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Clin Med > Endocrine > Flashcards

Endocrine Flashcards

1
Q

hyperaldosteronism: is K low or high?

A

low

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2
Q

triad of hyperaldosteronism manifestations?

A

HTN, hypoK, metabolic alkalosis

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3
Q

order what 2 lab tests for suspected hyperaldosteronism

A

serum aldosterone, aldosterone/renin ratio

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4
Q

aldosterone/renin ratio in hyperaldosteronism

A

> 20

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5
Q

MCC overall of Cushing’s syndrome

A

: long-term high-dose glucocorticoid therapy

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6
Q

MCC of Cushing’s dz

A

pituitary adenoma

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7
Q

3 options for testing in Cushing’s syndrome and expected results

A

24 hr urinary free cortisol (high), 1mg dexamethasone suppression test (will have high levels of cortisol in the morning after being given
steroid the night prior; normal pts will have low cortisol levels), OR midnight
salivary cortisol level (cortisol levels are typically lowest around midnight, so if levels are high that could be indicative)

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8
Q

MCC of Addison’s dz

A

autoimmune

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9
Q

Pt c/o nausea, anorexia with low BP and tanned skin.dx?

A

Addison’s

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10
Q

abnormalities in BMP in Addison’s (3)

A

hypoglycemia, hypoNa, hyperK

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11
Q

tx for Addison’s

A

hydrocortisone, fludrocortisone

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12
Q

ACTH level in Addison’s

A

high

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13
Q

main difference b/w Addison’s and secondary adrenocortical insufficiency

A

in secondary, aldosterone NOT affected, so hypoglycemia is main sx

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14
Q

pt c/o fever, weakness w/ hypotension and CMP results: hypoglycemia, hypoNa, hyperK. dx?

A

adrenal crisis

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15
Q

how to tell the difference between ACTH problem vs adrenal problem + expected results

A

Cortrosyn stimulation test (high dose ACTH): If problem is in pituitary gland, you will get increased
levels of cortisol; if the problem is in the adrenal gland, you will NOT get
increased levels of cortisol

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16
Q

which 2 hormones increase serum Ca levels?

A

1,25(OH) vitamin D
(calcitriol) and parathyroid hormone (PTH)

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17
Q

MCC (2) of hyperCa

A

primary hyperparathyroidism or malignancy

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18
Q

serum and urine Ca, PTH levels in hyperCa of malignancy

A

high serum, high urine Ca, low PTH

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19
Q

level of Ca in urine in familial hypocalcuric hyperCa

A

low

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20
Q

PTH level in primary hyperparathyroidism

A

normal to high

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21
Q

pt c/o bone pain, constipation, depression, weakness. dx?

A

hyperCa

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22
Q

EKG finding in hyperCa

A

shortened QT

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23
Q

MCC of hypoCa

A

hypoparathyroidism

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24
Q

pt’s wrist spasms as you inflate BP cuff over SBP. what is this called? cause?

A

Trousseau’s sign, hypoCa

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25
Q

MCC of hyperparathyroidism

A

parathyroid adenoma

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26
Q

hypo vs hyperCa: which has decreased DTR?

A

hyperCa

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27
Q

triad of hypercalcemia + increased intact PTH + decreased phosphate. dx?

A

hyperparathyroidism

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28
Q

tx of choice for hyperparathyroidism

A

parathyroidectomy

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29
Q

DEXA result for osteopenia dx

A

-1.0 to -2.4

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30
Q

DEXA result for OP dx

A

-2.5 or less

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31
Q

in osteopenia, treat if FRAX 10 yr risk of hip fx is __% or any fx is __%

A

> 3% for hip, >20% for any

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32
Q

1st line med class for OP

A

bisphosphonates

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33
Q

CIs for bisphosphonates (4)

A

severe GERD/ulcers/esophagitis, active dental issues, CKD
[GFR <30/stage 4 or worse], new/recent fracture

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34
Q

BBW for Teriparatide (Forteo)

A

osteosarcoma

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35
Q

Can you switch OP pt from denosumab to Teriparatide (Forteo)?

A

NO, CI

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36
Q

bisphosphonates vs denosumab. which requires drug holiday?

A

bisphos

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37
Q

how often to order labs for trans person after starting hormone therapy?

A

labs done Q3 months for the first year, then yearly/twice yearly after that

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38
Q

order what lab to assess beta cell functioning

A

C-peptide

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39
Q

DM dx if A1C is >________

A

6.5 or more

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40
Q

DM dx if fasting plasma glucose is >________

A

126 or more

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41
Q

in pt w/ classic s/s of hyperglycemia, random plasma glucose of____ = DM

A

200+

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42
Q

A1C levels that indicate pre-DM

A

5.7-6.4

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43
Q

how often to get A1C on unstable DM pts

A

Q3 mo

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44
Q

how often to get A1C on stable DM pts

A

Q6 mo

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45
Q

what heart meds can mask hypoglycemcia?

