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PANCE review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

define Diabetic Ketoacidosis (DKA)

A

Glucose is not available for the body to use as energy, so instead, fat is used for fuel, producing
byproducts - ketones.

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2
Q

most common Precipitating factor of DKA

A

infection, missing insulin, or unknown

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3
Q

Dehydration, Acetone smell on breath, Abdominal tenderness, Tachycardia/hypotension/shock, AMS, Kussmaul respirations and Coffee ground emesis

A

DKA

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4
Q

dx of DKA

A

Glucose level >250mg/dL

● Bicarbonate

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5
Q

management of DKA

A
  1. fluids to dilute sugars
  2. give potassium
  3. know that sodium will be falsely low
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6
Q

role of insulin in DKA

A

Start 0.1 units/kg/hr IV drip. don’t worry about returning glucose to a normal level, instead focus on stoping DKA

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7
Q

Drugs can cause glucose intolerance

A

Glucocorticoids, anti-hypertensives

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8
Q

how do you dx DM?

A

two different accounts of fasting glucose >126, or random glucose >200 + symptoms or A1C >6.5

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9
Q

is DKA an acid or base disorder

A

acidosis

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10
Q

complications of DKA therapy

A

hypoglycemia, cerebral edema!!!!!

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11
Q

Sulfonylureas

A

Squeeze-stimulate pancreas to release more insulin

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12
Q

Biguanides

A

(bite) suppress hepatic gluconeogenesis

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13
Q

Thiazolidenediones (TZDs)

A

Increases sensitivity to insulin

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14
Q

Glipizide®, Glyburide®

A

sulfonylureas

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15
Q

Actos®, Avandia®

A

Thiazolidenediones

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16
Q

Metformin®

A

Biguanides

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17
Q

SE of sulfonylureas / Glipizide®, Glyburide®

A

hypoglycemia

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18
Q

SE of biguanides / Metformin

A

GI issues and Can cause lactic acidosis

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19
Q

SE of Thiazolidenediones ( actos and Avandia)

A

hepatitis & edema

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20
Q

Incretins:

A

Hormones released by small intestine enteroendocrine cells in response to dietary glucose, delays gastric emptying.

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21
Q

names of incretins (they end in TIDE)

A

GLP-1 analogs [GLP-1 receptor agonists]):
Albiglutide (advantage: once-weekly dosing)
Exenatide (synthetic version of exendin-4 found in Gila monster saliva!; extended release version is also once-weekly dosing)
Liraglutide (advantage: once-daily dosing)

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22
Q

Main disadvantage of incretins

A

must be administered by subcutaneous injection and cause GI SE

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23
Q

● Main risks:

A

pancreatitis, thyroid C-cell tumors

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24
Q

when are incretins used

A

incretin mimetics are recommended as potential 2nd
line treatment options to add to metformin (or other agents, including insulin) in
patients not achieving glycemic goals

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25
Q

we can block the enzyme that breaks down incretins using;

A

“DPP-4 inhibitors”

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26
Q 
gliptins):
o Sitagliptin
o Saxagliptin
o Linagliptin 
what are these?
A

DPP-4 inhibitors

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27
Q

Sodium-glucose linked transporter (SGLT): effect

A

proximal tubule of the kidney

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28
Q

Dapagliflozin
o Canagliflozin
o Empagliflozin
what are these

A

Sodium glucose linked transporter, add on has 2nd of 3rd therapy with metformin

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29
Q

medications that contribute to hypercholesterolemia

A

thiazides, glucocorticoids, beta blockers

30
Q

ANY condition that results in excess thyroid hormone

A

Thyrotoxicosis (ex: Graves disease, toxic goiter, thyroiditis, medication ingestion)

31
Q

Thyroid Storm

A

A life-threatening condition that develops from untreated thyrotoxicosis induced by trauma or infection

32
Q

test findings for hyperthyroid

A

Low TSH

● Usually elevated free T3 and/or T4

33
Q

fine tremor, hypereflexia, Proptosis/Pretibial myxedema

○ Lid Lag

A

Graves (autoimmune)

34
Q

treatment of hyperthyroidism

A

Propylthiouracil/Methimazole : Blocks new hormone synthesis & Iodides: SSKI (saturated solution of potassium iodide) Blocks release of preformed hormone, must give PKU first then give iodide.

