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CDP > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Anyone with a thyroid nodule should get:

A

History and physical exam
Measurement of serum TSH
Ultrasound

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2
Q

Reasons for decreased C-peptide

A

Factitious hypoglycemia

Type 1 diabetes mellitus

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3
Q

Reasons for increased C-peptide

A

Insulinoma

Type 2 diabetes mellitus

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4
Q

Diagnostic threshold level for OGTT

A

200+ mg/dL (after two hours)

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5
Q

A positive thyroid antibody test suggests …

A

Autoimmune disorder (Hashimoto’s or Graves)

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6
Q

Hypothyroidism side effects

A

Everything slows down

Hyporeflexia
Slower brain
Fatigue
Weight gain (fluid)
Constipation
Menorrhagia
Easily chilled

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7
Q

Gestational diabetes screening for women with risk factors/history

A

Screen at first prenatal visit with OGTT

(risk factors same as diabetes, except age is 35 instead of 45)

Screen women with history 6-12 weeks postpartum using OGTT and lifelong every 3 years

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8
Q

Is there a poor or strong correlation between plasma and urine glucose?

A

Poor correlation (variable renal threshold)

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9
Q

If pituitary or hypothalamic disease is suspected (e.g. a young woman with amenorrhea and fatigue) what would you want to measure?

A

BOTH serum TSH and free T4

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10
Q

The most accurate method for evaluating thyroid nodules when TSH is normal or elevated is …

A

FNA biopsy (fine needle aspiration)

Uses ultrasound to guide

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11
Q

Reasons for decreased insulin

A

Diabetes mellitus

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12
Q

This medication inhibits extrathyroidal conversion of T4 to T3 and can cause T4 toxicosis

A

Amiodarone

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13
Q

Which is more likely to be cancerous, a “hot” or “cold” thyroid nodule?

A

Cold

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14
Q

Next steps if:

1.) TSH normal

2.) TSH high

3.) TSH low

A

1.) TSH normal - no further testing

2.) TSH high - Free T4 (determine degree of hypothyroidism)

3.) TSH low - Free T4 and T3 (determine degree of hyperthyroidism)

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15
Q

Primary labs for hyperthyroidism

A

Free T4 and T3

Once steady state, use TSH to monitor disease

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16
Q

What hormone is used in pregnancy tests?

A

hCG (human chorionic gonadotropin)

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17
Q

The precursor to testosterone and estrogen is …

A

DHEA

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18
Q

Most common cause of hyperthyroidism

A

Graves disease

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19
Q

Thyroid disease in the ambulatory setting can be excluded if this test is normal

A

TSH levels

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20
Q

Normal fasting blood glucose

A

60-100 mg/dL

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21
Q

Ingestion of this vitamin can interfere with TSH lab levels

A

Biotin

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22
Q

When to take a pregnancy test

A

hCG appears 3-7 days after conception

Not good to do before first missed period

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23
Q

Casual glucose threshold (any time of day regardless of food intake)

A

<200 mg/dL

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24
Q

What are the three points of Whipple’s triad?

A

Symptoms consistent with hypoglycemia

A low plasma glucose concentration (<50 mg/dL)

Immediate relief of symptoms with IV glucose

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25
Q

Most important test to assess thyroid

A

TSH level

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26
Q

Anterior pituitary hormones

A

TSH

LH

FSH

(also GH and ACTH, but not talked about here)

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27
Q

Diabetic and pre-diabetic levels for HbA1c

A

Diabetic = 6.5% or more

Pre-diabetic = 5.7 to 6.4%

28
Q

If TSH is elevated, order this test …

A

Free T4

29
Q

Non-diabetic reasons for increased blood sugar (hyperglycemia)

A

Acute stress response

Corticosteroids

30
Q

Test levels of this to assess ED/fertility in men, PCOS/masculine features in women, or early/precocious puberty in teens

A

Testosterone

31
Q

Estrogen levels can be used to monitor these four things

A

Puberty
Menstruation
Fertility
Menopause

32
Q

Reason for HbA1c to be elevated

A

Newly diagnosed diabetic patient

33
Q

Reasons for decreased TSH

A

Hyperthyroidism

34
Q

This test is done when TSH is low to determine the functional status of thyroid nodules

A

Scintigraphy (aka thyroid uptake, radionuclide thyroid scan)

35
Q

Describe myxedma coma

A

Medical emergency with high mortality rate

Severe hypothyroidism

Periorbital edema, puffy, dull, dry face, hair thinning

Low T4, TSH variable

36
Q

Reasons for non-diabetic low blood sugar (hypoglycemia)

A

Excessive alcohol intake

Hepatitis

Anorexia nervosa

Tumors of the pancreas (insulinoma)

37
Q

ADA screening recommendations for diabetes or pre-diabetes

A

Don’t screen for DM1

Screen all adults overweight with at least one other risk factor

If no risk factors, screening begins at 45 (fasting plasma glucose recommended)

38
Q

Hyperthyroidism side effects

A

Everything speeds up

Skin smooth and moist
Hyperreflexia
Racing mind
Weight loss (10 lbs)
Low volume frequent stools
Oligomenorrhea
Heat intolerance
Arrythmias (Afib)

39
Q

In hypothyroidism would TSH and free T4 be elevated or decreased?

