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Flashcardlet > Endocrine > Flashcards

Endocrine Flashcards

1
Q

USPSTF recommends screening for colon cancer using three different methods for which age groups?

A

Annual high sensitivity fecal occult blood testing

Sigmoidoscopy every 5 years

Colonoscopy every 10 years

Screen persons 50-75years old

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2
Q

The USPSTF guidelines recommend that asymptomatic adults with sustained blood pressure greater than 135/80mmHg be tested for

A

Type 2 diabetes using fasting plasma glucose

2-hour glucose Toler test

Or hemoglobin A1c

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3
Q

First test to be performed on a patient who presents with a palpable thyroid nodule

A

Thyroid ultrasound

TSH

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4
Q

Ultrasound can help detect clinically inapparent nodules and characteristics of cancer. What are high risk characteristics

A

Microcalcifications, hypoechogenicity, a solid nodule, a nodule more tall than wide, chaotic intranodular vasculature. fNA indicated two in a nonpalpable nodule

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5
Q

If a TSH is depressed and the ultrasound shows a solitary nodule or multinodular what test can be performed to make the diagnosis

A

Radioactive iodine uptake

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6
Q

If the nodule is hot it confirms the presence of

A

Hyperfunctioning adenoma benign no FNA

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7
Q

Increased uptake on RAIU in a diffuse heterogeneous pattern is indicative of

A

Toxic multinodular toxic goiter

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8
Q

If the TSH is normal or elevated in patient with palpable nodule what test to make diagnosis

A

Fine needle aspiration

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9
Q

An FNA positive nodule is malignant management?

A

Refer

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10
Q

A FNA negative nodule is benign, management?

A

Observe with yearly clinical and sonographic examinations

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11
Q

FNA suspicious nodule management?

A

REFER

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12
Q

Nondiagnostic FNA nodule

A

REFER

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13
Q

Thyroid nodule palpated first test to perform

A

Thyroid ultrasound

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14
Q

Thyroid ultrasound performed reveals single nodule if TSH suppressed what test makes the diagnosis

A

Radioactive iodine scan

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15
Q

Nodule with cold uptake on RAIU. Management?

A

perform FNA

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16
Q

Pt has palpable nodule. You perform thyroid ultrasound identify single nodule TSH is elevated or normal management?

A

Perform FNA

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17
Q

Palpable nodule thyroid ultrasound performed reveals multinodular goiter. TSH SUPPRESSED management?

A

Perform radioactive iodine scan -diffuse heterogeneous uptake BENIGN. FNA unnecessary

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18
Q

Patient presents with history of viral illness a few weeks prior to visit complains feeling better but then anterior neck pain/sore throat profuse sweating palpitations now exhausted and constipated. DX?

A

Subacute granulomatous thyroiditis

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19
Q

Treatment of subacute thyroiditis?

Thyroid is firm nodular and tender RAIU decreased ⬆️thyroglobulin ⬆️esr

A

Treat and reassure patient thyroid function will normalize in a few weeks

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20
Q

In hypothyroidism systemic vascular resistance increase causing ?

A

Rise in diastolic blood pressure

Other signs- ⬆️LDL cholesterol, reduced exercise tolerance

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21
Q

What is starting dose replacement once hypothyroidism is diagnosed

A

Synthetic thyroxine 1.6 mcg/kg per day

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22
Q

When should TSH be rechecked after initiating therapy

A

4-6 weeks

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23
Q

Elderly patients with diagnosis hypothyroidism should be treated at what starting dose?

A

25-50mcg/day

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24
Q

Hashimotos the most common cause of hypothyroidism is due to?

A

Antibody and cell mediated destruction of the thyroid gland

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25
Q

Patient presents slightly elevated TSH and normal T4. DX?

A

Subclinical hypothyroidism

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26
Q

Pt presents low TSH and elevated T4 scan: diffuse increased uptake most likely DX?

A

Graves’ disease

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27
Q

Female patient taking contraceptive meds presents c/o irregular menses TSH normal but total T4 elevated Why?

A

Elevated thyroid binding globulin (TBG)

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28
Q

TBG is elevated in persons with increased levels of?

A

Circulating estrogen

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29
Q

After hyperthyroidism is confirmed with TSH , what is next most appropriate test to deteriorate underlying etiology?

A

Radioactive iodine uptake scan

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30
Q

What is treatment of choice for adults with Graves’ disease?

A

Radioactive iodine ablation

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31
Q

What is treatment of choice children and adolescents with hyperthyroidism

A

Antithyroid drugs PTU, and methimazole

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32
Q

In elderly patient who becomes depressed consider?