A

BBs

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46
Q

A1C goal in DM

A

<7

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47
Q

fasting glucose goal in DM

A

80-130

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48
Q

7 hypoglycemia sx

A

Tremor, palpitations, anxiety, sweating, hunger, dizziness, weakness. AMS if severe

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49
Q

MC cause of ESRD

A

diabetic nephropathy

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50
Q

tx for diabetic nephropathy

A

ACEi/ARB, SGLT2 inhibitors

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51
Q

what DM med can cause neuropathy?

A

metformin–B12 deficiency

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52
Q

what abx for mild-mod DM ulcer w/ no hx of MRSA or pseudo

A

augmentin

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53
Q

rx what med to all DM pts age 40-75

A

statin

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54
Q

peaks for T1DM dx (2)

A

age 4-6, early puberty

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55
Q

classic presentation: weight loss, polyuria, polydipsia

A

T1DM

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56
Q

start DM meds if A1C ___

A

> 7.5-8

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57
Q

1st line med for T2DM

A

metformin

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58
Q

metformin CIs

A

GFR <30, severe liver dz

59
Q

metformin SEs

A

GI most common, lactic acidosis, B12 deficiency

60
Q

when to add on 2nd med in T2DM

A

if A1C still 7-9 w/ lifestyle changes + metformin

61
Q

when to start newly dx T2DM pt on 2 meds

A

A1C>9

62
Q

which DM med classes cause weight gain? (3)

A

think “sit and get fat”
Sulfonylureas
Insulin
TZDs

63
Q

worst DM med class for hypoglycemia

A

sulfonylureas ( glyburide, glipizide, glimepiride)

64
Q

which 2 DM med classes can cause weight loss?

A

GLP-1 agonists, SGLT2 inhibitors

65
Q

which DM med class can cause AKI, UTIs, fornier’s gangrene?

A

SGLT2 inhibitors

66
Q

MCC of DKA

A

infx

67
Q

glucose level in DKA

A

> 250 (>200 in peds)

68
Q

triad of DKA on labs

A

High blood glucose (>250), anion gap metabolic acidosis (venous pH <7.3 or serum bicarb <15), and
ketosis (presence of ketones in blood)

69
Q

K levels in DKA + what lab results will show

A

hypokalemia (stores are low, but blood levels may indicate they are
normal or high!)

70
Q

work up to order for suspected DKA (4)

A

Work-up: finger stick glucose, urinalysis, BMP, VBG

71
Q

must check what before giving insulin in DKA

A

K must be >3.5

72
Q

fluids to give in DKA: amount and what determines NS vs LR

A

20cc/kg bolus of balanced isotonic fluid (LR) or NS if K is high

73
Q

when to give Na bicarb in DKA

A

pH <6.9

74
Q

rate to lower glucose to prevent cerebral edema

A

Prevent by lowering glucose at 80/hr max

75
Q

glucose level in HHS

A

> 600

76
Q

acidosis in HHS??

A

no

77
Q

what sx req for HHS dx?

A

Must have altered sensorium (drowsiness, lethargy, delirium, seizures, visual changes, sensory deficits)

78
Q

urine ketones in HHS?

A

possible, but small if present

79
Q

1st line test for hypogonadism in males

A

total testosterone (must do twice; measure 1st thing in the morning and fasting)

80
Q

tell men to stop what supplement before doing testosterone testing

A

biotin (72 hrs before)

81
Q

Pt w/ HA, hormone deficiencies, bitemporal hemianopsia. dx?

A

pituatary mass

82
Q

measure ___ for suspected GH deficiency

A

IGF-1

83
Q

effect of decreasing dopamine on prolactin?

A

increases prolactin

84
Q

TRH stimulates PRL slightly, so ____thyroidism can lead to hyperprolactinemia

A

hypo

85
Q

common class of meds that cause hyperprolactinemia

A

antipsychotics

86
Q

results of urine osmolality and specific gravity in diabetes insipidus

A

decreased urine osmolality and specific gravity

87
Q

will Na be high or low in SIADH

A

low

88
Q

Pheochromocytoma main 3 sz

A

palpitations, headache/HTN, excessive sweating

89
Q

labs for Pheochromocytoma

A

: 24hr urine catecholamines and metanephrines OR plasma fractionated
metanephrines

90
Q

what is very dangerous for Pheochromocytoma pts?

