Endocrine Flashcards
1
Q
DM
Def: A -1- with disordered metabolism and inappropriate hyperglycemia due to either a -2- secretion or a -3- in its biologic -4-
> DM is classified as iether -5-
A
- chronic syndrome
- deficiency of insulin
- reduction
- effectiveness
- Type 1 or Type 2
2
Q
DM
> Age of onset is not a criterion; -1- is usually -2- and -3-. Type 2 most often develops in -4- years; however, development in children, -5- is also common (usually related to obesity).
A
- Type 1
- diagnosed in childhood
- early adolescence
- adults > 45
- teens/young adults
3
Q
DM
> -1- is -2-; Type 1 is usually dx in childhood and early adolescence. -3- most often develops in adults older than -4-; however, development in children, teens, and young adults is also common (usually related to -5-).
A
- Age of onset
- not a criterion
- Type 2
- 45 years
- obesity
4
Q
DM - Dx
> -1- in the untreated state, and -2-
A
- T1DM produces ketosis
2. Type 2 usually doesn’t
5
Q
T1DM
> -1- onset
> -2- are strongly associated
A
- acute
2. human leukocyte antigens (HLS-DR3 or HLA-DR4)
6
Q
T1DM
> Pathophys: -1- islet cells by islet cell antibodies (autoimmune process)
> Dx: -2- in the -3- and -4-
A
- Destruction of pancreatic
- Ketones
- blood
- urine
7
Q
T1DM - S/S > -1- are classic symptoms > -2- > -3-, despite -4- > -5-, weakness, paresthesia
A
- polyuria/-dipsia/-phagia
- nocturnal enuresis
- Weight loss
- increased appetite
- Fatigue
8
Q
T1DM - S/S
> -1- changes ranging from irritability to -2-
> -3- fat and -4- suggestive of insidious onset
> Dysfunction of -5-
A
- Consciousness
- coma
- Loss of subQ
- muscle wasting
- peripheral sensory nerves
9
Q
T1DM - S/S > in -1-: >> ophthalmic exam may reveal microaneurysms or cotton wool spots >> -2- vascular insufficiency >> Diminished -3-
A
- advanced disease
- evidence of peripheral
- DTRs
10
Q
T1DM - S/S > in advanced disease: >> -1- may reveal microaneurysms or -2- >> evidence of peripheral vascular -3- >> Diminished -4-
A
- ophthalmic exam
- cotton wool spots
- insufficiency
- DTRs
11
Q
T1DM - S/S
> may show…
A
…evidence of dehydration
12
Q
T1DM - Lab/dx
> Serum -1- on -2- is diagnostic
> -3- and -4- indicate the need to confirm the dx -5-
A
- FBG 126+ mg/dL
- 2 separate occasions
- RBG 200+
- polyuria/-dipsia and weight loss
- with fasting studies
13
Q
T1DM - Lab/dx > -1-: FBG 100-125 > -2- > UA: -3- > Serum -4- and -5- may be elevated
A
- Impaired glucose tolerance
- Hgb A1C (Glycated hgb): 6.5+%; (physio < 5.7%; prediabetes = 5.7-6.4)
- glucosuria & ketonuria
- BUN
- creatinine
14
Q
T1DM - Mgmt > Need to establish the following -1- >> Fasting trigs/cholesterol and -2- >> -3- >> Physical exam including -4-, and -5- exams
A
- Baseline (studies)
- renal studies
- ECG
- peripheral pulses
- neuro & foot
15
Q
T1DM - Mgmt
> -1-: may consult -2-
» Total -3-: about 45% of total caloric intake
A
- Dietary teaching
- dietitian
- carb intake
16
Q
T1DM - Mgmt
> Patients presenting with ketones -1- (long-acting or rapid). The rule of thumb is to begin with -2-, usually using -3-.
> -4-: lifestyle mods r/t -5-
A
- must start insulin
- 0.5 u/kg/day
- an insulin pump
- AG
- diet/exercise and complications
17
Q
T1DM - Somogyi Effect and the Dawn Phenomenon
Two conditions that result in …, but have different etiologies an different mgmt strategies
A
early morning HYPERglycemia
18
Q
T1DM - Somogyi Effect and the Dawn Phenomenon
> The Somogyi effect: Results when -1- stimulates a surge of counter regulatory hormones that -2-. This pt is hypoglycemic at -3- rebounds with a(n) -4- blood sugar -5-
A
- nocturnal hypoglycemia
- raise blood sugar (Tsunami!)
