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Q3 Clin Med II Final (Endocrine) > Endocrine > Flashcards

Endocrine Flashcards

1
Q

TSH regulation?

A
  • feedback of free T3

+ control of TRH

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2
Q

TSH screen used for?

A

Best initial test for thyroid fxn:

Low TSH = hyperfxn or over-treatment

High TSH = hypofxn or under-treatment

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3
Q

Total T4 tells us?

Free T4 tells us?

A

All serum thyroxine (not good marker of fxn)

Direct measure of hormone activity

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4
Q

Thyroglobulin (Tg) is?

A

Thyroid-exclusive protein used for T3/4 synth

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5
Q

Tg levels tell us?

A

Normally low/undetectable

Used as marker for thyroid CA tx/recurrence

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6
Q

Autoimmune Thyroiditis labs tests show?

A 
Antibodies against:
Tg (TgAb)
Thyroid peroxidase (TPOAb)
TSH receptors (TrAb)
Thyroid-stim immunoglobulins (TSIg)
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7
Q

TgAb (U) seen w/?

Evaluates?

A

(U) Hashimoto’s
(P) Grave’s

Likelihood of Grave’s to become hypothyroid

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8
Q

TPOAb do what?

Seen w/?

A

Ø peroxidase that coverts T4 to T3

(U) Hashimoto’s
(P) Grave’s

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9
Q

TrAb (TBAb) do what?

Seen w/?

A

Block TSH binding to receptors -> hypothyroid

ONLY Hashimoto’s

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10
Q

TSIg seen w/?

A

(U) Grave’s

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11
Q

Thyroid labs?

A

TSH:
High -> eval FT4 and all Ab’s
Low -> eval FT4/3, Tg, TPOAb, TgAb, TSIg

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12
Q

Thyroid US used when?

A

Distinguish b/w solid or cystic nodules
Abn thyroid fxn tests
Palp thyroid
Eval tx of Grave’s

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13
Q

Hyper/Hypo/Isoechoic is?

A

measure of density in US

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14
Q

Hemorrhage w/i nodule seen as what ∆ on US

A

hyperechoic becomes hypo

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15
Q

Heterogenous thyroid on US indicates?

Next step?

A

(P) autoimm destruction

Get TFTs, repeat US in 6 mo

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16
Q

Nodules on US:

< 4mm, next step?

> 4 mm, next step?

A

< 4: repeat US 3mo

> 4: biopsy

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17
Q

Test of choice for thyroid nodules?

A

fine needle aspiration (bx)

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18
Q

Follicular cells considered what?

A

malignant until proven otherwise

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19
Q

Thyroid nuclear scan used for?

A 
Differentiate hot/cold:
Grave's
toxic goiter
thyroiditis
malignancy
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20
Q

Nuclear scan results:

Hot?

Patchy hot?

Cold?

A

Hot = Grave’s

Patchy hot = Hashimoto

Cold = 20% CA

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21
Q

Calcitonin is?

Does?

A

Thyroid gland hormone for Ca2+/PO4 metabolism

↓ blood Ca2+ via:
Osteoclast inhib (↓ bone resorp)
Renal tubular reabsorp inhib of Ca2+/PO4 (excreted in urine)

22
Q

PTH regulates?

Calcitriol (active Vit D) regulates?

A

minute-to-minute ionized Ca2+

intestinal Ca2+ absorption

23
Q

PTH circulates in what forms?

A

90% fragmented
10% intact

INTACT evals PT disease

24
Q

PT disease labs?

A 
Intact PTH
Serum Ca2+
Ionized Ca2+
Mg
PO4
Vit D
BMD
25
Q

Test for BMD?

Tells us?

A

DEXA

bone mineral content (BMC)
bone area (BA)

BMC/BA = BMD

26
Q

T-score results from DEXA:

Normal?

Osteopenia?

Osteoporosis?

Severe?

A

N ≥ -1.0

Penia: between -2.5 and -1.0

Porosis: < -2.5

Sever: < -2.5 w/ fragility fractures

27
Q

Risks of fracture independent of BMD?

A 
Age
Glucocort use
Low body weight
FHx
Smoke/drink
28
Q

Cortisol levels highest?

A

a.m.

29
Q

Meds that ↑ cortisol?

A

E2/birth control, amphetamines, spironolactone, prednisone

30
Q

Meds that ↓ cortisol?

A

androgens, lithium, levodopa

31
Q

Adrenal fxn labs?

A 
Plasma cortisol
Plasma ACTH and Ab
24 hr urine cortisol
Cosyntropin stim test
Dexamethasone suppression test
Clonidine suppression test
32
Q

Plasma ACTH and Ab tells us?

A

anterior pitu fxn

Levels N higher in a.m.

33
Q

Plasma ACTH ↑ by what states?

A

stress, menses, pregnancy

34
Q

Meds that ↑ ACTH?

A

E2, ampheta, sprionol, insulin, ETOH

35
Q

Meds that ↓ ACTH?

A

steroids

36
Q

24 hr urine cortisol(17-OCHS) tells us?

A

HYPERadrenal fxn

37
Q

Meds that ↑ 17-OCHS?

A

spirono, quini’s, EMC

38
Q

Meds that ↓ 17-OCHS?

A

E2/birth cont

39
Q

Cosyntropin Stim Test tells us?

A

HYPOadrenal fxn

adrenal gland response to ACTH

40
Q

Rapid Cosyntropin results that confirm HYPOadrenal fxn?

A

Cortisol does NOT ↑ > 18 mg and > 7 above baseline

41
Q

Dexamethasone Suppression Test tells us?

What things interfere w/ results?

A

Hypothalm, pitu, adrenal fxn

Stress, E2, spirono, TCN, steroids can interfere

42
Q

Dexamethasone Suppression Test results w/ Cushings?

A

(Bilateral Adrenal Hyperplasia)

Prolonged/High Dose:
50% ↓ in plasma and urine cortisol

Rapid/Low Dose:
no ∆

43
Q

Dexamethasone Suppression Test results showing no ∆ in cortisol tells us?

A

Adrenal adenoma/carcinoma

Ectopic ACTH-producing tumor

44
Q

Clonidine Suppression Test tells us?

A

pheochromocytoma

45
Q

Clonidine Suppression Test done where?

A

inpatient

46
Q

Clonidine Suppression Test results positive for pheochromocytoma?

A

Levels HIGHER than the following at 3 hrs:
Norepi 0.2 - 0.8
Epi 0.04 - 2

47
Q

Adrenal imaging?

A

CT - standard for abdom masses

MRI - more accurate

US - not helpful

48
Q

Pituitary fxn labs?

A 
Prolactin
GH/IGF1
LH/FSH
ACTH
Vasopressin
49
Q

HyperProlactin can result in?

A

↓ GnRH/FSH -> hypogonadism, amenorr

Milk prdxn

50
Q

GH best evaluated by what labs?

A

IGF1 due to pulsatile release of GH

51
Q

Pituitary Adenoma MRI results?

A

Size not indicative of extent of disease
Must have comparison MRI to follow
Must do lab w/u regardless of MRI results

Q3 Clin Med II Final (Endocrine) (6 decks)

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