Endocrine Flashcards
1
Q
hyperaldosteronism: is K low or high?
A
low
2
Q
triad of hyperaldosteronism manifestations?
A
HTN, hypoK, metabolic alkalosis
3
Q
order what 2 lab tests for suspected hyperaldosteronism
A
serum aldosterone, aldosterone/renin ratio
4
Q
aldosterone/renin ratio in hyperaldosteronism
A
> 20
5
Q
MCC overall of Cushing’s syndrome
A
: long-term high-dose glucocorticoid therapy
6
Q
MCC of Cushing’s dz
A
pituitary adenoma
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)
8
Q
MCC of Addison’s dz
A
autoimmune
9
Q
Pt c/o nausea, anorexia with low BP and tanned skin.dx?
A
Addison’s
10
Q
abnormalities in BMP in Addison’s (3)
A
hypoglycemia, hypoNa, hyperK
11
Q
tx for Addison’s
A
hydrocortisone, fludrocortisone
12
Q
ACTH level in Addison’s
A
high
13
Q
main difference b/w Addison’s and secondary adrenocortical insufficiency
A
in secondary, aldosterone NOT affected, so hypoglycemia is main sx
14
Q
pt c/o fever, weakness w/ hypotension and CMP results: hypoglycemia, hypoNa, hyperK. dx?
A
adrenal crisis
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
16
Q
which 2 hormones increase serum Ca levels?
A
1,25(OH) vitamin D
(calcitriol) and parathyroid hormone (PTH)
17
Q
MCC (2) of hyperCa
A
primary hyperparathyroidism or malignancy
18
Q
serum and urine Ca, PTH levels in hyperCa of malignancy
A
high serum, high urine Ca, low PTH
19
Q
level of Ca in urine in familial hypocalcuric hyperCa
A
low
20
Q
PTH level in primary hyperparathyroidism
A
normal to high
21
Q
pt c/o bone pain, constipation, depression, weakness. dx?
A
hyperCa
22
Q
EKG finding in hyperCa
A
shortened QT
23
Q
MCC of hypoCa
A
hypoparathyroidism
24
Q
pt’s wrist spasms as you inflate BP cuff over SBP. what is this called? cause?
A
Trousseau’s sign, hypoCa
25
MCC of hyperparathyroidism
parathyroid adenoma
26
hypo vs hyperCa: which has decreased DTR?
hyperCa
27
triad of hypercalcemia + increased intact PTH + decreased phosphate. dx?
hyperparathyroidism
28
tx of choice for hyperparathyroidism
parathyroidectomy
29
DEXA result for osteopenia dx
-1.0 to -2.4
30
DEXA result for OP dx
-2.5 or less
31
in osteopenia, treat if FRAX 10 yr risk of hip fx is __% or any fx is __%
>3% for hip, >20% for any
32
1st line med class for OP
bisphosphonates
33
CIs for bisphosphonates (4)
severe GERD/ulcers/esophagitis, active dental issues, CKD
[GFR <30/stage 4 or worse], new/recent fracture
34
BBW for Teriparatide (Forteo)
osteosarcoma
35
Can you switch OP pt from denosumab to Teriparatide (Forteo)?
NO, CI
36
bisphosphonates vs denosumab. which requires drug holiday?
bisphos
37
how often to order labs for trans person after starting hormone therapy?
labs done Q3 months for the first year, then yearly/twice yearly after that
38
order what lab to assess beta cell functioning
C-peptide
39
DM dx if A1C is >________
6.5 or more
40
DM dx if fasting plasma glucose is >________
126 or more
41
in pt w/ classic s/s of hyperglycemia, random plasma glucose of____ = DM
200+
42
A1C levels that indicate pre-DM
5.7-6.4
43
how often to get A1C on unstable DM pts
Q3 mo
44
how often to get A1C on stable DM pts
Q6 mo
45
what heart meds can mask hypoglycemcia?