A

TSH up

T4 down

40
Q

Risk factors for diabetes (11)

A
  1. Age 45+
  2. BMI 25+ (overweight)
  3. 1st degree family history DM
  4. Physical inactivity
  5. High-risk ethnic group (Black, Hispanic, Native American, Asian American, Pacific Islander)
  6. History of delivering fat baby (9lbs+)
  7. HTN (140/90)
  8. Dyslipidemia (HDL <35 and/or TGs >250)
  9. Previous impaired glucose tolerance or impaired fasting glucose
  10. PCOS
  11. History of vascular disease
41
Q

Which is more likely to require FNA, a hyper or hypo functioning thyroid nodule?

A

Hypo

42
Q

Reasons (3) for increased TSH

A

Primary hypothyroidism

Thyroiditis

Severe and chronic illness

43
Q

Screening recommendations for microalbuminuria and what med to use to treat

A

Annually

Two out of three tests positive = start patient on an ACE!

44
Q

HbA1c level goal for diabetes patients

A

7%

45
Q

Two reasons to order a TPO antibody

A

Goiter (enlargement of thyroid gland)

Subclinical hypothyroidism or postpartum thyroiditis

46
Q

USPSTF rating, age range, and frequency for prediabetes and DM2

A

B

Age 35-70

Every three years

47
Q

These four tests can be done to differentiate type one from type two diabetes

A

Insulin assay

C-peptide

Islet cells (antibodies?)

GAD 65 antibodies

48
Q

Most patients with hyperthyroidism caused by nodular goiter or Graves have greater increase in …. (T3 or T4?)

A

T3

(watch out for T3 toxicosis)

49
Q

Describe a thyroid storm

A

Rare life threatening condition, severe or exaggerated clinical manifestations of thyrotoxicosis

Hyperthyroidism

50
Q

C-peptide levels correlate with … levels in the blood

A

Insulin (degree of insulin insufficiency)

51
Q

Gestational diabetes screening for women without risk factors or history

A

Screen at 24-28 weeks with OGTT

52
Q

HbA1c measures average blood glucose levels over this period of time

A

120 days (lifespan of red blood cell)

53
Q

Primary lab to monitor hypothyroidism

A

TSH

54
Q

If patient has symptoms of hyper or hypothyroidism but a normal TSH result, what is your next step?

A

Measure serum free T4

55
Q

Blood levels of hCG for negative, indeterminate, positive pregnancy tests

A

Negative = under 5

Indeterminate = 5-25

Positive = over 25

56
Q

Patients with low serum TSH but normal free T4 and T3 have …

A

Subclinical hyperthyroidism

57
Q

TSH is released from the …. and T3, T4 are released from the ….

A

TSH from pituitary

T3,T4 from thyroid

58
Q

ADA diagnostic criteria for diabetes mellitus

A

A. Symptoms of diabetes and a casual plasma glucose 200+ mg/dL

B. Fasting plasma glucose >125 mg/dL

C. OGTT 200+ mg/dL

D. HbA1c 6.5+%

In absence of unequivocal hyperglycemia, DM dx must be confirmed on a subsequent day by measuring any one of b, c, d.

59
Q

Posterior pituitary hormones

A

ADH

Oxytocin

60
Q

Reasons for increased insulin

A

Insulinoma

Obesity

61
Q

What TSH level (high, normal, low) increases the possibility that a thyroid nodule is hyperfunctioning?

A

Low TSH

62
Q

Insulin assay should always be performed in conjunction with this test

A

Blood glucose

63
Q

Cortisol levels are highest at this time of day

A

6am to 8am

64
Q

Except for lab error, all patients with low TSH and high free T4 and/or T3 have ….

A

Primary hyperthyroidism

65
Q

It is generally accepted that a woman has reached menopause when …

A

No menstruation for a year

AND

FSH reaches 30+ mIU/mL

66
Q

What imaging should be used to screen for non-palpable thyroid cancers?

A

None, don’t screen if it’s non-palpable

(but if palpable it’s ultrasound)

CDP (13 decks)

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