● Blunt systemic effects (medications) Beta-blocker: Propranolol (stops the conversion of T4 to T3)

○ Glucocorticoids: Prevent conversion of T4 to T3

● Prevent decompensation
○ Aggressive IV fluids
○ Dextrose containing solution (high metabolic demand)
○ Cooling blankets, ice packs
○ Acetaminophen
DON’T GIVE ASPIRIN (increases release of thyroid hormone)

35
Q

painful causes of hypothyroidism

A

Subacute thyroiditis
○ de Quervain’s
○ Pain may radiate to ear
○ Viral and self-limited

Bacterial thyroiditis
tx with antibiotics

36
Q

Thyroid Nodules management

A

FNA only 5% are cancerous

37
Q

most common thyroid cancer

A

papillary

38
Q

how do you dx

Hyperparathyroidism

A

get PTH level

39
Q

treatment of hyperparathyroidism

A 
Surgery
● Treat hypercalcemia
○ IV Fluids
○ Lasix (after fluids)
○ Bisphosphonates
○ Calcitonin (short lived)
○ Steroids
40
Q

hypoparathyroidism due to no parathyroid glands

A

DiGeorge syndrome

41
Q

tx for hypoparathyroidism

A

Calcium

● Vitamin D

42
Q

most common cause of Adrenocortical Insufficiency

A

autoimmune

43
Q

crisis Adrenocortical Insufficiency is induced due to???

A

infection, stress

44
Q

Orthostatic hypotension & Hyperpigmentation

A

addison’s dz

45
Q 
Obesity, hypertension, increased thirst
● Proximal muscle weakness is clue
● Pigmented abdominal striae
● Oligomenorrhea, amenorrhea, erectile dysfunction
● Impaired would healing, fractures
● Psychiatric symptoms
A

cushing dz ( looks like too much steroid)

46
Q

dx of cushing

A
  1. High urine cortisol

2. Overnight dexamethasone suppression test - will have high cortisol

47
Q

difference between cushing syndrome and disease

A

Disease: only high dexamethasone suppression test will decrease ACTH
Syndrome: if its an adrenal tumor, low dexamethasone suppression test will decrease ACTH

48
Q

Acromegaly/Gigantism due to too much

A

growth hormone (pituitary tumor)

49
Q

Acromegaly/Gigantism may be associated to

A

MEN syndrome

50
Q

dx of acromegaly/gigantism

A

MRI for pituitary tumor

● Prolactin, Growth hormone, Insulin-like growth factor 1 (IFG-1)

51
Q

Cushing’s disease tx

A

resection

52
Q

cushing disease syndrome tx

A

depends on size of tumor and level of cortisol

53
Q

tx of acromegaly

A

Adenoma resection
● Somatostatin for refractory cases
● Pegvisomant normalizes IGF-1 in 90% of cases

54
Q

Pituitary Dwarfism

A

lacking growth hormone–hormone replacement

55
Q

deficiency of vasopressin (ADH)

A

Diabetes Insipidus (Central) you pee a lot!!

56
Q

symptom of Diabetes insipidus

A

Intense thirst
● Craving for ice water
● Large volume polyuria
● Unremitting enuresis may be present in partial disease

57
Q

dx confirmed

A

Central DI can be confirmed with vasopressin challenge test

58
Q

Treatment

A

Desmopressin acetate

59
Q

addision crisis can be caused by

A

primary at the adrenals, secondary at the pituitary (ACTH) or tertiary at the hypothalamus (CRH)

60
Q

tx of addison’s dz

A

replacing the absent hormones (oral hydrocortisone and fludrocortisone

61
Q 
Patient has Hyperkalemia, hyponatremia Hypoglycemia
● Hypercalcemia
● Low BUN
○ Low am cortisol
● High ACTH
A

addison’s crisis

62
Q

what is cushing dz

A

Cushing’s syndrome is caused by either excessive cortisol-like medication such as prednisone or a tumor that either produces, or results in the production of excessive cortisol by the adrenal glands.

63
Q

These patients present with hypertension, hypernatremia, and hypokalemia due to the effects of aldosterone on the body.

A

primary hyperaldosterism

64
Q

As a coronary heart disease equivalent, type 2 diabetes should be managed with a goal of LDL

A
65
Q

Nocturnal spikes of ___________secretion are the most likely mechanism of the dawn phenomenon

A

growth hormone

66
Q

another name for Acantholysis is

A

Nikolsky’s sign’

67
Q

what two hormones are produced by the posterior pituitary

A

Vasopressin (ADH) and oxytocin are the hormones produced in the posterior pituitary

68
Q

the most likely diagnosis is a prolactinoma, what is the surgical procedure if medical therapy has failed

A

Trans-sphenoidal resection

69
Q

A 66 year old male that is receiving corticosteroid replacement therapy because of Addison’s disease is scheduled for a total knee arthroplasty for next week. Which of the following is the best course of action for this patient’s treatment?

A

Stress dose steroids on the day of surgery

70
Q

Rosiglitazone is a thiazolidinedione that is used to increase the body’s sensitivity to insulin’s effects. Biggest side effect?

A

Hard on liver

PANCE review (19 decks)

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