- 3 AM, but
- elevated
- at 7 AM
19
Q
T1DM - Somogyi Effect
|»_space; Treatment: -1- the bedtime -2-
A
- Reduce/eliminate
2. dose of insulin
20
Q
T1DM - Somogyi Effect and the Dawn Phenomenon
> The Dawn Phenomenon: Results when -1- to -2-. Blood sugar gets -3- the night and is elevated at 7 AM.
» Tx: -4- bedtime -5-
A
- tissue becomes desensitized (HGH)
- insulin nocturnally
- progressively higher throughout (dawn is gradual)
- Add new/increase the
- dose of insulin
21
Q
T2DM
> Not linked to -1-
> -2- Ab identified
> Presence of -3- or diabetic -4-
A
- the HLA system
- No islet cell
- obesity
- FMH increases risk
22
Q
T2DM - S/S
> Insidious onset of -1- may be -2-
> -3- (more common in T2DM)
> -4- may be present, but -5-
A
- hyperglycemia
- asymptomatic
- Acanthosis Nigricans
- polydipsia/-phagia/-uria
- less common in T2DM
23
Q
T2DM - Lab/Dx
> -1- as for -2-, except for -3- screening in the blood/urine
> Screening: -4-
A
- Same as
- T1DM
- ketone
- same as baseline
24
Q
T2DM - Considerations for Screening
> Patient has BMI classified as -1-, as well as two of the following risk factors:
» -2- of T2DM
» -3-
A
- “overweight” (>85%) or “obese” (>95%)
- Family history
- Persons of color (specifically AFAM, native americans, hispanics, and API)
25
T2DM - Considerations for Screening
> Risk Factors
>> -1- of -2-
1. Maternal history
| 2. gestational diabetes
26
```
T2DM - Considerations for Screening
> Risk Factors
>> Signs -1- resistance:
>>> Acanthosis Nigricans
>>> -2-
>>> dyslipidemia
>>> -3-
>>> SGA birthweight
```
1. associated with insulin
2. HTN
3. polycystic ovary syndrome
27
```
T2DM - Considerations for Screening
> Risk Factors
>> Signs associated with insulin resistance:
>>> -1-
>>> HTN
>>> -2-
>>> polycystic ovary syndrome
>>> -3- birthweight
```
1. Acanthosis Nigricans
2. dyslipidemia
3. SGA
28
T2DM - Considerations for Screening
| > Screening, -1-, should begin -2- or -3- (whichever occurs -4-) and repeat -5-
1. if done
2. at age 10
3. onset of puberty
4. first
5. every 2 years
29
```
T2DM - Mgmt
> Obtain similar -1- to T1DM
> -2- mgmt
> Oral -3-
> -4- in addition to oral therapy for severe -5-
```
1. baseline data
2. weight (nutrition)
3. antidiabetics
4. insulin therapy
5. hyperglycemia & ketoacidosis
30
T2DM - Oral Antidiabetics
| > -1- is approved by -2- for use in -3-; a -4- is available for children -5-
1. Metformin (glucophage)
2. the FDA
3. children
4. liquid form
5. unable to swallow tablets
31
T2DM - Oral Antidiabetics
> Metformin
>> -1- insulin action, but -2-
>> -3- given in those with -4-, or to those prone to hypoxia
1. Does not stimulate
2. reduces gluconeogenesis
3. Should not be
4. hepatic/renal failure
32
```
T2DM - Oral Antidiabetics
> Metformin
>> SE: -1-; however, typically -2- (-3-)
>> -4- hypoglycemia
>> To be -5-
```
1. significant GI upset
2. transient
3. 2-3 months
4. Little or no
5. administered w/ food
33
T2DM - Oral Antidiabetics
> Metformin
>> Needs to be -1- before -2-; force fluids -3- following -2- using -4-, as interaction with metformin could cause -5-
1. **discontinued** 48 hours
2. procedures
3. for 48 hours
4. dye
5. Acute kidney failure
34
Hyperthyroidism
| Def: Series of clinical disorders assoc. w/ -1- of -2- or -3-; also known as thyrotoxicosis (-4- TSH)
1. increased circulating levels
2. free thyroxine (T4)
3. triiodothyronine (T3)
4. Everything's elevated except
35
Hyperthyroidism
> -1- (most common in children) is associated with the following:
>> -2- of the thyroid
>> -3- of the gland
>> -4- against different fractions of the thyroid gland
1. Graves' disease
2. Diffuse enlargement
3. hyperactivity
4. presence of antibodies
36
Hyperthyroidism - Causes/Incidence
> More common in -1-
> Causes of -2- (e.g., thyroid growths, -3-, -4-)
1. females (8:1)
2. hyperthyroidism
3. subacute thyroiditis
4. TSH-secreting pituitary tumor
37
```
Hyperthyroidism - S/S
> -1-, restlessness
> -2-, increased -3-
> -4- changes
> -5- irregularities
```
1. Nervousness
2. heat intolerance
3. sweating
4. Weight (usually weight loss)
5. menstrual
38
Hyperthyroidism - S/S
> -1-
> Thyroid -2-
> -3- may be present (-4-)
1. tachycardia
2. goiter
3. Graves' ophthalmopathy
4. exophthalmos
39
Hyperthyroidism - Lab/Dx
> -1- is the -2- and -3-
> Serum -4-, thyroid resin update, and free thyroxine index will all be -5-
1. TSH
2. most sensitive test
3. will be low
4. T3 & T4
5. high
40
Hyperthyroidism - Mgmt
| > Refer...
