Endocrine Flashcards
1
Q
What 2 hormones are secreted by the Posterior Pituitary?
A
Oxytocin and ADH
2
Q
What is Sheehan’s syndrome?
A
Ischemia of the pituitary due to volume depletion during or after childbirth
3
Q
How do Glitazones work?
A
They improve Insulin Sensitivity
4
Q
Large dough hands?
A
Gigantism
5
Q
Diabetes insipidus is caused by deficiency of which hormome?
A
Vasopressin (ADH)
6
Q
What is more potent, T3 or T4?
A
T3 3-4 X
7
Q
What is first line tx for Pheochromocytoma?
A
Alpha blocker, you should never use a pure beta blocker
8
Q
Best imaging for a thyroid nodule?
A
US
9
Q
Pt wtih ED and complains of numbness in feet. Also with significant polyuria and polydipsia?
A
Diabetic Neuropathy
10
Q
Pretibial myxedema?
A
Grave’s Disease
11
Q
A 35 year old presents with heat intolerance, wt loss and palpatatoins?
A
Think Hyperthyroidism
12
Q
Most common cause of Cushing’s?
A
Pituitary Adenoma
13
Q
First line tx for pt who presents with palpatations and nervousness 2 to hyperthyroidism?
A
BB
14
Q
Hashimoto’s Disease?
A
An autoimmune casue of hypothyroidism
15
Q
How does Levothyroxine work?
A
Help convert T4 to T3
16
Q
Hyperthyroidism, TSH?
A
Decreased
17
Q
How do fibrates work to affect the lipid profile?
A
They inhibit synthesis of VLDL and elevate lipoprotein lipase
18
Q
Med might you use prior to thyroidectomy in a pt with hyperthyroidism?
A
Methiamzole or PTU
19
Q
Whipple’s Triad of hypoglycemia?
A
Hypoglycemia
< 40
immediate recovery upon administration of glucose
20
Q
Positive antithyroid peroxidase antithyroglobulin antibodies should make you think of?
A
Hashimoto’s
21
Q
Tx for Myxedema?
A
Levothyroxine and slow warming
22
Q
Most common cause of hypothyroidism?
A
Post thyroidectomy with the complicatioin of Parathyroidectomy
23
Q
Chvostek’s Sign?
A
Tap on facial nerve and get a twitch with low Ca
24
Q
Cortical adrenal insufficency is also known as?
A
Addison’s Disease
25
Trousseau's sign?
Infalte BP cuff and hold for 3 minutes. Pt with low Ca will get carpal tunnel symptoms
26
In Cushing's is ACTH elevated or decreased?
Elevated
27
Breathing pattern with Diabetic Ketoacidosis?
Kussmaul's
28
2 tests to rule out Cushing's syndrome?
24 hour free cortisol urine test
| Dexamethasome suppression test
29
2 Ectopic tumors that may produce ACTH and giva a pt Cushing's syndrome?
-Small cell lung Ca
-Pancreatic islet cells
Thymomas
30
Tx for Addison's?
-Hydrocortisone and Prednisone
31
Test to begin if you suspect Pheochromocytoma?
24 hour urine cathecholamines
32
Exopthalmosis should make you think about?
Hyperthyroidism
33
% of diabetics in US DM2?
80-90%
34
HLA-DR is the marker for?
DM type I
35
Main fxn of the Parathyroid hormone?
Increase Serum Ca
36
4 diagnostic criteria for DM
Random glucose > 200
Fasting Plasma > 126
Two Hour Postprandial Glucose > 200
HgAic . 6.5%`
37
Moans, groans, stones, describe sxms
Hyperparathyroid
38
HLA-DR gene is marker for what endocrine disorder?
DM type I
39
Stocking glove should make you think of?
Diabetic Neuropathy and B12 deficiency
40
Fruity breath should make you think of?
Diabetic Ketoacidosis
41
Dawn Phenomeonon?
Reduced insulin response between 5 and 8 am
42
Most common cause of hypopituitarism?
Tumor
43
How does Metformin work?
Decreases the hepatic glucose production and increases peripheral uptake of insulin
Euglycemic
44
How do Sulfonylureas work?
They stimulate the production of insulin
45
What class of meds does Pioglitazone fall into?
TZDs
46
Suffix for sulfonylureas?
-Ide Glipizide, Tolbutamide
47
What is first med typically started in T2 DM?
MFM
48
How often should a Diabetics Hgb A1C be checked and what should it be?
Every 3 months (RBC life span 120 days) should keep below 6.5%
49
What lipid med causes Flushing?
Niacin
50
Life threatening SE for Statins?
Rhabdomyolysis
51
Does Niacin increase of decrease HDL?
Increase
52
What class does MFM fall into?
Bituanide
53
Is MFM ok to use in Renal failure?
NO
54
Most common cause of DM1?
