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Endocrine Flashcards

1
Q

What 2 hormones are secreted by the Posterior Pituitary?

A

Oxytocin and ADH

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2
Q

What is Sheehan’s syndrome?

A

Ischemia of the pituitary due to volume depletion during or after childbirth

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3
Q

How do Glitazones work?

A

They improve Insulin Sensitivity

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4
Q

Large dough hands?

A

Gigantism

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5
Q

Diabetes insipidus is caused by deficiency of which hormome?

A

Vasopressin (ADH)

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6
Q

What is more potent, T3 or T4?

A

T3 3-4 X

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7
Q

What is first line tx for Pheochromocytoma?

A

Alpha blocker, you should never use a pure beta blocker

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8
Q

Best imaging for a thyroid nodule?

A

US

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9
Q

Pt wtih ED and complains of numbness in feet. Also with significant polyuria and polydipsia?

A

Diabetic Neuropathy

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10
Q

Pretibial myxedema?

A

Grave’s Disease

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11
Q

A 35 year old presents with heat intolerance, wt loss and palpatatoins?

A

Think Hyperthyroidism

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12
Q

Most common cause of Cushing’s?

A

Pituitary Adenoma

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13
Q

First line tx for pt who presents with palpatations and nervousness 2 to hyperthyroidism?

A

BB

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14
Q

Hashimoto’s Disease?

A

An autoimmune casue of hypothyroidism

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15
Q

How does Levothyroxine work?

A

Help convert T4 to T3

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16
Q

Hyperthyroidism, TSH?

A

Decreased

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17
Q

How do fibrates work to affect the lipid profile?

A

They inhibit synthesis of VLDL and elevate lipoprotein lipase

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18
Q

Med might you use prior to thyroidectomy in a pt with hyperthyroidism?

A

Methiamzole or PTU

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19
Q

Whipple’s Triad of hypoglycemia?

A

Hypoglycemia
< 40
immediate recovery upon administration of glucose

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20
Q

Positive antithyroid peroxidase antithyroglobulin antibodies should make you think of?

A

Hashimoto’s

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21
Q

Tx for Myxedema?

A

Levothyroxine and slow warming

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22
Q

Most common cause of hypothyroidism?

A

Post thyroidectomy with the complicatioin of Parathyroidectomy

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23
Q

Chvostek’s Sign?

A

Tap on facial nerve and get a twitch with low Ca

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24
Q

Cortical adrenal insufficency is also known as?

A

Addison’s Disease

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25
Q

Trousseau’s sign?

A

Infalte BP cuff and hold for 3 minutes. Pt with low Ca will get carpal tunnel symptoms

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26
Q

In Cushing’s is ACTH elevated or decreased?

A

Elevated

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27
Q

Breathing pattern with Diabetic Ketoacidosis?

A

Kussmaul’s

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28
Q

2 tests to rule out Cushing’s syndrome?

A

24 hour free cortisol urine test

Dexamethasome suppression test

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29
Q

2 Ectopic tumors that may produce ACTH and giva a pt Cushing’s syndrome?

A

-Small cell lung Ca
-Pancreatic islet cells
Thymomas

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30
Q

Tx for Addison’s?

A

-Hydrocortisone and Prednisone

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31
Q

Test to begin if you suspect Pheochromocytoma?

A

24 hour urine cathecholamines

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32
Q

Exopthalmosis should make you think about?

A

Hyperthyroidism

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33
Q

% of diabetics in US DM2?

A

80-90%

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34
Q

HLA-DR is the marker for?

A

DM type I

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35
Q

Main fxn of the Parathyroid hormone?

A

Increase Serum Ca

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36
Q

4 diagnostic criteria for DM

A

Random glucose > 200
Fasting Plasma > 126
Two Hour Postprandial Glucose > 200
HgAic . 6.5%`

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37
Q

Moans, groans, stones, describe sxms

A

Hyperparathyroid

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38
Q

HLA-DR gene is marker for what endocrine disorder?

A

DM type I

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39
Q

Stocking glove should make you think of?

