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WHOLE PT > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Pt has insominia, sweating, heat intolerance, and palpitations, tachycardia, wt loss?

A

hyperthyroidism

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2
Q

What are the cx of hyperthyroidism and how can they be differentiated?

A

Graves dz - autoimmune dz; has goiter + bruit and exophthalmopathy

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3
Q

How to tx hyperthyroidism?

A

1) BB
2) methimazole/PTU
3) radioiodine 131
4) surgery

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4
Q

What is gold standard for Grave dz?

A

radioactive iodine uptake scan

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5
Q

What is the active form: T3 or T4?

A

T3

T4 converts to T4

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6
Q

TSH, T3/T4 elevated or decreased in Grave dz?

A

TSH is LOW

T3/T4 is HIGH

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7
Q

What else to think about if pt has high T3/T4?

A

pregnancy

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8
Q

If pt is pregnant and has hyperthyroidism - how to tx?

A

PTU

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9
Q

Pt has fever, tachycardia, confusion, N/V/D?

A

thyroid storm

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10
Q

How to tx thyroid storm?

A

1) IV fluids
2) cooling blankets
3) glucose + Beta blockers + PTU

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11
Q

Pt has low RR, bradycardia and is in coma?

A

myxedema coma - d/t hypothyroidism (LONG UNTX)

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12
Q

Pt has trouble concentrating, bradycardia, dull expression, hyporeflexia, menstural disturbances?

A

hypothyroidism

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13
Q

How to tx hypothyroidism?

A

levothyroxine

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14
Q

Autoimmune dz of hypo/hyperthyroidism?

A

hypo: hashimoto
hyper: grave

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15
Q

TSH, T3/T4 levels in hypothyroidism?

A

HIGH TSH

LOW T3/T4

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16
Q

Pt has hx of flu last week and now has a painful thyroid gland? What to expect on labs?

A

subacute thyroiditis

low TSH and high T3/T4

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17
Q

Pt has hx of carpal tunnel sx and now has dry skin and brittle hair?

A

hypothyroidism

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18
Q

How to tx thyroiditis?

A

ASA, steroids

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19
Q

Pt has goiter + low T3/T4?

A

chronic lymphocytic thyroiditis - hashimoto (hypothyroidism)

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20
Q

How to tx chronic lymphocytic thyroiditis (hashimoto)?

A

levothyroxine

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21
Q

Pt has nodule on thyroid - what PE should you do to r/in further work up? What is the next step?

A

nodule is bigger than 1cm have pt swallow and if it doesn’t move and it’s hard –> FNA nodule
also do a thyroid scan - hot is normal BUT 5% are malginant; cold is cancer

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22
Q

What are the types of thyroid cancer and what is the prognosis?

A

papillary - good
follicular - not good
medullary - bad

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23
Q

How to tx thyroid cancer?

A

exicision
radioiodine tx
+/-chemo

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24
Q

What are the types of MEN 2 syndrome?

A

MEN 2A- parathyroid hyperplasia

MEN 2B- NO parathyroid hyperplasia

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25
Q

What are the 2 types of DI?

A
  • central: posterior pit is broken –> ADH is low

- nephrogenic: kidneys are broken –> ADH is normal/high

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26
Q

Hallmark for DI?

A

polyuria -urine is colorless
polydipsia
hypernatremia - b/c so much water is excreted

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27
Q

What is dx for DI? What would you expect for central vs. nephro? What lab can you do at the office?

A

water deprivation test
-central: serum ADH does not increase when plasma osm increase
-nephro: serume ADH does not increase when urine osm increase
UA and glucose finger
-UA will have LOW specific gravity b/c urine is dilute

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28
Q

How to tx central vs nephro DI?

A

central: desmopressin
nephro: stop meds of Lithium, steroids; no Na and use thiazide diuretics

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29
Q

Pt annual exam shows hyponatremia but NO pitting edema, what should be suspected? In this pt, what is the tx?

A

SIADH
too much ADH is produced - water is being withheld
restrict water

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30
Q

Pt is vomiting w/ diarrhea and labs show hyponatermia-how to tx? And what may this pt have (complication)?

A

hypertonic saline to correct hyponatremia but not too quickly to avoid osmotic demylination
swelling of the brain - visual changes

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31
Q

Pt has positive chvostecks sign and trousseaus sign (what are they), what EKG would you expect? What is this?

A

chvostek: tapping on facial nerve and spasms occur
trousseaus: BP cuff is tight and carpal spasms occur
ekg: QT prolongation
hypoparathyroidism

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32
Q

How to dx hypoparathyroidism?

A

high phosphate

low PTH

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33
Q

How to tx hypoparathyroidism?

A

IV Ca glyconate

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34
Q

What is hallmark for hyperparathyroidism?

