Endocrine Flashcards by Michael Roche

BBlox can mask sx of ____

hypoglycemia

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Insulinoma tx

diazoxide and octreotide

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How does increase in ETOH lead to hypoglycemia?

NADPH is used up converting ETOH. Liver cant use for gluconeogenesis.

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GIVE THIAMINE BEFORE GLUCOSE

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Painful goiter

DeQuervian (subacute)/viral?

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What thyroid tx can acutely worsen sx of hyperthyorid state?

RAI - can worsen Graves OPTHO acutely. Also may temporarily worsen hyperthyroid state

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metabolic abnl assoc w hypothyroid

hyperLDL and hypoNa

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Tx for acromegaly

Octreotide, cabergoline, pegvisomat

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Sheehan synd

after pregnancy - pituitary necrosis. Pan hypopit. Loss of pubic hair etc

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FLudrocortisone

strong mineralocorticoid used to replace in decreased adrenal fcn

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CAH

dx with increased 17 OH progesterone

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Triad of hyperaldosteronism

HTN, hypoK, metabolic ALKalosis

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Chronic ingestion of what can look like hyperaldosteronism

Licorice. Prevents cortisol to cortisone. Stimulates aldosterone receptors more than cortisol

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HHS

VERY high glucose, precipitated by some stressor (URI/illness), typically DMII

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Causes of eosinophilia

DNAAACP
Drugs
Neoplasm
Allergies/asthma/churgg strauss
Addisons
AIN
Collagen vasc dz
Parasite (loeffler's eosinophilic pneumonitis (Ascaris))

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Acromegaly and peptic ulcers

THINK MENI

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Early sx of ASA o/d

Tinnitus

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DM, liver failure, heart failure

Hemochromatosis

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Best way to control diabetic nephropathy?

HTN control

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First step in evaluating suspected Hyperaldost?

Check Aldost/Renin ratio

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1st step to evaluate hypercalcemia

Check PTH, no matter the clinical suspeicion

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Methimazole AE

Agranulocytosis. Also, not in preggers

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What electrolyte abnormality is a contraindication to succinylcholine use?

Hyper K

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Fastest way to correct hyperkalemia

Insulin/glucose

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Hashimotos Abs

Anti Thyroidperoxidase

Graves Dz Abs

Thyroid stimulating Abs (especially TSH receptor Abs)

Cardiac Tamponade CXR

normal cardiac silhouette

Dipyridamole/cardiac steal phenom

It's an Anti PLT and VasoD. Used to check to see which vessels can dilate anymore. When given, the dead vessels cannot expand any more. So blood will flow away from diseased vessels to healthy vessels

Native valve endocarditis s/p dental work

Viridans strep (mutans, sanguis, mitis, salivaria)

Work up for cold leg following MI -

Get ECHO to check for mural thrombus

Crescendo/decrescendo systolic murmur, left sternal border w/o radiation to carotids

HCM

What risk factor is associated with highest risk of AAA growth and rupture?

Smoking

Mechanical complications s/p MI

MR from papillary mm rupture LV free wall rupture IV septum rupture

Lipid lowering tx with statins rec'd 40-75 in pts w CV risk event rate of 7.5% or greater

Best way to lower HTN?

Weight loss, followed closely by DASH diet. Smoking doesn't help all that much

Pressors like NE can cause symmetrical ischemia of distal fingers and toes 2/2 vasospasm

Dig tox

n/v/d, vision changes. arrhythmias. Can be precipitated by stress (virus/diuretic/volume depletion)

Very high levels of diphenhydramine tox can mimic ?

Anti M

Emotional syncope

Vasovagal syncope. Dx w tilt table test

What is the most common valve defect in infectious endocarditis

MVP and regurg

What drugs to hold prior to cardiac stress test?

Anything that can cover up angina. Nitrates, BBlox and CCB

How do you treat Asx PVCs?

NONE. No need to treat

How do you treat Sx PVCs?

1) BBlox | 2) Amiodarone

How does CHF lead to increase in TBW?

Renal hypoperfusion - increase RAS - renal aa constrict - increase TBW and sodium retain

Treatment for stable SVT?

Vagal maneuvers and Adenosine (unstable = cardiovert)

Tylenol increases anticoag effects of warfarin

so do nsaids and stuff

HTN work up should include UA/Chem7/Lipids/EKG

Diastolic dysfcn, increased wall thick (no increased volume), low voltage ekg, renal abnormalities

THINK AMYLOID

Single S2, harsh crescendo-decrescendo @ L USB

Tetrology

Most common cause of death s/p MI

Ventricular Arrhythmia. Re-entrant VFib most common

Normal JVD

Less than 3 cm

Dissection

Really high HTN, dx with TEE

HCM transmission

Why do you not give BBlox without ABlox in pheo?

Block beta, you get unmasked alpha - leads to dangerous increase in BP

Pinealomas can sometimes release BHCG and stim leydig cells - causing androgen secretion

Dark hair in a kid and all that

Addisons has increased in what type of WBC cell line?

Eos

Obese children and hispanic/black children are at increased risk of precocious pubertal development.

In obesity - it's because leptin activates HPA and pulsatile GNRH release. This activates LH/FSH. Also, high insulin stims ovarian and adrenal androgen production.

Workup for acromegaly after igf-1 levels?

measure GH after oral glucose suppression test. Those with acromegaly cannot properly suppress GH.

severe cystic acne, LH that doesnt increase after GnRH stim test, advanced bone age, coarse axillary and pubic hair,

Think non-traditional CAH - 21 a hydroxylase (HTN normal and high sex)

What level of sodium do we start seeing altered mental status?

120 or lower

Weakness and myalgias with very very high bp?

Think hyperaldosteronism (weakness frome low K). Also maybe very thirsty

Very High Calcium (like 14/15) is most often due to?

Malignancy. Hyper PTH usually only mildly elevated

irregular periods, infertility, galactorrhea?

prolactinoma - tx bromociptine

DKA treatment?

IVF, K, insulin. Might need to start k bnefore insulin if patient is hypo K

Most common type of thyroid nodule

colloid nodule (cold nodule). follicular adenoma #2

Treatment for SIADH

demeclocycline

Treatment for DI

desmopressin. Patients with central DI increase urine OSM at least 50% with administration of DDAVP

thyrotoxicosis with low radioactive Iodine uptake?

Think thyroiditis. Graves has HIGH uptake

hypercalcemia following long periods of not moving

hypercalcemia of immobilization

fatigue, myalgias, proximal mm weakness, sluggish ankle reflexes, normal esr and hi CK. dx?

Hypothyroid myopathy

watery diarrhea, hypoK, mm cramps, achlorhydria. panc mass

VIPoma

Which calcium form is physiologically available: unbound to albumin or bound to albumin?

Unbound

What calcium abnormalities do we see with met alk?

Low Ca. Increase affinity of Ca to albumin. Making the unbound form less available.

How do you dx avascular necrosis of hip?

MRI. Steroids can cause

Whats the acid base status in primary adrenal insuff?

Non AG met acid - also see eosinophils

Regardless of RF, when should you test patients for DM/A1C?

45 years old

most common mechanism for malignancy-induced hyperCa?

PTHrP. More common than when cancers secrete osteolytic factors to bone

Best initial way to treat severe hypercalcemia of malignancy

LOTS OF FLUIDS. Bisphosphonates for long term tx

What electrolyte abnormality do we see in SAH?

HypoNa because cerebral salt wasting/SIADH

How do increased ER states (meds/preg) affect thyroid?

Increase TBG. This results in decreased free thyroxine. A normal thyroid will compensate for this. But patients on replacement tx will need higher doses