A

Diabetic Neuropathy and B12 deficiency

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40
Q

Fruity breath should make you think of?

A

Diabetic Ketoacidosis

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41
Q

Dawn Phenomeonon?

A

Reduced insulin response between 5 and 8 am

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42
Q

Most common cause of hypopituitarism?

A

Tumor

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43
Q

How does Metformin work?

A

Decreases the hepatic glucose production and increases peripheral uptake of insulin
Euglycemic

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44
Q

How do Sulfonylureas work?

A

They stimulate the production of insulin

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45
Q

What class of meds does Pioglitazone fall into?

A

TZDs

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46
Q

Suffix for sulfonylureas?

A

-Ide Glipizide, Tolbutamide

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47
Q

What is first med typically started in T2 DM?

A

MFM

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48
Q

How often should a Diabetics Hgb A1C be checked and what should it be?

A

Every 3 months (RBC life span 120 days) should keep below 6.5%

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49
Q

What lipid med causes Flushing?

A

Niacin

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50
Q

Life threatening SE for Statins?

A

Rhabdomyolysis

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51
Q

Does Niacin increase of decrease HDL?

A

Increase

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52
Q

What class does MFM fall into?

A

Bituanide

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53
Q

Is MFM ok to use in Renal failure?

A

NO

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54
Q

Most common cause of DM1?

A

Autoimmune destruction of the Islet cells of the pancreas

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55
Q

4 PE for Cushing’s?

A

Moon face, buffalo hump, purple strai, central obesity, Supraclav fat pads, easy bruising.

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56
Q

During pregnancy which is the preffered agent for hyperthyroidism?

A

PTU

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57
Q

Preg with DM2?

A

Take off oral hypoglycemic, start insulin

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58
Q

Most common thyroid cancers?

A

Papillary

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59
Q

What heparin complication is relevant to endocrinology?

A

Adrenal infarct leading to cushing’s syndrome

60
Q

How does nicotinic acid work to affect lipid profile?

A

It inhibits the secretion of VLDL

61
Q

Hyperpigmentation of the skin along the creases should make you think of?

A

Addison’s disease?

62
Q

What thyroid cancer is most aggressive?

A

Anaplastic

63
Q

How do statins work?

A

They slow the rate limiting step of cholesterol synthesis

64
Q

QIll ACTH be elevated in Addison’s?

A

Elevated if the problem is at the adrenal glands

65
Q

C-peptide in Dx of DM?

A

Marker of Insulin production:

  • Increased: Points to DM2
  • Decreased: points to DM1
66
Q

Most common cause of Hyperthyroidism?

A

GRAVES disease

67
Q

Graves disease?

A

Formation of autoantibodies to TSH receptors and stimulate the thryoid gland to hyperfunction

68
Q

Labs with Graves?

A

Increased T3, T4 and Free T4

Decreased TSH

69
Q

First line with Graves?

A

Propanolol for symptoms (tachy, tremor, diaphoresis, anxiety and palpatations)

70
Q

What drugs are used to inhibit hormone synthesis with Graves?

A

PTUand Methimazole—:>safe in pregnancy

71
Q

No Radioactive Iodine with?

A

Pregnant pts

72
Q

Most common cause of Hypothyroidism?

A

Autoimmune Thyroiditis (HASHIMOTO’S)

73
Q

Myxedema coma (hypothyroidism precipitate by illness or trauma)

A

IV Levothyroxine

74
Q

Labs for Hypothyroidism?

A

Low: Free T4
High: TSH

75
Q

What scan will reveal if a thyroid nodule is cold?

A

Iodine-123

76
Q

Definitive Dx for a thyroid nodule?

A

Fine needle Bx

77
Q

I 131 ablation is used when?

A

when patients who have undergone a near-total thyroidectomy to destroy the remainder of the thyroid gland

78
Q

Aldosterone?

A

-Produced in the Zona Glomerulosa
Regultes sodium balance
Controlled by Renin

79
Q

Cortisol?