A

stones -kidney stones
bones- bone aches
groans -muscle, gout, constipation
psychiatric overtones - depression, anxiety

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35
Q

Pt has polyuria, polydipsia - ddx?

A

DM

DI

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36
Q

EKG for hyperparathyroidism?

A

SHORT QT

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37
Q

What is primary vs secondary hyperparathryoidism? Tx?

A

primary: adenoma in brain - tx: bisphosphates, surgery
secondary: renal failure, or some other underlying dz-tx: surgery, Ca acetate

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38
Q

Pt has brown tumors of the jaw- what else would you expect on DEXA?

A

osteopenia d/t hyperparathyroidism (primary)

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39
Q

What are the sx for cushing sx?

A

round face
purprle straie
buffalo hump

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40
Q

What is the most common cx of cushing sx?

A

iatrogenic - steroid use

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41
Q

How to dx cushing sx?

A

24hr urine cortisol test

overnight dexamethasone suppression test

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42
Q

Which one has the hyperpigmentation: cushing sx or dz? Why?

A

cushing dz b/c of increased ACTH

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43
Q

Difference between cushing sx and cushing dz

A

Cushing dz is prob with the pit gland and needs MRI

cushing sx OUTSIDE and secondary -> chest, abdomen CT

44
Q

Pt has HA, lots of sweating, palpitation, tachycardia, sense of impending doom? Next step and what to expect as results?

A

pheochromocytoma

urine screen - metanephrine which is a breakdown product of catecholamines

45
Q

How to tx phenochromocytoma?

A

beta and alpha blocker

46
Q

How to differentiate MEN IIA and IIB?

A

both have: medullary thyroid carcinoma + pheochromocytoma
MENIIA- parathyroid carcinoma
MENIIB- mucosal neuroma (nasopharynx, oropharynx) + marfanoid body habitus (long and lanky)

47
Q

Pt is hypertensive + hypokalemia + NO EDEMA; NOT on diuretic?

A

hyperaldosteronism

48
Q

How to dx hyperalodsteronism?

A

saline infusion test

  • plasma renin activity is LOW-primary
  • plasma renin activity is HIGH - secondary
49
Q

How to tx primary hyperaldosteronism?

A

surgery

50
Q

How to tx hyperplasia hyperaldosteronism?

A

sprinolactone

51
Q

Pt has wt loss, PIGMENTATION, anorexia, abdominal pain, hypoglycemia?

A

primary adrenal insufficiency

52
Q

Cx for primary and secondary adrenal insufficiency?

A

primary: TB
secondary: abrupt stop of steroids

53
Q

How to dx Addison?

A

ACTH/corticotropin stimulation test

54
Q

What is adrenal crisis and how to tx?

A

NO cortisol and aldosterone

tx: HD cortisol, IV saline, mineralcorticoids

55
Q

In Addison is ACTH, renin, and aldosterone high or low?

A

ACTH is high
renin is high
aldosterone is low

56
Q

How to tx Addison?

A

steroids and mineralocorticoid

57
Q

Pt has high PTH, high serum Ca but low urine ca?

A

familiar hypocalcuric hypercalcemia

58
Q

What is the cornerstone management of thyroid cancer?

A

supratherapeutic doses of thyroid hormone

59
Q

What are the three congenital adrenal hyperplasia outcomes d/t deficiency? What do the babies look like?

A

most common - 21hydroxylase
11 hydroxylase
17hydroxylase
all have ambiguous genitalia

60
Q

How to dx congenital adrenal hyperplasia?

A

high 17 hydroxyprogesterone

61
Q

How to tx congenital adrenal hyperplasia?

A

cortisol and mineralocoricoid

62
Q

What is the PTH feedback?

A

25hydroxy vita D –> 1,25 dihydroxy vitD –> this increases gut absorption of Ca –> increase absorption of Ca tells PTh to decrease 1,25 dihydroxy vitD conversion in the kidney

63
Q

How to tx hypercalcemia?

A

tx w/ volume and sodium

64
Q

Bisphosphates can cause what?

A

ostenecrosis of the jaw

65
Q

Cortisol should be the highest in am or pm? What should be suspected if abnormal?

A

high in AM

66
Q

Pt is thin, with ketosis and had recent sudden dx of DMI - would you expect HLA association and are kids are risk for DM?

A

YES

kids are most likely not at risk

67
Q

How does a DMII typically present and what genetic counseling should they get?

A

obese

can be passed off to future offsprings

68
Q

How to determine if pt has Somogyi effect vs dawn phenomenon?

A

pt checks glucose level at 3a -> if elevated: dawn phenomenon and increase insulin; if low: Somogyi and reduce evening insulin

69
Q

What is happening in DMI vs DMII pts -pathophys?

A

DMI- autoimmune disorder that kills all B cells in pancreas; when you find out pt has DMI - most of B cells are gone
DMII: fat decreases glucose uptake -> insulin resistance occurs; even though B cells are there, they become desensitized to glucose -> less insulin is released

70
Q

What age are DMI pts usually dx?