A

Hypothyroidism CHECK TSH

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33
Q

Patients with fruity breath are ketotic and likely have DKA. These patients are usually dehydrated initial treatment?

A

Large volume IV fluid with isotonic fluids like normal saline

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34
Q

To minimize risk of cerebral edema, lowering of blood glucose should be done no faster than what rate per hour

A

80 mg/dL

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35
Q

DM is associated with autoimmune disorders like

A

Hashimotos hypothyroidism, onset usually late adolescence or childhood

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36
Q

Islet cell antibodies are found in what percentage of cases of type 1 diabetes

A

90%

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37
Q

Goals to reduce macrovascular complications in diabetics

A

LDL40 men, >50 women, triglycerides

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38
Q

Fluid deficit in DKA is often

A

6 to 8 L

39
Q

In DKA the initial fluid replacement should be

A

Normal (0.9%) saline unless severe hypernatremia

40
Q

In DKA potassium levels should be monitored frequently during initial treatment phase how?

A

Every hour at first then every 2-4 hours

41
Q

In at patient with acute DKA but otherwise organ function, serum potassium concentration is 4 to 5 mEq/L, ivf changes

A

Add 20-40mEq/L of potassium chloride to IVF

42
Q

Sulfonylurea that increases insulin sensitivity in the peripheral tissues - causes hypoglycemia in the elderly

A

Glimepiride ( amaryl

Glyburide

43
Q

Oral hypoglycemia agent that inhibits gluconeogenesis, decreases production of glucose, decrease rate of glucose absorption, and increases glucose uptake in the periphery

A

Biguanides (metformin,i.e. Glucophage

COMPLICATION lactic acidosis

44
Q

Two advantages of metformin

A

1) should not induce

2) does not promote weight gain

45
Q

Oral hypoglycemic agent decreases insulin resistance and inhibits liver gluconeogenesis

A

Thiazolidinediones like Avandia ( rosiglitazone, Actos (pioglitazone) assoc ⬆️liver enzymes, jaundice, contraindicated HF

46
Q

Nonsulfnylureas benzoic acid derivative works by stimulating insulin release from the pancreas, very short half life

A

Meglitinides like Prandin (repaglinide ) and starlix (nateglinide

47
Q

DPP-4 inhibitors like sitagliptin and saxagliptin work by

A

Increasing incretin which inhibits glucagon release thereby increasing insulin secretion through pancreatic alpha and beta cell stimulation main side effect headache, nausea

48
Q

Potent antioxidant that enhances glucose uptake and prevents glycosylation of tissues 600mg daily improves diabetic neuropathy

A

Alpha lipoic acid

49
Q

How much fish oil is required to lower triglycerides

A

4g omacor is a high quality and concentrated prescription source of omega 3 fatty acids

50
Q

This supplement has been shown to reduce progression of macular degeneration

A

Lutein

51
Q

Maximal dose of Vit A for retinal function

A

10,000 units per day

52
Q

Average insulin doses

A

0.6-0.8 units/kg of body Weight per day

53
Q

Glargine insulin is very long acting should be given

A

Once daily often in the evening or at bedtime

54
Q

How to calculate starting dose of insulin

A

Morning 2/3 total daily dose
Evening 1/3 total daily dose
Morning 2/3 intermediate, 1/3 regular
Evening 2/3 intermediate 1/3 regular

55
Q

Because of high rate recurrence initial treatment prolactinoma

A

Bromocriptine

56
Q

This level serum prolactin is almost always the result of a pituitary adenoma in the abscence of pregnancy

A

300ng/mL

57
Q

Imaging scan of pituitary gland to confirm confirm diagnosis

A

MRI with gadolinium

58
Q

Combination symptoms of gallactorrhea amenorrhea decrease libido, infertility, bitemporal hemianopsia is indicative of

A

Prolactinoma

59
Q

Acromegaly is almost always a result of growth hormone excess caused by

A

Pituitary adenoma

60
Q

Treatment of acromegaly

A

Treatment of choice- transsphenoidal pituitary microsurgery

Cabergoline, growth hormone receptor blockers like pegvisomant

61
Q

Symptoms of hyperpigmentation weakness weight loss and hypotension is indicative of

A

Addison’s disease

62
Q

Lab findings of hyponatremia, hyperkalemia, hypercalcemia, increased plasma ACTH, decreased serum cortisol are indicative of

A

Addisons disease

63
Q

Most common cause of Addison disease

A

Autoimmune destruction of the adrenal gland

64
Q

Treatment of choice Addison disease

A

Dexamethasone sodium phosphate 4 mg every 12 hours or hydrocortisone 100mg IV every 6 hours