A

-Zona Fasciculate
Maintains physiologic integrity
controlled by ACTH

80
Q

What test is used to screen for adrenal dysfunction?

A

Dexamethasone Suppression test
Screens for Adrenal hyperfunction
Cushing’s

81
Q

Most common cause of Cushing’s?

A

ACTH-sectreting primary tumor

82
Q

SS Cushing’s?

A 
Wt gain-Buffalo hump
Ruddy complexion
Stria: Violaceous and occurring in thin skin
Prox muscle weakness
Oligomenorrhea or amenorrhea
83
Q

Best test for screening Cushing’s?

A

Dexamethasone screening test
Low am Cortisol excludes Cushing’s

Check urine free Cortisol level

84
Q

Tx for Cushing’s?

A
  • Surgical removal of tumor followed by HRT’

- Adrenal inhibitors: Metyrapoine and Ketaconazole

85
Q

Simplified Cosyntropin stimulation test with a cortisol level under 20 with positive sxms?

A

Adrenal crisis—> most common in Addisons

86
Q

Tx for adrenal crisis

A

IV saline and hydrocortisone

87
Q

Cushing’s is cause by?

A

Gluccocorticoid excess 2 to ACTH secreting PITUITARY tumor or a secondary ACTH tumor

88
Q

Secondary ACTH tumors?

A

Small cell lung cancer
endocrine tumors of foregut
pheochromocytomas
ovarian tumors

89
Q

Excessive growth hormone is called

A

Giantism if before closure of Epiphyses

Acromegaly if after closure of Epiphyses

90
Q

Most common cause of Acromegaly?

A

PITUATARY ADENOMA

91
Q

Headaches and vision problems (Hemianopia) may develop in Acromegaly because?

A

of the impingement of the optic chiasm by the tumor

Mass effect

92
Q

DX of Acromegaly?

A
  • Elevated Prolactin levels
  • After administration of glucose and elevated growth hormone is noted
  • MRI may reveal a Pituitary tumor
93
Q

What endocrine disorder are pts with Acromegaly at increased risk for?

94
Q

Transnasal, transsphenoidal surgery is used for

A

Removal of Pitiuitary tumor

95
Q

Short stature, growth curve parallel to the 5th percentile?

A

Think Dwarfism

96
Q

Mutation of FGR2 gene?

A

Think Dwarfism

97
Q

Achondroplasia?

A

Dwarfism prototype

98
Q

Diabetes Insipidus is due to?

A

Deficiency of Vasopressin 2 to hypothamic damage

99
Q

Clinical picture of Polyuria with Dehydration?

A

Check Vasopressin levels, Nephrogenic Diabetes insipidus

100
Q

Treatment of choice for Diabetes Insipidus?

A

Desmopressin Acetate is treatment of choice

May respond to HCTZ

101
Q

Prolactin inhibitory factor

A

Dopamine (PIF)

102
Q

Men with ED, gyneomastica, and decreased libido

Women with Oligomenorrhea, amenorrhea, or galactorrhea MAY have?

A

Hyperprolactinemia

Many causes: check MRI for pituitary tumor

103
Q

Treatment of choice for hyperproactemia 2 to Pituitary tumor?

A 
Dopamine agonists
-Cabergoline
-Bromocriptine
-Pergolide
Surgery if large tumors.....
104
Q

Lispro/Aspart

A

Ultra short acting

  • Onset: 5-15 min
  • Peak: 1-2 hours
  • Duration: 3-4 hours
105
Q

Regular Insulin

A

Short acting

  • Onset: 15-30 min
  • Peak: 2-4 hours
  • Duration: 5-8 hours
106
Q

NPH/Lente

A

Intermediate acting
Onset: 2-4 hours
Peak: 5-10 min
Duration: 18-24 hours

107
Q

Ultralente/Glargine?

A

Long acting anywhere from 24->30 hours

108
Q

Diabetic Ketoacidosis?

A

Due to increased Lipolysis, ketonuria, and acidosis

109
Q

What does Diabletic Ketoacidosis lead to?