BBs
46
A1C goal in DM
<7
47
fasting glucose goal in DM
80-130
48
7 hypoglycemia sx
Tremor, palpitations, anxiety, sweating, hunger, dizziness, weakness. AMS if severe
49
MC cause of ESRD
diabetic nephropathy
50
tx for diabetic nephropathy
ACEi/ARB, SGLT2 inhibitors
51
what DM med can cause neuropathy?
metformin--B12 deficiency
52
what abx for mild-mod DM ulcer w/ no hx of MRSA or pseudo
augmentin
53
rx what med to all DM pts age 40-75
statin
54
peaks for T1DM dx (2)
age 4-6, early puberty
55
classic presentation: weight loss, polyuria, polydipsia
T1DM
56
start DM meds if A1C ___
>7.5-8
57
1st line med for T2DM
metformin
58
metformin CIs
GFR <30, severe liver dz
59
metformin SEs
GI most common, lactic acidosis, B12 deficiency
60
when to add on 2nd med in T2DM
if A1C still 7-9 w/ lifestyle changes + metformin
61
when to start newly dx T2DM pt on 2 meds
A1C>9
62
which DM med classes cause weight gain? (3)
think "sit and get fat"
Sulfonylureas
Insulin
TZDs
63
worst DM med class for hypoglycemia
sulfonylureas ( glyburide, glipizide, glimepiride)
64
which 2 DM med classes can cause weight loss?
GLP-1 agonists, SGLT2 inhibitors
65
which DM med class can cause AKI, UTIs, fornier's gangrene?
SGLT2 inhibitors
66
MCC of DKA
infx
67
glucose level in DKA
>250 (>200 in peds)
68
triad of DKA on labs
High blood glucose (>250), anion gap metabolic acidosis (venous pH <7.3 or serum bicarb <15), and
ketosis (presence of ketones in blood)
69
K levels in DKA + what lab results will show
hypokalemia (stores are low, but blood levels may indicate they are
normal or high!)
70
work up to order for suspected DKA (4)
Work-up: finger stick glucose, urinalysis, BMP, VBG
71
must check what before giving insulin in DKA
K must be >3.5
72
fluids to give in DKA: amount and what determines NS vs LR
20cc/kg bolus of balanced isotonic fluid (LR) or NS if K is high
73
when to give Na bicarb in DKA
pH <6.9
74
rate to lower glucose to prevent cerebral edema
Prevent by lowering glucose at 80/hr max
75
glucose level in HHS
>600
76
acidosis in HHS??
no
77
what sx req for HHS dx?
Must have altered sensorium (drowsiness, lethargy, delirium, seizures, visual changes, sensory deficits)
78
urine ketones in HHS?
possible, but small if present
79
1st line test for hypogonadism in males
total testosterone (must do twice; measure 1st thing in the morning and fasting)
80
tell men to stop what supplement before doing testosterone testing
biotin (72 hrs before)
81
Pt w/ HA, hormone deficiencies, bitemporal hemianopsia. dx?
pituatary mass
82
measure ___ for suspected GH deficiency
IGF-1
83
effect of decreasing dopamine on prolactin?
increases prolactin
84
TRH stimulates PRL slightly, so ____thyroidism can lead to hyperprolactinemia
hypo
85
common class of meds that cause hyperprolactinemia
antipsychotics
86
results of urine osmolality and specific gravity in diabetes insipidus
decreased urine osmolality and specific gravity
87
will Na be high or low in SIADH
low
88
Pheochromocytoma main 3 sz
palpitations, headache/HTN, excessive sweating
89
labs for Pheochromocytoma
: 24hr urine catecholamines and metanephrines OR plasma fractionated
metanephrines
90
what is very dangerous for Pheochromocytoma pts?
anesthesia
91
Multiple Endocrine
Neoplasia (MEN1)
Syndrome prone to tumors where? (5)
parathyroid
glands, thyroid, anterior pituitary, adrenal glands, and enteropancreatic endocrine cells
92
most common presentaation of MEN1
Primary hyperparathyroidism (asymptomatic)
93
MCC of symptomatic MEN1
ZES
94
MC tumor in MEN1
Parathyroid
95
MEN2a characterised by: (3)
medullary thyroid CA, pheochromocytoma, and primary
parathyroid hyperplasia
96
MEN2b characterised by: (2)
medullary thyroid CA, pheochromocytoma, but NOT
parathyroid hyperplasia
97
which Develops at earlier age and is more aggressive: MEN2A or MEN2B
B
98
all pts with MEN2b have ____ in mouth
mucosal neuromas
99
what CA is ASW MEN2?