...to peds endocrine
41
Hyperthyroidism - Mgmt
> Medications
>> -1- relief: 0.5-2 mg/kg/day divided into 3-4 doses
>> -2- advantages: cardioselective, less risk of bronchospasm, dosed once daily
1. Propranolol for symptomatic
| 2. Atenolol
42
Hyperthyroidism - Mgmt - Meds
>> Thiourea drugs [e.g., propylthiouracil (PTU) and -1-]: for pts with mild cases, small goiters, or fear of isotopes; avoid -1- use in -2- age due to -3-.
1. methimazole (Tapazole)
2. women of child-bearing
3. teratogenic effects
43
Hyperthyroidism - Mgmt - Meds
>> Thiourea drugs [e.g., propylthiouracil (PTU) and methimazole (Tapazole)]: for pts with mild cases, -1-, or -2-; warning: methimazole is -3-.
1. small goiters
2. fear of isotopes
3. conceptionally teratogenic (not to be given to women of child-bearing age)
44
Hyperthyroidism - Mgmt
> Defnitive treatments
>> -1- (can affect fertility)
>> -2- (must be -3- preoperatively)
1. radioactive iodine 131-I
2. Thyroid surgery
3. euthyroid
45
Hyperthyroidism - Mgmt - Definitive treatments7
>> -1- solution every day for -2- can reduce the -3- of the gland prior to the surgery
>> Diet: use -4- instead of -5-
1. 5-7 drops Lugol's
2. 10 days
3. vascularity
4. non-iodized salt
5. iodized salt
46
Hypothyroidism
Def: a condition resulting in the -1- thyroid -2-
> May be due to -3- of the -4-, or to a deficiency of pituitary TSH or hypothalamic TRH
> MOst foten due to -5-; other causes include iodine deficiency, deficient pituitary, and destruction of the gland by surgery, external radiation, or trauma.
1. lack of circulating
2. hormone
3. disease
4. thyroid gland itself
5. autoimmune thyroiditis (often comorbid with T1D, celiac, or other autoimmune disorders)
47
```
Hypothyroidism - Causes/Incidence
> -1-
>> Absence or -2- of the -3-
>> -4- in transport/assimilation of iodine
>> Occurs in about -5- children
```
1. Congenital
2. underdevelopment
3. thyroid gland
4. inherent dysfunction
5. 1 in 2,000-4,000
48
```
Hypothyroidism - Causes/Incidence
> -1-
>> -2- thyroiditis
>> Pituitary -3-
>> -4- deficiency
>> -5- to the gland
```
1. Juvenile acquired
2. Hashimoto's
3. TSH deficiency
4. Iodide
5. Damage
49
```
Hypothyroidism - S/S: Neonates & Infants
> -1- in the first month of life
> Prolonged bili elevation
> -2-, -3-
> Large -4-
> Lethargy, -5-
```
1. no obvious symptoms
2. poor feeding
3. growth deceleration
4. fontanels
5. hypotonia
50
```
Hypothyroidism - S/S: **Older children**
> -1- intolerance
> -2-
> -3-, poor growth
> -4-, thinning hair, brittle nails
```
1. Cold
2. constipation
3. delayed bone age
4. dry skin
51
Hypothyroidism - S/S: **Older children**
> -1- and -2-
> Slowed -3-
> -4- Sounds
1. Puffy eyes
2. thick tongue
3. DTRs
4. diminished heart
52
```
Hypothyroidism - Lab/Dx
> -1- mandatory
> Elevated -2-
> The following will be decreased:
>> -3-
>> -4- (Not -5-)
```
1. newborn screening is
2. TSH
3. T4 (or low physio)
4. T3
5. reliable/non-diagnostic
53
Hypothyroidism - Lab/Dx
> -1- serum -2- enzymes
> -3-, -4-
> -5-
1. Increased
2. cholesterol & liver
3. hyponatremia
4. hypoglycemia
5. anemia
54
Hypothyroidism - Mgmt
> Refer to -1-
> -2-
1. pediatric endocrine
| 2. Levothyroxine!
