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PANCE/EOC > Endocrine #2 > Flashcards

Endocrine #2 Flashcards

1
Q

Most aggressive type of thyroid cancer

A

-Anaplastic Thyroid Cancer

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2
Q

Symptoms of anaplastic Thyroid cancer

A
  • Rapid growth, compressive symptoms (dyspnea, dysphagia)

- Rock hard thyroid mass

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3
Q

A medullary thyroid carcinoma is associated with

A
  • Calcitonin synthesizing parafollicular cells

- MEN IIa or IIb

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4
Q

Follicular Thyroid Carcinoma has METs that go

A

Distant (lung MC, liver, brain, bone)

Think Follicular goes FAR

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5
Q

Risk Factors for thyroid nodules

A

-Extremes of age, history head and neck radiation

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6
Q

MC type of thyroid nodule

A

Follicular adenoma (colloid)

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7
Q

Symptoms of thyroid nodule

A
  • Most asymptomatic

- Can have compressive symptoms (recurrent laryngeal nerve impingement)

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8
Q

On physical examination, what symptoms are concerning for malignant?

A

-rapid growth, fixed in place, no movement with swallowing

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9
Q

On PE, what is found on a benign thyroid nodule?

A

-Varied, smooth, firm, irregularly sharply outlined, discrete, painless

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10
Q

Diagnostics for thyroid nodule

A
  • Thyroid function testing (initial). If TSH normal or high, FNA indicated
  • Thyroid US: irregular margins, hypoechoic, central vascularity
  • FNA: best test and done if (Nodules > 1.5 cm with normal TSH)
  • Radioactive iodine uptake scan: Cold nodules (biopsied to rule out malignancy)
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11
Q

Do hot or cold nodules have a higher chance of malignancy?

A

Cold

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12
Q

Diagnostics for DM

A
  • Fasting plasma glucose > 126 (at least 8 hours apart on 2 occasions) = GOLD
  • 2 hour glucose tolerance test > 200
  • A1c > 6.5%
  • Random Plasma > 200
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13
Q

When to screen for DM?

A

-All adults > 45 every 3 years OR any adult with BMI > 25 and 1 additional risk factor

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14
Q

MOA for Metformin

A
  • Decreased hepatic glucose production by inhibiting gluconeogenesis
  • No effect on pancreatic beta cells; not associated with hypoglycemia
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15
Q

Adverse reactions to Metformin

A
  • GI complaints (MC)
  • Vitamin B12 deficiency
  • Lactic Acidosis
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16
Q

Contraindications to Metformin

A
  • Severe renal or hepatic impairment
  • Excessive alcohol intake
  • Hold before contrast and resumed within 48 hours
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17
Q

Somogyi Phenomenon

A

-Nocturnal hypoglycemia followed by rebound hyperglycemia

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18
Q

How to prevent Somogyi Phenomenon

A
  • Decrease nighttime NPH dose
  • Move evening NPH dose earlier
  • Give bedtime snack
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19
Q

Dawn Phenomenon

A

-Normal glucose until rise in serum glucose levels between 2 AM - 8 AM

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20
Q

How to manage Dawn Phenomenon

A
  • Bedtime injection of NPH

- Avoid carb snack late at night

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21
Q

How long does NPH normally work?

A

-Covers insulin for about a half day or overnight

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22
Q

When do you give Lispro or Aspart, which are rapid acting insulin agents?

A

At the same time as the meal.

23
Q

Short-acting, or regular insulin, lasts how long?

A

-Given 30-60 minutes prior to meal

24
Q

Symptoms of DKA

A
  • Fruity (acetone) breath
  • Kussmaul respirations (deep, continuous respirations)
  • Tachycardia, tachypnea, hypotension, decreased skin turgor
25
Q

What diagnostic shows DKA

A
  • Plasma glucose > 250
  • Positive ketones in the urine
  • High anion gap metabolic acidosis
26
Q

Treatment for DKA

A
  • SIPS
  • -Saline, Insulin (regular), Potassium Repletion, Search for underlying cause
  • –Isotonic 0.9% (Normal saline)
  • –Correction of DKA will invariably cause hypokalemia
27
Q