medullary thyroid CA
100
TSH level in primary hypothyroidism
high
101
If TSH <10 you don’t HAVE to start tx if pt is asx unless
they are pregnant
102
MCC of hypothyroidism
Hasthimoto's thyroiditis (autoimmune)
103
order hwat lab if suspect Hasthimoto's thyroiditis
anti-thyroid peroxidase/TPO antibodies
104
1st line tx for hypothyroidism and dose
Levothyroxine (T4; first line; 1.6mcg/kg;
105
MCC of hyperthyroidism in US
Grave's
106
common demographics for Grave's
F 20-40
107
sx specific to Grave's (2)
Ophthalmopathy (proptosis, exophthalmos, lid lag) and pretibial myxedema are
specific to Graves
108
hyperthyroidism PE (5 areas/ things to check)
hair, eyes (exopthalmos, lid lag), thyroid palpate (enlarged) and listen (poss hear bruits), pretibial myxedema, hyperreflexia
109
During 1st trimester of pregnancy which is the preferred treatment of hyperthyroidism: PTU or methimazole?
PTU
110
labs to order to distinguish Grave's
Anti-thyrotropin antibodies (TSHR-Ab) - can be measured by either a TSI or TBII
111
1st line meds for hyperthyroidism
methimazole or propylthiouracil (PTU)
112
Radioactive iodine uptake results in GRave's
homogeneous, diffuse uptake
113
tx for cardiac sx in hyperthyroidism
BB (atenalol)
114
pt w/ hyperthyroidism comes in after a URI w/ high fever, tremors, CV dysfunction. suspect what?
thryoid storm
115
tx for thryoid storm(4)
IV fluids + propranolol + Propylthiouracil + IV glucocorticoids
116
what commonly preceeds subactue thyroiditis?
viral resp tract infx
117
subacute thyroiditis results on radioactive scan
Diffuse, decreased iodine uptake
118
MC type of malignant thyroid nodule
papillary
119
hot nodule on thyroid uptake scan. benign or malignant?
benign
120
most aggressive thyroid CA
anaplastic
121
During 2nd and 3rd trimester of pregnancy which is the preferred treatment of hyperthyroidism: PTU or methimazole?
methimazole
122
In nursing pt which is the preferred treatment of hyperthyroidism: PTU or methimazole?
methimazole
123
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
dawn phenomenon
124
what is this called: Nocturnal hypoglycemia followed by rebound hyperglycemia due to a surge in growth hormone
Somogyi effect
125
at what BP do you rx 2 meds for DM pt?
>160/100
126
BP goal for DM
<140/90 per JNC 8 and ADA
<130/80 per AHA if comorbidities or at high risk of CVD
127
which has a stronger genetic component: DM 1 or 2?
2
128
lipid panel goals for DM
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
metformin function
Decreases hepatic glucose production.
increases peripheral glucose utilization, decreases intestinal glucose absorption (these are reasons it leads to weight loss)
130
concern if sending DM for imaging w/ contrast
metformin must be discontinued 24 hours before contrast and resumed 48 hours after with monitoring for creatinine, stop if creatine is > 1.5
131
DM goal for Peak postprandial (1 to 2 hours after the beginning of the meal) blood glucose
<180
132
which DM med class has this MOA: Increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells
TZDs
133
which DM med class has this MOA: Lowers blood sugar by mimicking incretin - causes insulin secretion and decreased glucagon and delays gastric emptying
GLP-1 Agonists
134
can metformin be used in CKD4
no (lactic acidosis)
135
Which class of antidiabetic drug should be avoided in patients with a family or personal history of medullary thyroid carcinoma?
Glucagon-like peptide-1 agonists.
136
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
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
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)
Phenoxybenzamine is an alpha-blocker utilized to control hypertension in patient with a pheochromocytoma.
138
Radioactive iodine is most successful in treating hyperthyroidism that results from
Grave's disease.
subacute thyroiditis.
Hashimoto's thyroiditis
papillary thyroid carcinoma
graves
139
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
alpha-adrenergic blocker
140
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
DM
The description of the skin lesions is characteristic of necrobiosis lipoidica diabeticorum, one of the dermatologic manifestations of diabetes mellitus.
141
Which of the following glucose-lowering agents act by delaying glucose absorption?
Metformin (Glucophage)
Acarbose (Precose)
Glipizide (Glucotrol)
Pioglitazone (Actos
Acarbose (Precose). Alpha-glucosidase inhibitors, such as acarbose, reduce glucose by delaying glucose absorption
142
Which of the following conditions may result in hypokalemia?
Adrenal adenoma
Hypoparathyroidism
Hyperthyroidism
Adrenal insufficiency
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
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
Since approximately 50% of calcium is protein bound, total calcium levels should be interpreted relative to albumin levels.
144
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.
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.