65
Q

The chronic treatment of Addison disease

A

Combo fludrocortisone (0.05-0.3mg/day) and hydrocortisone 15-25mg/day)

66
Q

Nephrogenic ( the collecting tubules of the kidneys are unresponsive to ADH produced) diabetes insipidus is usually caused by

A

Drugs- lithium and amphotercin B

67
Q

Treatment nephrogenic diabetes insipidus

A

Stop offending drug

68
Q

Treatment central diabetes insipidus

A

Desmopressin either intranasally or orally

69
Q

Clinical signs of Conns disease

Lab signs- metabolic alkalosis,low renin,

A

Weakness, hypertension, polydipsia, polyuria, hypokalemic, , increased urine potassium

70
Q

Treatment of Conn syndrome ;primary hyperaldosteronism,is the result of excess mineralcorticoid production from a unilateral adenoma of the adrenal cortex

A

Laparoscopic removal adenoma

Or if result of bilateral hyperplasia adrenal glands- spironolactone

71
Q

Most common cause of Cushing’s syndrome is corticosteroid therapy, if yo exclude steroids most common cause

A

Pituitary adenoma

72
Q

Metastatic malignant disease is most likely to mimic

A

Hyperparathyroidism

73
Q

Recommended treatment for Cushing’s

A

Surgery to remove pituitary adenoma

74
Q

Best lab test Cushing’s

A

Serum cortisol, low dose dexamethasone suppression test ( in Cushing’s no suppression) 24h free urine cortisol
Confirm- high dose 8 mg dexamethasone suppression test ( suppresses pituitary adenoma but NOT adrenal Cushing’s)

75
Q

Renal stones most common symptomatic presentation salt pepper skull personality changes

A

Hyperparathyroidism

76
Q

Treatment of choice Graves’ disease

A

Radioactive iodine

77
Q

Drugs of choice treatment Graves’ disease

A

PTU, methimazole, beta blockers

Methimazole much safer than PTU

78
Q

PTU now second line treatment graves except

A

Pregnancy and lactation
Add 2 more pills per week
Keep below2.5

79
Q

Treatment of choice Graves’ disease during pregnancy
1st trimester?
2nd-3rd trimester?

A

1sr trimester PTU

2nd trimester switch to methimazole

80
Q

Treatment Graves’ disease if breastfeeding

A

PTU

81
Q

Most common type of thyroid cancer

A

Papillary

82
Q

For multinodular thyroid cancer more accurate test test than FNA

A

Dynamic contrast medium enhanced MRI (DCE-MRI)

83
Q

Difference between primary nod secondary male hypogonadism

A

Gonadotropin elevated primary ⬆️ LH, FSH, low testosterone no sperm count
Secondary ⬇️ gonadotropin, sperm count, testosterone

84
Q

Primary Hyperparathyroidism is most commonly caused by?

Treatment?

A

Adenoma of parathyroid

Treat with surgical parathyroidectomy

85
Q

Current guidelines recommend screening patients with stage IV chronic kidney disease for

A

Serum calcium and phosphate levels every 3-6 months and bone specific alkaline phosphatase activity every 6-12 months

86
Q

Half patients with a GFR

A

Hyperparathyroidism

87
Q

Metformin is contraindicated in patients with a creatinine level

A

Stop metformin when creatinine >1.5

88
Q

.”A 25-Year-Old Man with “Visual Problems- visual field defects,” Headaches, Weight Gain, Sweating, and “enlarging Hands and Feet

Gland?

Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
This material may be protected by copyright.

Check out this book on the iBooks Store: https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=573666697

A
  • Acromegaly a tumor in the pituitary that increases growth hormone

Pituitary

89
Q

Tumor that leads to excess prolactin, the hormone that stimulates production of breast milk? Pt presents complaints abnormal lactation, infertility, headache, decreased sexual interest

Gland?

A

Prolactinoma

Pituitary gland

90
Q

Patient with weight loss, fatigue, muscle weakness, low blood pressure

Gland?

A

Addison when the adrenal glands produce too little cortisol

Adrenal

Skinny Addison adrenal is low pressure low ?”cort “

91
Q

Patient with fluid retention, high blood pressure weak, muscle spasms

Gland?

A

Hyperaldosteronism when the adrenal glands produce too much aldosterone

Adrenal
Hyper Aldo adrenal is high pressure and spasms cause he’s holding his pee

92
Q

Patient presents with complaints of fatigue, and osteoporosis

Gland
Disorder

A

Parathyroid gland

Hyperparathyroidism is when parathyroid produces too much PTH

93
Q

Possible disorders of the adrenal gland

A

1) Addison too lit tittle cortisol
2) hyperaldosteronism
3) Cushing’s

Flashcardlet (18 decks)

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