Autoimmune destruction of the Islet cells of the pancreas
55
4 PE for Cushing's?
Moon face, buffalo hump, purple strai, central obesity, Supraclav fat pads, easy bruising.
56
During pregnancy which is the preffered agent for hyperthyroidism?
PTU
57
Preg with DM2?
Take off oral hypoglycemic, start insulin
58
Most common thyroid cancers?
Papillary
59
What heparin complication is relevant to endocrinology?
Adrenal infarct leading to cushing's syndrome
60
How does nicotinic acid work to affect lipid profile?
It inhibits the secretion of VLDL
61
Hyperpigmentation of the skin along the creases should make you think of?
Addison's disease?
62
What thyroid cancer is most aggressive?
Anaplastic
63
How do statins work?
They slow the rate limiting step of cholesterol synthesis
64
QIll ACTH be elevated in Addison's?
Elevated if the problem is at the adrenal glands
65
C-peptide in Dx of DM?
Marker of Insulin production:
- Increased: Points to DM2
- Decreased: points to DM1
66
Most common cause of Hyperthyroidism?
GRAVES disease
67
Graves disease?
Formation of autoantibodies to TSH receptors and stimulate the thryoid gland to hyperfunction
68
Labs with Graves?
Increased T3, T4 and Free T4
| Decreased TSH
69
First line with Graves?
Propanolol for symptoms (tachy, tremor, diaphoresis, anxiety and palpatations)
70
What drugs are used to inhibit hormone synthesis with Graves?
PTUand Methimazole---:>safe in pregnancy
71
No Radioactive Iodine with?
Pregnant pts
72
Most common cause of Hypothyroidism?
Autoimmune Thyroiditis (HASHIMOTO'S)
73
Myxedema coma (hypothyroidism precipitate by illness or trauma)
IV Levothyroxine
74
Labs for Hypothyroidism?
Low: Free T4
High: TSH
75
What scan will reveal if a thyroid nodule is cold?
Iodine-123
76
Definitive Dx for a thyroid nodule?
Fine needle Bx
77
I 131 ablation is used when?
when patients who have undergone a near-total thyroidectomy to destroy the remainder of the thyroid gland
78
Aldosterone?
-Produced in the Zona Glomerulosa
Regultes sodium balance
Controlled by Renin
79
Cortisol?
-Zona Fasciculate
Maintains physiologic integrity
controlled by ACTH
80
What test is used to screen for adrenal dysfunction?
Dexamethasone Suppression test
Screens for Adrenal hyperfunction
Cushing's
81
Most common cause of Cushing's?
ACTH-sectreting primary tumor
82
SS Cushing's?
```
Wt gain-Buffalo hump
Ruddy complexion
Stria: Violaceous and occurring in thin skin
Prox muscle weakness
Oligomenorrhea or amenorrhea
```
83
Best test for screening Cushing's?
Dexamethasone screening test
Low am Cortisol excludes Cushing's
Check urine free Cortisol level
84
Tx for Cushing's?
- Surgical removal of tumor followed by HRT'
| - Adrenal inhibitors: Metyrapoine and Ketaconazole
85
Simplified Cosyntropin stimulation test with a cortisol level under 20 with positive sxms?
Adrenal crisis---> most common in Addisons
86
Tx for adrenal crisis
IV saline and hydrocortisone
87
Cushing's is cause by?
Gluccocorticoid excess 2 to ACTH secreting PITUITARY tumor or a secondary ACTH tumor
88
Secondary ACTH tumors?
Small cell lung cancer
endocrine tumors of foregut
pheochromocytomas
ovarian tumors
89
Excessive growth hormone is called
Giantism if before closure of Epiphyses
| Acromegaly if after closure of Epiphyses
90
Most common cause of Acromegaly?
PITUATARY ADENOMA
91
Headaches and vision problems (Hemianopia) may develop in Acromegaly because?
of the impingement of the optic chiasm by the tumor
Mass effect
92
DX of Acromegaly?
- Elevated Prolactin levels
- After administration of glucose and elevated growth hormone is noted
- MRI may reveal a Pituitary tumor
93
What endocrine disorder are pts with Acromegaly at increased risk for?
Diabetes
94
Transnasal, transsphenoidal surgery is used for
Removal of Pitiuitary tumor
95
Short stature, growth curve parallel to the 5th percentile?
Think Dwarfism
96
Mutation of FGR2 gene?
Think Dwarfism
97
Achondroplasia?
Dwarfism prototype
98
Diabetes Insipidus is due to?
Deficiency of Vasopressin 2 to hypothamic damage
99
Clinical picture of Polyuria with Dehydration?
Check Vasopressin levels, Nephrogenic Diabetes insipidus
100
Treatment of choice for Diabetes Insipidus?
Desmopressin Acetate is treatment of choice
| May respond to HCTZ
101
Prolactin inhibitory factor
Dopamine (PIF)
102
Men with ED, gyneomastica, and decreased libido
| Women with Oligomenorrhea, amenorrhea, or galactorrhea MAY have?