A

Hyperglycemia, ketonuria and acidosis

110
Q

SS Diabetic Ketoacidosis?

A

Abd pain, N/V, tachycardia, dehydration, fruity breath odor

111
Q

Labs Diabetic Ketoacidosis

A 
Hyperglycemia: 250-1000
Ketones in blood and urine
Elevated anion gap
Metabolic acidosis PH <7.30
Electrolyte imbalances
112
Q

Tx diabetic Ketoacidosis?

A

IV fluids, regular insulin, correct elecrolytes, tx underlying cause

113
Q

What accounts for 90% of all diabetes?

114
Q

Diagnosis of DMII?

A

Sxms of DM
Random Gucose> 200
Fasting plasma glucose > 126
Two hour GTT greater >200

115
Q

Elderly person with T2DM with severe dehydration and altered mental status with severe hyperosmolarity and hyperglycemia >600 presents, think?

A

Hyperosmolar Hyperglycemic State`

116
Q

When do symptoms of hypoglycemia begin?

A

When blood sugar <60

117
Q

Impaired bran fxn when blood sugar under

118
Q

Insulinoma?

A

symptoms developing early am or after missing a meal with blurry vision, slurred speech and weakness

119
Q

What DM med is associated with Lactic Acidosis?

120
Q

Tx of Insulinoma?

A

Dextrose, surgical resection of tumor, frequent feedings, and diazoxide

121
Q

Familial Hypercholesterolemia?

A

Autosomal dominant disorder due to defective or absent LDL receptors

122
Q

Type I Triglycerides

A

Chylomicrons

123
Q

IIA Cholesterol

124
Q

IIB Cholesterol and Triglycerides

A

VLDL and LDL

125
Q

III cholesterol and triglycerides

A

Beta-VLDL and LDL

126
Q

IV Triglycerides

127
Q

V Triglycerides

A

VLDL and chylomicrons

128
Q

SS of hyperlipidemia?

A

-Xanthomas on Achilles Tendon, patellar tendon, extensor tendons of hand
High Cholesterol usu >300

129
Q

Bile Acid Agents?

A

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
Q

HMG-CoA Reductase Inhibitors?

A

Statins

  • Directly inhibits cholesterol biosynthesis
  • –:> Side effects: Myositis, Rhabdo
131
Q

Nicotinic Acid?

A

Inhibit the release of lipoproteins from the liver

SE: flushin

132
Q

What is linked to the develop of Pancreatitis?

A

Hypertriglyceridemia can be linked to SLE, DM, Uremia, Obesity, ETOH
May have s/s pancreatitis and or Xanthomas

133
Q

Familial Hypertriglyceridemia?

A

Autosomal dominant disorder

134
Q

Meds for tx of hypertriglyceridemia?

A

After lifestyle changes

—Fibric acid derivations: Gemfibrozil/Fenofibrate

135
Q

Side effects of Fibric acid derivations for Hypertryglycerides

A

Cholelithiasis and drug induced hepatitis

136
Q

Diet for DM2?

A
  • Limit cholesterol to 300 mg/day
  • Restrict saturated fats to 10% of total calories
  • Restrict sodium to 2.4 g/day
137
Q

Pregnant with Graves?

A

PTU 100 mg PO TID

138
Q

Avoid Glipizides with pts with?

A

Liver impairment

139
Q

Tachycardia/heart palpatations with a multinodular goiter?

A

I (131) Ablation

140
Q

Carbamazepine can cause?

A

Can cause SIADH

141
Q

LDL goal for a 50 year old with no cardiac complications?

A

Less than 160

142
Q

LDL goal for a 67 year old with T2DM?

A

Less than 100

143
Q

Pt with palpable thyroid mass with wt gain, fatigue, dry skin, oligomenorrhea?

A

Think Hashimoto’s Thyroiditis

144
Q

Adrenal crisis?

A

Hydrocortisone 500 mg PO

145
Q

Tx for Diabetes insipidus with ADH def?

A

Antidiuretic

146
Q

Thyroid Storm?

PANRE (14 decks)

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