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ACNP Certification > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Diabetic meds that cause hypoglycemia

A

Sulfonylureas(increase insulin)=glipizide, glyburide, glimiperide

Incretins (increase insulin)=byetta, januvia

Amylin analog =Pramlintide /symlin

Non-sulfonylurea insulin release(“glinides”)= Prandin/starlix

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2
Q

Other anti-diabetics side effects

A
  • Biguinides (inhibits gluconeogenesis) = metformin-, Lactic acidosis, Renal issues
  • Alpha-glucosidase inhibitors (decrease absorption in gut) =Precose, glycet - GI effects, not for Chrohns, IBS
  • Thiazolidolidinediones (decrease gluconeogenesis) =actos/avandia, heart, transaminases, bladder CA
  • Incretin mimetics (increase insulin)=byetta, januvia =pancreatitis, gastroparesis
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3
Q

Symogyi effect

A

BS down then a Surge=Symogi

tx: reduce HS insulin dose

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4
Q

Dawn effect

A

slowly rising BS, like the sun rising

tx: add or increase HS insulin dose

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5
Q

High levels of TSH = what disease?

A

Hypothyroidism

T4 may be low

T3

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6
Q

Most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

Caused by auto=immune

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7
Q

Symptoms of hypothyroidism

A

Weakness

Fatigue

cold intolerance

constipation

hair loss

brittle nails

puffy eyes, edema of hands and face

bradycardia

Hypoactive bowel sounds

Slowed DTR

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8
Q

Labs in hypothyroidism

A

Tsh high, T4 low or normal

T3 is not reliable

hyponatremia

hypoglycemia

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9
Q

Most common presentation of thyroiditis

A

Grave’s dz

autoimmune

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10
Q

High T3 and low TSH is what condition?

A

Hyperthyroidism

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11
Q

Rare cause of thyroiditis

A

Subacute thyroiditis=viral

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12
Q

symptoms of hyperthyroidism

A

Nervousness

Anxiety

sweating

weight loss

Smooth skin

fine hair

exopthalmus

tachycardia

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13
Q

Which test establishes etiology of hyperthyroidism?

A

Thyroid radioactive iodine uptake

High in Grave’s

Low in Sub-acute

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14
Q

What drug is used to tx symptoms and the mainstay tx for subacute thyroiditis?

A

Propranolol, non-cardio selective beta blocker

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15
Q

What drugs are used to treat thyroid storm?

A

Thioureas: PTU or methimazole

Lugol’s soln gtts

sodium iodine slow IV

propranolol

Hydrocortisone with fast taper to tx hypoglycemia

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16
Q

What is used to destroy goiters?

A

Radioactive iodine 131-I

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17
Q

What blood test is used to monitor PTU?

A

CBC with diff to eval for agranulocytosis

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18
Q

Tx for hypothyroidism

A

Synthroid 50-100 mcg daily

derease dose in elderly

Take 2 hrs apart from food

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19
Q

Management of myxedema coma

A

Protect airway

Fluid replacement

Levothyroxine IV (T4)

Support BP

Slow rewarming to avoid circulatory collapse with vasodilation

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20
Q

Difference between a hot nodule

and a cold nodule in thyroid issues?

A

Hot nodule produces hormone ectopically

and a cold does NOT

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21
Q

What is the most sensitive maker of thyroid function?

A

TSH

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22
Q

Adrenal cortex makes what 3 compounds?

A

Glucocorticoids=cortisol

Mineralocorticoids=Aldosterone

Androgens

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23
Q

Sodium and glucose go together

A
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24
Q

Glucocorticoid function

A

Support stress response

elevated BP

decrease inflammation

moves glucose

shedding extra fluid

increased vascular tone

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25
Q

Cushings etiology x 3 types

A

ACTH hypersecretion by pituitary tumor **most common cause

Adrenal tumors

Chronic glucocorticoids

get too much androgen and cortisol, not too much aldosterone

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26
Q

Triad of Cushing’s Labs

A

hyperglycemia

hypernatremia

hypokalemia

leukocytosis (help with healing)

plasma cortisol elevated in am

serum ACTH elevated

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27
Q

Cushing’s symptoms

A

Buffalo hump

Central obesity

Moon face

striae

hypertension

hirsutism

amenorrhea

weakness/ muscle wasting

impotence

headache

frequent infections

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28
Q

What test is used to differentiate cause of Cushing’s?

A

Dexamethasone supression test

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29
Q

Aldosterone function

A

retention of sodium and water

excretion of potassium

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30
Q

Which diseases can lead to myxedema coma?

