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Step 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

LH/FSH deficiency in MWB

A

M: no T/no sperm/ED/lower muscle mass
F: amenorrhea
B: decreased libido/decreased body hair

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2
Q

Kallman syndrome

A

Decreased GnRH leads to decreased FSH and LH
Anosmia
Renal Agenesis in 1/2

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3
Q

2 electrolytes that inhibit ADH’s effects

A

HyperCa

HypoK

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4
Q

How do you distinguish central and nephrogenic DI

A

Central: corrects with vasopressin
Nephrogenic: responds to correction of underlying cause

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5
Q

Cause of death in acromegaly

A

CHF and cardiomegaly

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6
Q

3 tests for acromegaly

A

Initial: IGF1
Accurate: glucose suppression test
Additional: Prolactin (consecrated with GH - increase causes ED)

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7
Q

Specific acromegaly medication

A

Pegvisomant: GH receptor antagonist inhibiting IGF release from the liver

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8
Q

What other hormone changes with hypothyroidism?

A

Prolactin increases

1) low thyroid levels
2) extremely high TRH
3) prolactin secretion

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9
Q

Meds that raise prolactin level

A

Verapamil, Antipsychotics, methyl dopa, metoclopramide, opioids, TCAs

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10
Q

What do you never do first with endocrine disorders

A

MRI the head!

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11
Q

What tests do you order after confirming a high prolactin (4 + bonus)

A

TFTs
Pregnancy test
BUN/Creatinine (renal disease raises prolactin)
LFTs (cirrhosis raises prolactin)
*MRI once level confirmed + not pregnant + 2ndary causes excluded

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12
Q

3 causes of hypothyroidism

A

Hashimotos&raquo_space; iodine deficiency = amiodarone

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13
Q

What is the one process not slowed in hypothyroidism

A

Menstrual flow (actually increases)

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14
Q

If very high TSH and normal T4, how do you treat

A

Hormone replacement

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15
Q

If TSH is mildly elevated, how do you treat

A

Get antibody tests and replace thyroid hormone if they are positive

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16
Q

Thyroid abnormality tests

A

Initial: TSH

Suppressed TSH?: free T4

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17
Q

Hyperthyroidism with tender thyroid?

A

Subacute thyroid itis

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18
Q

High thyroid hormone with nonpalpable gland?

A

Exogenous use

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19
Q

Treating acute hyperthyroidism

A

Propranolol (blocks target organ effect/inhibits peripheral conversion)
MMU>PTU
Steroids (esp for eyes)

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20
Q

Next step after finding a mass on the thyroid?

A

Measure T4 and TSH (cancer is not hyper functioning)

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21
Q

What size thyroid nodule requires a biopsy

A

> 1cm needs FNA

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22
Q

Most common cause of high calcium

A

Hyperparathyroidism

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23
Q

Cardiovascular concerns with high calcium?

A

Short QT syndrome and HTN

24
Q

Treating high calcium

A

1) saline hydration
2) bisphosphonates (pamidronate, zoledronic acid)
3 if BPs fail) Calcetonin
4 if sarcoidosis) prednisone

25
Q

HyperPTH causes

A

Adenoma&raquo_space;> hyperplasia of all 4 glands&raquo_space; cancer

26
Q

High PTH presents with high calcium and…

A

Low Phopshate

27
Q

Causes of low calcium

A

Prior neck surgery&raquo_space; hypomagnesium (needed to release PTH) > renal failure

28
Q

What is the effect of low albumin on calcium

A

Decreases total calcium but free calcium stays normal (thus no symptoms)

29
Q

EKG and eye findings of low calcium

A

Long QT

Early cataracts on slit lamp exam

30
Q

Prolactin deficiency in men Sx

A

None!

31
Q

High cortisol causes

A

Pituitary acth&raquo_space;> adrenals > ectopic > unknown ACTH

32
Q

Initial test for high cortisol (1st and 2nd choices)

A

24 hour urine cortisol (more specific) > 1mg overnight dex suppression test (false positive risk)

33
Q

What is the next step if ACTH is elevated and does not suppress?

A

Brain MRI

34
Q

Why do you not start with imaging the pituitary if you suspect a cortisol issue?

A

> 10% of people have a pituitary abnormality on MRI, so you may be removing the pituitary when the Adrenals are the problem

35
Q

What tests do you order if you find an asymptomatic adrenal lesion on imaging?

A

metanephrines (rule out Pheo)
Renin/aldosterone (rule out hyperaldosteronism)
1mg overnight dex suppression test

36
Q

How does acute adrenal crisis present?

A

Profound hypoTN, fever, confusion, coma

37
Q

What is the most specific test of adrenal function

A

Cosyntropin (synthetic ACTH) –> should cause rise in cortisol if adrenals work

38
Q

How do you treat a patient with suspected acute adrenal insufficiency?

A

Hydrocortisone (and then draw cortisol level to confirm)

39
Q

Most common causes of primary hyperaldosteronism

A

Solitary adenoma&raquo_space;> bilateral hyperplasia&raquo_space; cancer

40
Q

Testing for hyperaldosteronism

A

Initial: plasma renin to aldosterone ratio
Accurate: sample venous blood from adrenal for aldosterone level

41
Q

Initial treatment of a pheochromocytoma

A

Phenoxybenzamine (alpha blocker)

42
Q

Testing for Pheo

A

Initial: plasma free metanephrines
Confirmatory: 24 hour urine metanephrines

43
Q

Diabetes dx criteria

A

2 fasting glucose levels >125
Single glucose of >200 with symptoms
Increased glucose level on oral tolerance testing
Hba1c >6.5 (best criteria to follow)

44
Q

Goal of dm treatment

A

Hba1c

45
Q

Metformin contraindication

A

Renal failure patients (can accumulate and cause metabolic acidosis)

46
Q

Sitagliptin/ -gliptin

A

DPP-IV inhibitors: block incretin metabolism (GIP/GLP) –> insulin release is inhibited and glucagon release is maintained

47
Q

Exanatide/ -glutide

A

Incretin mimetics
need to be injected
Slow gastric motility – weight loss!

48
Q

Glitazones

A

TZDs: no clear benefits, contraindicated in CHF because they increase fluid overload

49
Q

Nateglinide/ -glinide

A

Insulin stimulators

50
Q

Acarbose/Miglitol

A

Alpha glucosidase inhibitors: block glucose absorption in the bowel
Decrease hba1c by .5
Cause stomach issues

51
Q

Pramlintide

A

Amylin analog: decreases gastric emptying + decreases glucagon levels + decreases appetite

52
Q

Insulin formulations and durations

A 
Lispro/Aspart/Glulisine = peak @ 1, duration 3 hours
Regular = peak @ 2, duration 6-8
NPH = peak @ 6, duration 10-20
Glargine = peak @ 1, duration 24
53
Q

How do you best measure the severity of DKA

A

Serum bicarbonate (if low the AG is high which is bad)

54
Q

Diabetes health maintainance

A

Pneumococcal vaccine
Yearly eye exam for proliferative retinopathy
Statin if ldl is >100
ACE/ARB if BP > 140/90 or positive urine microalbumin
ASA if >30 years old
Foot exam

55
Q

How do you treat diabetes induces gastroparesis

A

Metoclopramide and erythromycin

56
Q

How do you treat diabetes induced proliferative retinopathy

A

Laser photocoagulation

57
Q

How do you treat the pain of diabetic neuropathy

A

Pregabalin/gabapentin/TCAs

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