

MRSA has developed resistance to

A

clindamycin

131
Q

newer tx for MRSA

A
  1. Linezolid
  2. Tedizolid
  3. Daptomycin
  4. Tygecycline
  5. Ceftaroline
  6. Oritavancin
  7. Dalbavancin
132
Q

hot tub folliculitis is caused by

A

pseudomonas

133
Q

tx for hot tub folliculitis

A

op: no tx

if progresses: Cipro

134
Q

dog/cat bite treatment

A
  1. irrigate!
  2. Augmentin or Ampicillin
  3. rabies/tetanus vaccine
135
Q

Eikenella corrodens is associated with

A

dog/cat bikes

136
Q

measles prodrome triad

A

fever, cough, coryza

also: conjunctivitis, malaise

137
Q

Kolik spots (maculopapular rash) are pathopneumonic for

A

measles

138
Q

Hyperparathyroidism symptoms

A

stones, bones, abdominal groans, thrones, psychiatric overtones

139
Q

hyperparathyroidism labs will show elevated PTH and elevated

A

calcium

140
Q

5 symptoms of hypoparathyroidism

A
  1. abdominal cramps
  2. muscle cramps
  3. tetany
  4. numbness/tingling
  5. paresthesias
141
Q

Chovstek sign is associated with

A

hypoparathyroidism

142
Q

what is Chovstek sign

A

contraction of eye, nose, or mouth muscle by tapping facial nerve anterior to ear

143
Q

Trosseau sign is associated with

A

hypoparathyroidism

144
Q

what is Trosseau sign

A

spasm in hand/wrist w. compression to forearm

145
Q

most common cause of hypoparathyroidism

A

post surgical removal of thyroid or parathyroid

146
Q

1st test for growth hormone deficiency

A
  1. IGF
    then:
  2. 2 provocative stimulation tests: insulin, deep sleep, glucagon, exercise etc
147
Q

tx for growth hormone deficiency

A

recombinant HGH SQ daily

monitor w. IGF and growth response

148
Q

in kids, growth hormone excess is called

A

gigantism

149
Q

in adults, growth hormone excess is called

A

acromegaly

150
Q

growth hormone excess is almost always caused by

A

pituitary adenomas - usually benign macroadenomas

151
Q

testing for growth hormone excess

A
  1. IGF1
  2. then fasting BG, prolactin, glucose, LFTs, BUN/CR
    OGTT is gold standard: shows failure of GH to suppress
152
Q

growth hormone tx

A

transphenoidal resection

153
Q

growth hormone excess pharm

A

Somastatin analogs:
Ocreotide
Lanreotide

Dopamine agonists:
Cabergoline

GH receptor antagonist:
Pegvisomant

Clin Med 1 (6 decks)

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