_____ are more important than glucose levels in determining the severity of DKA

A

-Bicarbonate levels

28
Q

Treatment for diabetic neuropathy

A
  • Optimal glucose control

- Pregabalin and Duloxetine, Amitriptyline, or Gabapentin

29
Q

Treatment for Gastroparesis from Diabetes

A
  • Dietary modifications are initial management

- Prokinetics: Metoclopramide or Erythromycin

30
Q

Diabetes mellitus is the MCC of

A

End stage renal disease

31
Q

What is syndrome of inappropriate ADH (SIADH)

A

-Excess of ADH from pituitary gland or ectopic source leading to free water retention and hyponatremia due to kidney’s inability to dilute the urine

32
Q

Symptoms of SIADH

A

-Neurologic symptoms of hyponatremia and cerebral edema (confusion, lethargy, seizure, coma)

33
Q

Diagnostics for SIADH

A
  • Hyponatremia
  • Decreased serum osmolarity
  • Increased urine osmolarity (>20)
  • Increased ADH levels
34
Q

Treatment for SIADH

A
  • Water restriction

- IV hypertonic saline + Furosemide (if severe)

35
Q

Diabetes Insipidus leads to production of

A

large amounts of dilute urine

36
Q

Symptoms of Diabetes Insipidus

A
  • Polyuria (20 L daily)
  • Polydipsia
  • Neurologic symptoms of hypernatremia (confusion, lethargy)
37
Q

Labs for DI

A
  • Increased serum osmolarity
  • Decreased urine osmolarity
  • Decreased specific gravity
  • Increased urine volume
38
Q

diagnostics for DI

A
  • Fluid deprivation test: DI continues to produce large amounts of dilute urine
  • Desmopressin Stim Test: Distinguishes the types
  • —Central: reduction in urine output
  • —Nephrogenic: continued production of large amounts of urine
39
Q

Treatment for Central DI

A

Desmopressin (DDAVP)

40
Q

Treatment for Nephrogenic DI

A

Hydrochlorothiazide, Indomethacin, Amiloride

41
Q

Symptoms of Hypercalcemia

A
  • Stones (Nephrolithiasis)
  • Bones (bone pain and fractures)
  • Abdominal groans (ileus, constipation)
  • Psychic Moans (Depression, anxiety, cognitive dysfunction)
42
Q

Diagnostics for hypercalcemia

A
  • Intact PTH

- ECG: shortened QT interval

43
Q

MCC of hypercalcemia

A

-Hyperparathyroidism

44
Q

Symptoms of Hypocalcemia

A
  • Increased muscular contractions: muscle cramps, bronchospasm, tetany, Chvostek Sign (facial spasm with tapping of facial nerve), Trousseau’s Sign (inflation of BP cuff above systolic causes carpal spasm)
  • Increased DTR
45
Q

What does an ECG for hypocalcemia show?

A

-ECG: prolonged QT interval classic

46
Q

Treatment for hypocalcemia

A
  • Oral Calcium + VItamin D

- IV calcium gluconate for severe

47
Q

Triad of Symptoms for Primary hyperparathyroidism

A

-Hypercalcemia + Increased intact PTH + Decreased Phosphate

48
Q

What is the treatment for primary hyperparathyroidism

A

Parathyroidectomy

49
Q

Symptoms of a Prolactinoma

A
  • Hypogonadism
  • Amenorrhea
  • Infertility
  • Galactorrhea
  • Headache, Visual Changes
  • Bitemporal Hemianopsia
50
Q

Diagnostic for prolactinoma

A

-Increased prolactin, decreased FSH, and LH

51
Q

Treatment and Prolactin

A

-Dopamine agonists (Cabergoline or Bromocriptine) first-line treatment

52
Q

What is the key component of Metabolic Syndrome

A

-Insulin resistance

53
Q

Diagnostic Criteria of Metabolic Syndrome

A
  • Decreased HDL: < 40 in men, < 50 in women
  • High blood pressure
  • High fasting TG levels: > 150
  • High fasting blood sugar: > 100
  • Abdominal obesity
54
Q

What are some weight loss medications

A
  • Phentermine
  • Lorcaserin
  • Orlistat

PANCE/EOC (63 decks)

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