55
Short Stature
Def: height -1- deviations or more below the -2- of that sex, or age, or a marked deviation from previously established growth; -3- more than -4- (-5-)
1. falling two standard
2. mean for children
3. failure to grow
4. **4 cm/year**
5. 1.5 inches
56
Short Stature - Causes/Incidence
> Occurs in -1- population
> -2- variant
1. 2.5% of the
| 2. Familial genetic (physio linear growth, short target height)
57
Short Stature - Causes/Incidence
> **Constitutional Delay**: -1- w/ -2- age
>> -3- for the first two to three years of life, then a -4- velocity
1. bone age consistent
2. height
3. slow growth rate
4. low-physiologic growth
58
Short Stature - Causes/Incidence
> **-2- Stature**: -1- are -2- to -3-
>> -4- restriction
>> -5- pathophysiology
1. limbs
2. **proportionate**
3. the torso
4. intrauterine growth
5. chromosomal
59
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Short Stature - Causes/Incidence - Proportionate Stature
> -1-
> Variety of -2-
>> -3- deficiency
>> -4-
```
1. FTT
2. endocrine disorders
3. HGH
4. DM
60
Short Stature - Causes/Incidence
> **Disproportionate stature**: limbs are -1- to torso
>> -2-
>> -3-
1. smaller in proportion
2. dwarfism
3. rickets
61
Short Stature - Causes/Incidence
Assessment
> Assess for -1-, -2-, neglect
> Investigate -3- based upon proportion
1. chronic disease
2. endocrine deficiencies
3. underlying causes
62
Short Stature - Lab/Dx
| > -1-, liver function tests, -2-, -3-
1. CBC
2. Electrolytes
3. ESR
63
Short Stature - Lab/Dx
> -1-: consider skeletal survey for disproportionate features
> -2- test
> -3- level
1. bone age
2. thyroid function
3. HGH
64
```
Short Stature - Mgmt
> Depends -1-
> Refer -2-
> Further testing may inlcude
>> -3- and -4-
```
1. upon cause
2. to endocrine
3. IGF-1
4. IGFBP-3
65
Short Stature - Mgmt
> Further testing may inlcude
>> -1- through karyotype and comparative genomic hybridization
>> anti-endomysial and anti-gliadin antibodies -2-
>> Sweat test if recurrent bronchitis (-3-)
1. Turner syndrome r/o
2. for celiac disease
3. r/o CF
66
-1-, a class of antidiabetic drugs, should not be given to heavy consumers of alcohol or to those -2-. Patients who take -1- can become sick if they consume more than two to four alcoholic drinks a week. -3- and -4- do not adversely interact with alcohol and are, therefore, safe. -5- is not given orally.
1. Biguanides
2. prone to hypoxia
3. Dipeptidyl-peptidase 4 inhibitors
4. alpha-glucosidase inhibitors
5. Insulin
67
For patients presenting with ketones, the rule of thumb is to begin with -1-, giving -2-, of the dose in the morning and -3- in the evening. A -4- is sometimes used in other patients, such as those splitting their treatment between regular human insulin and -5-, but it is not recommended for patients who present with ketones.
1. 0.5 u/kg/day
2. 0.34 u/kg (2/3)
3. 0.16 u/kg (the remaining 1/3)
4. half dose
5. NPH
68
-1- is recommended for the relief of symptoms associated with hyperthyroidism. -2- benefit the condition, but the benefit does not compound with multiple types. -3- is usually performed, as long as the patient is -4- preoperatively. -5- is used to reduce the vascularity of the gland and is used for more chronic therapy rather than acute.
1. Propranolol
2. Thiourea drugs (like methimazole)
3. Thyroid surgery
4. euthyroid (asymptomatic on exam)
5. Lugol's solution