A

anesthesia

91
Q

Multiple Endocrine
Neoplasia (MEN1)
Syndrome prone to tumors where? (5)

A

parathyroid
glands, thyroid, anterior pituitary, adrenal glands, and enteropancreatic endocrine cells

92
Q

most common presentaation of MEN1

A

Primary hyperparathyroidism (asymptomatic)

93
Q

MCC of symptomatic MEN1

A

ZES

94
Q

MC tumor in MEN1

A

Parathyroid

95
Q

MEN2a characterised by: (3)

A

medullary thyroid CA, pheochromocytoma, and primary
parathyroid hyperplasia

96
Q

MEN2b characterised by: (2)

A

medullary thyroid CA, pheochromocytoma, but NOT
parathyroid hyperplasia

97
Q

which Develops at earlier age and is more aggressive: MEN2A or MEN2B

A

B

98
Q

all pts with MEN2b have ____ in mouth

A

mucosal neuromas

99
Q

what CA is ASW MEN2?

A

medullary thyroid CA

100
Q

TSH level in primary hypothyroidism

A

high

101
Q

If TSH <10 you don’t HAVE to start tx if pt is asx unless

A

they are pregnant

102
Q

MCC of hypothyroidism

A

Hasthimoto’s thyroiditis (autoimmune)

103
Q

order hwat lab if suspect Hasthimoto’s thyroiditis

A

anti-thyroid peroxidase/TPO antibodies

104
Q

1st line tx for hypothyroidism and dose

A

Levothyroxine (T4; first line; 1.6mcg/kg;

105
Q

MCC of hyperthyroidism in US

A

Grave’s

106
Q

common demographics for Grave’s

A

F 20-40

107
Q

sx specific to Grave’s (2)

A

Ophthalmopathy (proptosis, exophthalmos, lid lag) and pretibial myxedema are
specific to Graves

108
Q

hyperthyroidism PE (5 areas/ things to check)

A

hair, eyes (exopthalmos, lid lag), thyroid palpate (enlarged) and listen (poss hear bruits), pretibial myxedema, hyperreflexia

109
Q

During 1st trimester of pregnancy which is the preferred treatment of hyperthyroidism: PTU or methimazole?

A

PTU

110
Q

labs to order to distinguish Grave’s

A

Anti-thyrotropin antibodies (TSHR-Ab) - can be measured by either a TSI or TBII

111
Q

1st line meds for hyperthyroidism

A

methimazole or propylthiouracil (PTU)

112
Q

Radioactive iodine uptake results in GRave’s

A

homogeneous, diffuse uptake

113
Q

tx for cardiac sx in hyperthyroidism

A

BB (atenalol)

114
Q

pt w/ hyperthyroidism comes in after a URI w/ high fever, tremors, CV dysfunction. suspect what?

A

thryoid storm

115
Q

tx for thryoid storm(4)

A

IV fluids + propranolol + Propylthiouracil + IV glucocorticoids

116
Q

what commonly preceeds subactue thyroiditis?

A

viral resp tract infx

117
Q

subacute thyroiditis results on radioactive scan

A

Diffuse, decreased iodine uptake

118
Q

MC type of malignant thyroid nodule

A

papillary

119
Q

hot nodule on thyroid uptake scan. benign or malignant?

A

benign

120
Q

most aggressive thyroid CA

A

anaplastic

121
Q

During 2nd and 3rd trimester of pregnancy which is the preferred treatment of hyperthyroidism: PTU or methimazole?

A

methimazole

122
Q

In nursing pt which is the preferred treatment of hyperthyroidism: PTU or methimazole?

A

methimazole

123
Q

what is this called: Normal glucose until 2-8 am when it rises. Results from decreased insulin sensitivity and a nightly surge of counter-regulatory hormones during nighttime fasting

A

dawn phenomenon

124
Q

what is this called: Nocturnal hypoglycemia followed by rebound hyperglycemia due to a surge in growth hormone

A

Somogyi effect

125
Q

at what BP do you rx 2 meds for DM pt?

A

> 160/100

126
Q

BP goal for DM

A

<140/90 per JNC 8 and ADA
<130/80 per AHA if comorbidities or at high risk of CVD

127
Q

which has a stronger genetic component: DM 1 or 2?