A

Addison’s dz and hypothyroidsim

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31
Q

Cushing’s management

A

Transphenoidal resection of pituitary tumor

stop glucocorticoids

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32
Q

Adrenal insufficiency

A

Autoimmune destruction of the adrenal gland is the most common cause

Deficiency of all 3 hormones

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33
Q

Symptoms of Addison’s Dz

A

Hypotension always

Hyperpigmentation (knuckles, nipples,

scant secondary sex characteristics

fever

changes in LOC

inflammation/ joint pain

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34
Q

Triad of labs in Addison’s Dz

A

Hypoglycemia

Hyponatremia

Hyperkalemia

Hypotension

Elevated ESR due to inflammation

Lymphocytosis

Plasma coritsol <5 in am

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35
Q

TSH normal value

A

0.4-4

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36
Q

T3 normal value

A

100-200

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37
Q

T4 normal value

A

4.5-11

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38
Q

Two drugs used in out-pt treatment of Addison’s dz?

A

Glucocorticoid=hydrocortisone

Mineralocorticoid=fludrocortisone (florinef)

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39
Q

In patient managment of Addison’s dz?

A

Hydrocortisone Iv with D5NS (to replace low BS)

Treat underlying cause

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40
Q

What is a common, common cause of Addison’s dz?

A

Underlying infection such as UTI

Vasopressors are often ineffective

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41
Q

What is the am plasma cortisol level in Addison’s dz?

A

low < 5

42
Q

Addison’s symptoms

A

Orthostasis and Hypotension

Fatigue

Hyperpigmentation

Cant pubic and axillary hair

Fever, change in LOC (think myxedema coma)

43
Q

ADH retains what?

ACTH retains what?

A

ADH retains water

ACTH retains salt

44
Q

Difference between cushings and addisons?

A

Cushing’s = too much ACTH

Addisons= not enough ACTH

ACTH retains salt

NA and GLucose go together!

45
Q

Difference between SIADH and DI?

A

SIADH= too much ADH

DI= not enough ADH

ADH retains water

46
Q

Labs in SIADH

A

Hyponatremic but euvolemic

Decreased serum osmo <280

Urine Na > 20

47
Q

Common symptoms in SIADH

A

Neuro changes from low Na

Decreased DTR’s

hypothermia

weight gain/edema

cold intolerance

48
Q

Common etiology of SIADH

A

Head trauma

Tumor producing ADH

Chronic lung disease

49
Q

Common etiology of DI

A

Central

  • pituitary of hypothalamus damage-low ADH
  • trauma
  • infection
  • metastatic CA

Nephrogenic

  • defect in renal tubules causes insensitivity to the ADH
  • genetic (x -linked trait)
  • Acquired with pyelo, sickle cell, lithium toxicity

Psychogenic - drinks too much water

50
Q

DI symptoms

A

thirst

plyuria

wieght loss

fatigue

diziness

fever

tachycardia

hypotension

51
Q

Lab results in DI

A

high serum osmo >290

urine osmo < 100

urine specific gravity low <1.005

hypernatremia

increased BUN/Creat

52
Q

DI treatment

A

Na+ > 150, give D5W (free water) to replace 1/2 of volume defecit in 12-24 hrs

too fast=cerebral edema

Na+ < 150 = use 1/2 NS or NS

DDAVP=vasopressin=ADH

DDAVP 1-4 mcg IV or SQ Q 12-24 hrs

Maintenance at home DDAVP intranasally 10 mcg q 12-24 hrs

53
Q

Results of testing for differential of DI etiology

A

Vasopressin/Desmopressin challenge
given with measurement of urine

+ in central DI

  • in nephrogenic DI

If no apparent cause, MRI

54
Q

SIADH treatment

A

Treat the underlying cause

Serum NA >120 = FR x 1 L/24 hrs

Serum Na 110-120, no sx = FR 500 mL/24 hrs

Serum Na < 110 OR with sx = NS or 3% saline followed by lasix gtt

Monitor electrolytes hourly and replace

55
Q

Pheochromocytosis cause

A

Tumor of the adrenal medulla

result of chatecholamine release

56
Q

Symptoms of pheo

A

labile BP

diaphoresis

tachycardia

sweating

weight loss

postural hypotension

57
Q

Pheo diagnostics

A

TSH is normal - r/o thyroid cause

Plasma free metaphrines

Urine tests:

  • VMU
  • Chatecholamines
  • creatinine
  • metanephrines
58
Q

Treatment of pheo

A

Tumor resection

alpha-adrenergic meds pre=op (cardura/minipress)

Phentolamine: Regitine 1-2 mg IV until BP controlled, convert to phenoxybenzamine PO asap

PR=Pheo=Regitine

59
Q

Things to monitor for post-op pheo sg:

A

Hypotension

adrenal insufficiency

hemorrhage

60
Q

Anti-TPO antibodies cause what kind of thyroid dysfunction?

