Endocrine Flashcards
Pt has insominia, sweating, heat intolerance, and palpitations, tachycardia, wt loss?
hyperthyroidism
What are the cx of hyperthyroidism and how can they be differentiated?
Graves dz - autoimmune dz; has goiter + bruit and exophthalmopathy
How to tx hyperthyroidism?
1) BB
2) methimazole/PTU
3) radioiodine 131
4) surgery
What is gold standard for Grave dz?
radioactive iodine uptake scan
What is the active form: T3 or T4?
T3
T4 converts to T4
TSH, T3/T4 elevated or decreased in Grave dz?
TSH is LOW
T3/T4 is HIGH
What else to think about if pt has high T3/T4?
pregnancy
If pt is pregnant and has hyperthyroidism - how to tx?
PTU
Pt has fever, tachycardia, confusion, N/V/D?
thyroid storm
How to tx thyroid storm?
1) IV fluids
2) cooling blankets
3) glucose + Beta blockers + PTU
Pt has low RR, bradycardia and is in coma?
myxedema coma - d/t hypothyroidism (LONG UNTX)
Pt has trouble concentrating, bradycardia, dull expression, hyporeflexia, menstural disturbances?
hypothyroidism
How to tx hypothyroidism?
levothyroxine
Autoimmune dz of hypo/hyperthyroidism?
hypo: hashimoto
hyper: grave
TSH, T3/T4 levels in hypothyroidism?
HIGH TSH
LOW T3/T4
Pt has hx of flu last week and now has a painful thyroid gland? What to expect on labs?
subacute thyroiditis
low TSH and high T3/T4
Pt has hx of carpal tunnel sx and now has dry skin and brittle hair?
hypothyroidism
How to tx thyroiditis?
ASA, steroids
Pt has goiter + low T3/T4?
chronic lymphocytic thyroiditis - hashimoto (hypothyroidism)
How to tx chronic lymphocytic thyroiditis (hashimoto)?
levothyroxine
Pt has nodule on thyroid - what PE should you do to r/in further work up? What is the next step?
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
What are the types of thyroid cancer and what is the prognosis?
papillary - good
follicular - not good
medullary - bad
How to tx thyroid cancer?
exicision
radioiodine tx
+/-chemo
What are the types of MEN 2 syndrome?
MEN 2A- parathyroid hyperplasia
MEN 2B- NO parathyroid hyperplasia
What are the 2 types of DI?
- central: posterior pit is broken –> ADH is low
- nephrogenic: kidneys are broken –> ADH is normal/high
Hallmark for DI?
polyuria -urine is colorless
polydipsia
hypernatremia - b/c so much water is excreted
What is dx for DI? What would you expect for central vs. nephro? What lab can you do at the office?
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
How to tx central vs nephro DI?
central: desmopressin
nephro: stop meds of Lithium, steroids; no Na and use thiazide diuretics
Pt annual exam shows hyponatremia but NO pitting edema, what should be suspected? In this pt, what is the tx?
SIADH
too much ADH is produced - water is being withheld
restrict water
Pt is vomiting w/ diarrhea and labs show hyponatermia-how to tx? And what may this pt have (complication)?
hypertonic saline to correct hyponatremia but not too quickly to avoid osmotic demylination
swelling of the brain - visual changes
Pt has positive chvostecks sign and trousseaus sign (what are they), what EKG would you expect? What is this?
chvostek: tapping on facial nerve and spasms occur
trousseaus: BP cuff is tight and carpal spasms occur
ekg: QT prolongation
hypoparathyroidism
How to dx hypoparathyroidism?
high phosphate
low PTH
How to tx hypoparathyroidism?
IV Ca glyconate
What is hallmark for hyperparathyroidism?
stones -kidney stones
bones- bone aches
groans -muscle, gout, constipation
psychiatric overtones - depression, anxiety
Pt has polyuria, polydipsia - ddx?
DM
DI
EKG for hyperparathyroidism?
SHORT QT
What is primary vs secondary hyperparathryoidism? Tx?
primary: adenoma in brain - tx: bisphosphates, surgery
secondary: renal failure, or some other underlying dz-tx: surgery, Ca acetate
Pt has brown tumors of the jaw- what else would you expect on DEXA?
osteopenia d/t hyperparathyroidism (primary)
What are the sx for cushing sx?
round face
purprle straie
buffalo hump
What is the most common cx of cushing sx?
iatrogenic - steroid use
How to dx cushing sx?
24hr urine cortisol test
overnight dexamethasone suppression test
Which one has the hyperpigmentation: cushing sx or dz? Why?
cushing dz b/c of increased ACTH
Difference between cushing sx and cushing dz
Cushing dz is prob with the pit gland and needs MRI
cushing sx OUTSIDE and secondary -> chest, abdomen CT
Pt has HA, lots of sweating, palpitation, tachycardia, sense of impending doom? Next step and what to expect as results?
pheochromocytoma
urine screen - metanephrine which is a breakdown product of catecholamines
How to tx phenochromocytoma?
beta and alpha blocker
How to differentiate MEN IIA and IIB?
both have: medullary thyroid carcinoma + pheochromocytoma
MENIIA- parathyroid carcinoma
MENIIB- mucosal neuroma (nasopharynx, oropharynx) + marfanoid body habitus (long and lanky)
Pt is hypertensive + hypokalemia + NO EDEMA; NOT on diuretic?
hyperaldosteronism
How to dx hyperalodsteronism?
saline infusion test
- plasma renin activity is LOW-primary
- plasma renin activity is HIGH - secondary
How to tx primary hyperaldosteronism?
surgery
How to tx hyperplasia hyperaldosteronism?
sprinolactone
Pt has wt loss, PIGMENTATION, anorexia, abdominal pain, hypoglycemia?
primary adrenal insufficiency
Cx for primary and secondary adrenal insufficiency?
primary: TB
secondary: abrupt stop of steroids
How to dx Addison?