Hyperprolactinemia
Many causes: check MRI for pituitary tumor
103
Treatment of choice for hyperproactemia 2 to Pituitary tumor?
```
Dopamine agonists
-Cabergoline
-Bromocriptine
-Pergolide
Surgery if large tumors.....
```
104
Lispro/Aspart
Ultra short acting
- Onset: 5-15 min
- Peak: 1-2 hours
- Duration: 3-4 hours
105
Regular Insulin
Short acting
- Onset: 15-30 min
- Peak: 2-4 hours
- Duration: 5-8 hours
106
NPH/Lente
Intermediate acting
Onset: 2-4 hours
Peak: 5-10 min
Duration: 18-24 hours
107
Ultralente/Glargine?
Long acting anywhere from 24->30 hours
108
Diabetic Ketoacidosis?
Due to increased Lipolysis, ketonuria, and acidosis
109
What does Diabletic Ketoacidosis lead to?
Hyperglycemia, ketonuria and acidosis
110
SS Diabetic Ketoacidosis?
Abd pain, N/V, tachycardia, dehydration, fruity breath odor
111
Labs Diabetic Ketoacidosis
```
Hyperglycemia: 250-1000
Ketones in blood and urine
Elevated anion gap
Metabolic acidosis PH <7.30
Electrolyte imbalances
```
112
Tx diabetic Ketoacidosis?
IV fluids, regular insulin, correct elecrolytes, tx underlying cause
113
What accounts for 90% of all diabetes?
DMII
114
Diagnosis of DMII?
Sxms of DM
Random Gucose> 200
Fasting plasma glucose > 126
Two hour GTT greater >200
115
Elderly person with T2DM with severe dehydration and altered mental status with severe hyperosmolarity and hyperglycemia >600 presents, think?
Hyperosmolar Hyperglycemic State`
116
When do symptoms of hypoglycemia begin?
When blood sugar <60
117
Impaired bran fxn when blood sugar under
50
118
Insulinoma?
symptoms developing early am or after missing a meal with blurry vision, slurred speech and weakness
119
What DM med is associated with Lactic Acidosis?
Metformin
120
Tx of Insulinoma?
Dextrose, surgical resection of tumor, frequent feedings, and diazoxide
121
Familial Hypercholesterolemia?
Autosomal dominant disorder due to defective or absent LDL receptors
122
Type I Triglycerides
Chylomicrons
123
IIA Cholesterol
LDL
124
IIB Cholesterol and Triglycerides
VLDL and LDL
125
III cholesterol and triglycerides
Beta-VLDL and LDL
126
IV Triglycerides
VLDL
127
V Triglycerides
VLDL and chylomicrons
128
SS of hyperlipidemia?
-Xanthomas on Achilles Tendon, patellar tendon, extensor tendons of hand
High Cholesterol usu >300
129
Bile Acid Agents?
Cholestyramine
-Binds bile acids/cholesterol and promote loss in stool
----> increase LDL receptor expression and directly remove LDL particles
SE Constipation, bloating
May interfere with Absorptoin of numerous meds
130
HMG-CoA Reductase Inhibitors?
Statins
- Directly inhibits cholesterol biosynthesis
- --:> Side effects: Myositis, Rhabdo
131
Nicotinic Acid?
Inhibit the release of lipoproteins from the liver
| SE: flushin
132
What is linked to the develop of Pancreatitis?
Hypertriglyceridemia can be linked to SLE, DM, Uremia, Obesity, ETOH
May have s/s pancreatitis and or Xanthomas
133
Familial Hypertriglyceridemia?
Autosomal dominant disorder
134
Meds for tx of hypertriglyceridemia?
After lifestyle changes
---Fibric acid derivations: Gemfibrozil/Fenofibrate
135
Side effects of Fibric acid derivations for Hypertryglycerides
Cholelithiasis and drug induced hepatitis
136
Diet for DM2?
- Limit cholesterol to 300 mg/day
- Restrict saturated fats to 10% of total calories
- Restrict sodium to 2.4 g/day
137
Pregnant with Graves?
PTU 100 mg PO TID
138
Avoid Glipizides with pts with?
Liver impairment
139
Tachycardia/heart palpatations with a multinodular goiter?
I (131) Ablation
140
Carbamazepine can cause?
Can cause SIADH
141
LDL goal for a 50 year old with no cardiac complications?
Less than 160
142
LDL goal for a 67 year old with T2DM?
Less than 100
143
Pt with palpable thyroid mass with wt gain, fatigue, dry skin, oligomenorrhea?
Think Hashimoto's Thyroiditis
144
Adrenal crisis?
Hydrocortisone 500 mg PO
145
Tx for Diabetes insipidus with ADH def?
Antidiuretic
146
Thyroid Storm?
PTU 600mg