A

Hypothyroidism

61
Q

Pheo diagnostic in an acute crisis?

A

Use CT scan of the adrenals

Screening exam? urine tests

62
Q

Every patient with symptomatic hyperthyroidism should be on wht kind of drug?

A

Non-cardioselective BB

propranolol

63
Q

Cardinal finding in osteoporosis?

A

fractures

64
Q

Amenorrhea and headache, order what test?

A

prolactin level (posterior pituitary)

65
Q

What level do you check to see if synthroid is working?

A

TSH

66
Q

If ill and unable to eat, a patient taking insulin should do what with their am insulin dose?

A

Hold all insulin and check BS frequently

67
Q

What does serum fructosamine indicate?

A

It measures 2-3 weeks avg glucose in a pt that can’t have a HgA1C

fructose is glycosylated protein

68
Q

Low urine Na, high serum osmo, high serum Na+ is what condition?

A

DI

69
Q

TSH is down and T3 is high, free thyroxine index is increased in what condition?

A

Hyperthyroidism, Grave’s is most common

70
Q

To diagnose IDDM

A

BS> 200

Repeat x 2 FBS >126

71
Q

Normal HgA1C

A

5.5-7, like to keep pts at 6

72
Q

presence of what type of antibodies are in IDDM?

A

HLADR3, HLA-DR4

73
Q

IDDM is characterized by what finding?

A

Ketones

74
Q

What is impaired glucose tolerance?

A

FBS >100 <125

75
Q

When to start insulin?

Regimen?

A

Ketones

0.5 units/kg/day with 2/3 in morning and 1/3 evening

76
Q

Conventional split dose insulin therapy

A

morning: 2/3 reg, 1/3 NPH
evening: 1/2 reg, 1/2 NPH

77
Q

Intensive therapy

A

reduce or omit evening dose and add bedtime dose

78
Q

Name 3 insulin analogs

A

Novolog/aspart- rapid

Glargine/Lantus=Long acting

Lispro/Humalog-rapid

79
Q

Metabolic syndrome criteria

A

Waist >35 women, 40 men

HTN >130/85

Triglycerides >150

FBS >100

HDL <50 women, <40

80
Q
A
81
Q

Muscle pain in a diabetic might be seen with what drug for diabetes?

A

Metformin=Lactic acidosis

82
Q
A
83
Q

The G drugs for diabetes

A

glyburide, glipizide, glimiperide

=Sulfonylureas - increase insulin release

84
Q

Metformin

A

Biguinide

Standard of care

inhibits gluconeogenesis

85
Q

Acarbose, miglitol

A

alpha-glucosidase inhibitors - bind so less sugar is absorbed

86
Q

What category of fluid hydrates the cell?

A

1/2 NS

87
Q

Calculating an insulin gtt

A

0.1 unit/kg/hr blous followed by 0.1/units/kg/hr gtt

88
Q

What pH value is treated with bicarb?

A

<7.1

89
Q
A
90
Q

Thiazolidinediones

A

Glitazones

decrease gluconeogeneis

91
Q

Prandin, starlix

A

Non-sulfonylurea insulin relase stimulators

pill form

92
Q

Incretins

A

increase insuliln

byetta, januvia

93
Q

only drug for type 1 and 2 diabetes

A

symlin, slows absorption of glucose in gut

injectible

94
Q

Intracellular dehydration characterized by Kussmaul’s resp and ketones

A

DKA

BS >250

Metabolic acidosis

Hyperkalemia

Hyperosmolar

95
Q

Treatment for DKA

A

NS x 1 liter in first hr, then 500 mL/hr

1/2 NS if BS > 500 after 1st hr

D51/2 NS when BS < 250

Insulin gtt and bolus

96
Q

Intra cellular dehydration with BS >800-1000

A

Osmotic diuresis due to high BS

HHNK

**Normal anion gap**

97
Q

Tx for HHNK

A

NS for massive fluid replacement 6-10 L

once Na+ reaches 145, change to 1/2 NS

When BS 250, change to D51/2 NS

Insulin is 15 units reg followed by 10-15 units SQ

98
Q

Signs of hyperthyroidism

A

Anxiety

tremors

wieght loss

smooth skin

exopthalmos

hyperreflexia

tachycardia

heat intolerance

99
Q

What condition has hyponatremia and euvolemic?

A

SIADH

100
Q

Common causes of SIADH?

A

Skull fx

Trauma

Chronic lung disease

101
Q

normal serum osmo

A

280-290

102
Q

normal urine specific gravity

A

1.010-1.030

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