Endocrine Flashcards
BBlox can mask sx of ____
hypoglycemia
Insulinoma tx
diazoxide and octreotide
How does increase in ETOH lead to hypoglycemia?
NADPH is used up converting ETOH. Liver cant use for gluconeogenesis.
GIVE THIAMINE BEFORE GLUCOSE
GIVE THIAMINE BEFORE GLUCOSE
Painful goiter
DeQuervian (subacute)/viral?
What thyroid tx can acutely worsen sx of hyperthyorid state?
RAI - can worsen Graves OPTHO acutely. Also may temporarily worsen hyperthyroid state
metabolic abnl assoc w hypothyroid
hyperLDL and hypoNa
Tx for acromegaly
Octreotide, cabergoline, pegvisomat
Sheehan synd
after pregnancy - pituitary necrosis. Pan hypopit. Loss of pubic hair etc
FLudrocortisone
strong mineralocorticoid used to replace in decreased adrenal fcn
CAH
dx with increased 17 OH progesterone
Triad of hyperaldosteronism
HTN, hypoK, metabolic ALKalosis
Chronic ingestion of what can look like hyperaldosteronism
Licorice. Prevents cortisol to cortisone. Stimulates aldosterone receptors more than cortisol
HHS
VERY high glucose, precipitated by some stressor (URI/illness), typically DMII
Causes of eosinophilia
DNAAACP Drugs Neoplasm Allergies/asthma/churgg strauss Addisons AIN Collagen vasc dz Parasite (loeffler's eosinophilic pneumonitis (Ascaris))
Acromegaly and peptic ulcers
THINK MENI
Early sx of ASA o/d
Tinnitus
DM, liver failure, heart failure
Hemochromatosis
Best way to control diabetic nephropathy?
HTN control
First step in evaluating suspected Hyperaldost?
Check Aldost/Renin ratio
1st step to evaluate hypercalcemia
Check PTH, no matter the clinical suspeicion
Methimazole AE
Agranulocytosis. Also, not in preggers
What electrolyte abnormality is a contraindication to succinylcholine use?
Hyper K
Fastest way to correct hyperkalemia
Insulin/glucose
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
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
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
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
AD
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