A
71
Q

How to dx DM?

A

1) random plasma >200
2) fasting glucose >126 x2
3) 2hr post prandial or 75g OGTT >200
4) ha1c: >6.5

72
Q

Pt is 18yo + has recurrent yeast infxn + wt loss + fatigue + recent cold? What to other sx to expect?

A

DM
polyuria, polydipsia, numbness if severe
+/-DKA sx

73
Q

What is the tx goal of ha1c?

A

6.5

74
Q

What haps if mom has DMII?

A

premature labor

baby will be hypoglycemic

75
Q

Complication of mom having gestational diabetes?

A

can develop DMII w/in 20yrs

76
Q

What are the macrovascular complications of DM?

A

CAD
peripheral vascular ddz
cerebrovascular dz

77
Q

What are the microvascular complications of DM?

A

retinopathy
neuropathy
nephropathy

78
Q

What is BP goal for DM?

A

140/90

79
Q

How to tx HTN in DM

A

ACE/ARB
B blockers
thiazide

80
Q

When to use high dose statin?

A

DM + CVD + 10yr ASCVD risk >7.5%

81
Q

What can lead to ESRD in addition of DM?

A

htn

82
Q

How to tx nephropathy complication from DM?

A

ACE/ARB

83
Q

How to dx nephropathy in DM?

A

2 tests w/in 3-6mo

  • spot urine microalbumin
  • 24 collection for total protein: 30-300
84
Q

What are the 3 stages of retinopathy in DM? What do you see in each?

A

1) nonproliferative - macular edema, hard exudates, microanuerysms
2) proliferative - cotton wool patches, new vessels are forming
3) proliferative- retinal hemorrhaging, retinal detachment

85
Q

How to tx retinopathy DM?

A

photocoagulation
BP control
ASA -but NOT in hemorrhages

86
Q

What other eye probs can DM pts have?

A

catarcts
glaucoma
retinopathy

87
Q

Pt has DM - what should be checked at every visit to prevent complications re: neuropathy? How to check and what to advise pt?

A

feet
check w/ monofilament
tell pt to check feet everyday, make sure to check for any injuries (b/c they might not feel it), avoid dryness and cracking

88
Q

DM: What can occur if pt has injury to foot and doesnt realize?

A

ulcers –> amputation

89
Q

What other organs can get affected re: DM complications?

A

GI - constipation
impotence
CVA - stroke
bladder issues

90
Q

What to expect from DM pts w/ neuropathy?

A

stocking glove sx

91
Q

Pt had a pneumonia last week and now presents with N/V, mental status changes, and dehydration? What type of breathing would you expect and smell?

A

DKA
kussmauls respiration
fruity

92
Q

What are key lab findings for DKA?

A

glucose >450
urine: ketones -maybe absent if severe
acidosis
high B hydroxybutyrate

93
Q

How to tx DKA?

A

1) IV fluids - isotonic
2) insulin
3) K

94
Q

What to check before giving insulin in DKA? What are complications for DKA?

A

always check urine for kidney fxn

if fluids are given too quickly - cerebral edema can occur

95
Q

What are other cx of DKA?

A

missed insulin
infxn
trama

96
Q

Pt is very dehydrated with altered mental status - what is next step to r/o and r/in?

A

check for glucose: >600 (compared to DKA >450) –> hyperosmolar hyperglycemic state

97
Q

What is the main difference between DKA and hyperosmolar hyperglycemic state?

A

hyperosmolar hypeglycemic state has: NO ketosis NO acidosis (pH: 7.3)

98
Q

How to tx hyperosmolar hyperglycemic state?

A

1) fluids!

2) insulin is low dose

99
Q

What are the phases of DMII?

A

1) high insulin, low glucose
2) high insulin, norm glucose
3) norm insulin, high glucose
4) low insulin (pancreas has given out), high glucose

100
Q

Which is seen in DMI and DMII - DKA and hyperosmolar hyperglycemic state?

A

DMI-DKA

DMII- hyperosmolar hyperglycemic

101
Q

Pt has HA, tachycardia, confusion, and sweating who works in ER? What to expect from labs?

A

hypoglycemia

glucose

102
Q

When may sx of hypoglycemia not show?

A

elderly
use of Beta blockers
repeated episodes

103
Q

How to tx hypoglycemia?

A

oral glucose
glucagon injxn
IV glucose

104
Q

Pt is homeless, brought in with seizures - what to expect for labs and how to tx?

A

hypoglycemia:

105
Q

What is metabolic syndrome?

A 
bp 130/85
fasting blood sugar >100
waist circum: male 40, female 35
low hdl: male 40, female 50
triglyceride 150

WHOLE PT (19 decks)

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