A

2

128
Q

lipid panel goals for DM

A

LDL < 100 mg/dL (< 70 mg/dL if confirmed atherosclerotic vascular disease), HDL > 40 mg/dL in men and > 50 mg/dL in women, and triglycerides < 150 mg/dL

129
Q

metformin function

A

Decreases hepatic glucose production.
increases peripheral glucose utilization, decreases intestinal glucose absorption (these are reasons it leads to weight loss)

130
Q

concern if sending DM for imaging w/ contrast

A

metformin must be discontinued 24 hours before contrast and resumed 48 hours after with monitoring for creatinine, stop if creatine is > 1.5

131
Q

DM goal for Peak postprandial (1 to 2 hours after the beginning of the meal) blood glucose

A

<180

132
Q

which DM med class has this MOA: Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells

A

TZDs

133
Q

which DM med class has this MOA: Lowers blood sugar by mimicking incretin - causes insulin secretion and decreased glucagon and delays gastric emptying

A

GLP-1 Agonists

134
Q

can metformin be used in CKD4

A

no (lactic acidosis)

135
Q

Which class of antidiabetic drug should be avoided in patients with a family or personal history of medullary thyroid carcinoma?

A

Glucagon-like peptide-1 agonists.

136
Q

A patient is diagnosed with hypothyroidism and started on levothyroxine (Synthroid). When is it ideal to recheck the TSH level?

Two weeks

Three to four weeks

Two to three months

Six months

A

3-4 wk
Patients taking levothyroxine (Synthroid) for thyroid replacement will achieve peak levels of T4 within three to four weeks. The half-life of levothyroxine is 7 days so it will take three to four weeks in order to achieve a steady-state which means that TSH levels or T4 levels should not be checked sooner than this recommended time of three to four weeks.

137
Q

A 32 year-old male with a history of pheochromocytoma is seen in the office. The patient is scheduled for adrenalectomy, however has developed a throbbing headache and racing heart. Vital signs reveal pulse 126 bpm, blood pressure 160/115 mmHg, and respiratory rate 20. The patient appears diaphoretic and anxious. Which of the following is the most appropriate acute management in this patient?

Oral Phenoxybenzamine (Dibenzyline)

Hydrochlorothiazide (Diuril)

Lisinopril (Prinivil)

Bumetanide (Bumex)

A

Phenoxybenzamine is an alpha-blocker utilized to control hypertension in patient with a pheochromocytoma.

138
Q

Radioactive iodine is most successful in treating hyperthyroidism that results from

Grave’s disease.

subacute thyroiditis.

Hashimoto’s thyroiditis

papillary thyroid carcinoma

A

graves

139
Q

While awaiting operative removal of pheochromocytoma, which of the following classes of medications are used for control of hypertension?

alpha-adrenergic blocker

beta-adrenergic blocker

ACE inhibitor

diuretic

A

alpha-adrenergic blocker

140
Q

A 26-year-old obese female complains of a 3-4 month history of discrete erythematous plaques on the pretibial areas of her legs. The lesions have increased in size, become darker, and are painful. She is concerned because the centers of the lesions have become ulcerated. This patient should be screened for which of the following?

Hypothyroidism

Diabetes mellitus

Melanoma

Scleroderma

A

DM
The description of the skin lesions is characteristic of necrobiosis lipoidica diabeticorum, one of the dermatologic manifestations of diabetes mellitus.

141
Q

Which of the following glucose-lowering agents act by delaying glucose absorption?

Metformin (Glucophage)

Acarbose (Precose)

Glipizide (Glucotrol)

Pioglitazone (Actos

A

Acarbose (Precose). Alpha-glucosidase inhibitors, such as acarbose, reduce glucose by delaying glucose absorption

142
Q

Which of the following conditions may result in hypokalemia?

Adrenal adenoma

Hypoparathyroidism

Hyperthyroidism

Adrenal insufficiency

A

Excessive secretion of aldosterone from an adrenal adenoma will lead to sodium retention and the secretion of potassium in the distal tubule of the kidney, eventually leading to hypokalemia.

143
Q

A 43 year-old asymptomatic diabetic female is found to have an elevated total calcium level of 12.4 mg/dL. Which of the following tests must be assessed in order to evaluate this laboratory abnormality?

Intact parathyroid hormone

Serum albumin

24 hour urine calcium level

Complete blood count

A

Since approximately 50% of calcium is protein bound, total calcium levels should be interpreted relative to albumin levels.

144
Q

A 7-year-old child with a history of type 1 diabetes mellitus for 3 years presents for routine follow-up. The mother states that the child has been having nightmares and night sweats. Additionally, his average morning glucose readings have risen from an average of 100 mg/dL to 145 mg/dL over the past week. This child is most likely experiencing

a growth spurt.

emotional problems

the Somogyi effect.

the dawn phenomenon.

A

the Somogyi effect. This refers to nocturnal hypoglycemia, which stimulates counter-regulatory hormone release resulting in rebound hyperglycemia.

dawn phenom = This refers to an early morning rise in plasma glucose due to reduced tissue sensitivity to insulin between 5 AM and 8 AM. It is not associated with nightmares and night sweats.

Clin Med (14 decks)

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