ACTH/corticotropin stimulation test
What is adrenal crisis and how to tx?
NO cortisol and aldosterone
tx: HD cortisol, IV saline, mineralcorticoids
In Addison is ACTH, renin, and aldosterone high or low?
ACTH is high
renin is high
aldosterone is low
How to tx Addison?
steroids and mineralocorticoid
Pt has high PTH, high serum Ca but low urine ca?
familiar hypocalcuric hypercalcemia
What is the cornerstone management of thyroid cancer?
supratherapeutic doses of thyroid hormone
What are the three congenital adrenal hyperplasia outcomes d/t deficiency? What do the babies look like?
most common - 21hydroxylase
11 hydroxylase
17hydroxylase
all have ambiguous genitalia
How to dx congenital adrenal hyperplasia?
high 17 hydroxyprogesterone
How to tx congenital adrenal hyperplasia?
cortisol and mineralocoricoid
What is the PTH feedback?
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
How to tx hypercalcemia?
tx w/ volume and sodium
Bisphosphates can cause what?
ostenecrosis of the jaw
Cortisol should be the highest in am or pm? What should be suspected if abnormal?
high in AM
Pt is thin, with ketosis and had recent sudden dx of DMI - would you expect HLA association and are kids are risk for DM?
YES
kids are most likely not at risk
How does a DMII typically present and what genetic counseling should they get?
obese
can be passed off to future offsprings
How to determine if pt has Somogyi effect vs dawn phenomenon?
pt checks glucose level at 3a -> if elevated: dawn phenomenon and increase insulin; if low: Somogyi and reduce evening insulin
What is happening in DMI vs DMII pts -pathophys?
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
What age are DMI pts usually dx?
How to dx DM?
1) random plasma >200
2) fasting glucose >126 x2
3) 2hr post prandial or 75g OGTT >200
4) ha1c: >6.5
Pt is 18yo + has recurrent yeast infxn + wt loss + fatigue + recent cold? What to other sx to expect?
DM
polyuria, polydipsia, numbness if severe
+/-DKA sx
What is the tx goal of ha1c?
6.5
What haps if mom has DMII?
premature labor
baby will be hypoglycemic
Complication of mom having gestational diabetes?
can develop DMII w/in 20yrs
What are the macrovascular complications of DM?
CAD
peripheral vascular ddz
cerebrovascular dz
What are the microvascular complications of DM?
retinopathy
neuropathy
nephropathy
What is BP goal for DM?
140/90
How to tx HTN in DM
ACE/ARB
B blockers
thiazide
When to use high dose statin?
DM + CVD + 10yr ASCVD risk >7.5%
What can lead to ESRD in addition of DM?
htn
How to tx nephropathy complication from DM?
ACE/ARB
How to dx nephropathy in DM?
2 tests w/in 3-6mo
- spot urine microalbumin
- 24 collection for total protein: 30-300
What are the 3 stages of retinopathy in DM? What do you see in each?
1) nonproliferative - macular edema, hard exudates, microanuerysms
2) proliferative - cotton wool patches, new vessels are forming
3) proliferative- retinal hemorrhaging, retinal detachment
How to tx retinopathy DM?
photocoagulation
BP control
ASA -but NOT in hemorrhages
What other eye probs can DM pts have?
catarcts
glaucoma
retinopathy
Pt has DM - what should be checked at every visit to prevent complications re: neuropathy? How to check and what to advise pt?
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
DM: What can occur if pt has injury to foot and doesnt realize?
ulcers –> amputation
What other organs can get affected re: DM complications?
GI - constipation
impotence
CVA - stroke
bladder issues
What to expect from DM pts w/ neuropathy?
stocking glove sx
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?
DKA
kussmauls respiration
fruity
What are key lab findings for DKA?
glucose >450
urine: ketones -maybe absent if severe
acidosis
high B hydroxybutyrate
How to tx DKA?
1) IV fluids - isotonic
2) insulin
3) K
What to check before giving insulin in DKA? What are complications for DKA?
always check urine for kidney fxn
if fluids are given too quickly - cerebral edema can occur
What are other cx of DKA?
missed insulin
infxn
trama
Pt is very dehydrated with altered mental status - what is next step to r/o and r/in?
check for glucose: >600 (compared to DKA >450) –> hyperosmolar hyperglycemic state
What is the main difference between DKA and hyperosmolar hyperglycemic state?
hyperosmolar hypeglycemic state has: NO ketosis NO acidosis (pH: 7.3)
How to tx hyperosmolar hyperglycemic state?
1) fluids!
2) insulin is low dose
What are the phases of DMII?
1) high insulin, low glucose
2) high insulin, norm glucose
3) norm insulin, high glucose
4) low insulin (pancreas has given out), high glucose
Which is seen in DMI and DMII - DKA and hyperosmolar hyperglycemic state?
DMI-DKA
DMII- hyperosmolar hyperglycemic
Pt has HA, tachycardia, confusion, and sweating who works in ER? What to expect from labs?
hypoglycemia
glucose
When may sx of hypoglycemia not show?
elderly
use of Beta blockers
repeated episodes
How to tx hypoglycemia?
oral glucose
glucagon injxn
IV glucose
Pt is homeless, brought in with seizures - what to expect for labs and how to tx?
hypoglycemia:
What is metabolic syndrome?
bp 130/85 fasting blood sugar >100 waist circum: male 40, female 35 low hdl: male 40, female 50 triglyceride 150
