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Step 2 CK > Endocrine > Flashcards

Endocrine Flashcards

1
Q

LH/FSH deficiency manifestation in men/women

A

LH/FSH Men: No sperm/testosterone so decrease libido, body hair, ED, and decreased muscle mass.
LH/FSH Women: No ovulation/menstruate normally and become amenorrheic

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2
Q

Children vs. Adults GH deficiency presentation?

A

Children-short stature/dwarfism

Adults-Central obesity, increased LDL+cholesterol, reduced lean muscle mass

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3
Q

Electrolyte finding in panhypopituitarism?

A

Hyponatremia

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4
Q

Blood test: Low TSH/thyroxine

Abnormality confirmed with?

A

Decreased TSH response with TRH

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5
Q

Blood test: Low ACTH/Cortisol

Abnormality confirmed with?

A
  • Normal response to cosyntropin stimulation of adrenal.
  • Cortisol will rise (adrenal is normal) in recent disease, but abnormal in chronic disease because of adrenal atrophy.
  • No response to ACTH to TRH
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6
Q

Blood test: Low FSH/LH

Abnormality confirmed with?

A

No confirmatory test

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7
Q

Blood test: GH level low

Abnormality confirmed with?

A

-No response to arginine infusion or GHRH

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8
Q

Blood test: Prolactin level low?

Abnormality confirmed with?

A

-No response to TRH

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9
Q

Two electrolyte abnormalities that can cause nephrogenic diabetes insipidus?

A

Hypercalcemia, hypokalemia. Inhibit ADH effect on kidney

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10
Q

Electrolyte complication of diabetes insipidus?

A

Hypernatremia; secondary to high-volume urine and volume depletion.

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11
Q

Test to differentiate CDI vs. NDI?

A

Desmopressin stimulation

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12
Q

Treatment CDI vs. NDI

A

CDI-Desmopressin

NDI-Correct underlying cause; NDI also responds to HCTZ, amiloride, and prostaglandin inhibitors such as NSAID

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13
Q

Most common malignancy with acromegaly?

A

Colon cancer; growth of underlying colonic polyp

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14
Q

Best initial/most accurate acromegaly?

A

Best initial-IGF-1

Most accurate-Glucose suppression test (should normally suppress GH levels)

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15
Q

Tx. acromegaly

A

1) Surgery (trans-sphenoidal resection of pituitary)
2) Medication
- Cabergoline (Dopamine agonist that inhibit GH release)
- Octreotide/lanreotide (Somatostatin inhibit GH release)
- Pegvisomant (GH receptor antagonist, inhibits IGF release from liver)

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16
Q

Why is prolactin tested with GH?

A

Both cosecreted.

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17
Q

What Ca2+ blocker raises prolactin?

A

Verapamil

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18
Q

What drugs increase prolactin?

A
  • Antipsychotic
  • Methydopa
  • Metoclopromide
  • Opioids
  • TCA
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19
Q

Men/Women presentation of hyperprolactinemia?

A
  • Men-decreased libido, ED (secondary to inhibition of FSH/LH)
  • Galactorrhea, amenorrhea, and infertility (secondary to inhibitor of FSH/LH)
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20
Q

4 test for hyperprolactinemia?

A

1) Thyroid function (hypothyroid leads to increased prolactin)
2) Pregnancy test
3) BUN/creatinine (kidney disease increases prolactin)
4) LFT (cirrhosis elevates prolactin)

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21
Q

Tx. hyperprolactinemia

A

1) Dopamine agonists (cabergoline better than bromocriptine)
2) Transphenoidal surgery
3) Radiation is rare

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22
Q

Management of very high TSH (more than double upper limit of normal) vs. high TSH (less than double upper limit of normal)

A

Very high-Replace hormone

High-1) Antithyroid peroxidase/antithyroglobulin antibodies; if positive than replace!

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23
Q

which disease only has TSH receptor antibodies?

A

Graves

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24
Q

Treatment

Graves, subacute thyroiditis, painless thyroiditis, exogenous TH use, and pituitary adenoma?

A
  • Graves w/ radioactive iodine
  • Subacute thyroiditis w/ aspirin
  • Painless thyroiditis w/ NOTHINg
  • Exogenous TH w/ stop doing it
  • Pituitary adenoma w/ surgery
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25
Q

Tx. graves ophthalmopathy?

A

Steroids

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26
Q

Tx. thyroid storm

A

1) B-blocker
2) Methimazole>PTU
3) Steroids (decrease peripheral T4–>T3 conversion)
4) Iodinated contrast (blocks peripheral conversion of T4 to more active T3 and blocks release of existing hormone)

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27
Q

Workup of thyroid nodule

A

1) Perform thyroid function tests (TSH, T4)

2) If tests are normal and >1 cm size, biopsy the gland!

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28
Q

Tx. acute hypercalcemia?

A

1) Saline hydration
2) Bisphosphonates: pamidronate, zoledronic acid
3) Calcitonin (good for acute symptomatic hypercalcemia not responsive to first 2 options via osteoclast inhibition)

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29
Q

How do you differentiate Primary hyperparathyroid causing hypercalcemia vs. familial hypocalciuria hypercalcemia causing hypercalcemia?

A

calcium/Creatinine clearance

0.02 in Primary Hyperparathyroid and 0.01 in FHH

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30
Q

Best test for bone effects of high PTH?

A

DEXA densinometry

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31
Q

Tx. Primary hyperparathyroid?

A

1) Surgical removal STANDARD OF CARE of involved parathyroid

2) When surgery not possible, cinacalcet (allosteric activator of calcium sensing receptor)

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32
Q

3 major causes of hypocalcemia?

A

1) Mistaken prior parathyroid removal with neck surgery
2) Hypomagnesemia–>decreased PTH release and can also lead to more urinary loss with low Mg levels
3) Renal failure (decreased conversion of 25 OH vit D–>1,25 OH vitamin D)

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33
Q

What is hypoalbuminemia correction with regards to calcium

A

For every 1 point decrease in albumin, calcium drops 0.8

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34
Q

Best initial test to determine presence of hypercortisolism?

A

24 hour urine cortisol or 1 mg overnight dexamethasone suppression

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35
Q

Best initial test to determine cause (source) or location of hypercortisolism?

A

ACTH testing

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36
Q

What do you do if MRI does not show a clear pituitary lesion?

A

Petrosal venous sinus sampling and check ACTH

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37
Q

What tests do you need to do if you randomly came across an asymptomatic adrenal lesion on CT scan?

A

1) 24 hour urine metanephrines
2) 1 mg overnight dexamethasone suppression
3) Renin and aldosterone levels to exclude hyperaldosteronism

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38
Q

At what dose is it risky to suddenly stop prednisone?

A

Daily prednisone>20 mg taken for >3 weeks

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39
Q

Patient on chronic steroids undergoes surgery. What is critical to prevent acute adrenal crisis?

A

Perioperative stress dose of glucocorticoids

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40
Q

Electrolytes and acid/base status in hypercortisolism?

A

Electrolytes-Hypokalemia and metabolic alkalosis and hypernatremia. Hyperglycemia and hyperlipidemia also present.

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41
Q

Electrolytes and acid/base status in hypocortisolism (eg addisons)?

A

Electrolytes-Hyponatremia, hyperkalemia, metabolic acidosis. Hypoglycemia also present.

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42
Q

Most specific test for adrenal function?

A

Cosyntropin (synthetic ACTH) test

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43
Q

Which steroids to you use for adrenal insufficiency (addison)?

A
  • Replace with hydrocortisone
  • Fludrocortisone useful if patient has evidence of postural instability b/c of mineralcorticoid of aldosterone like effect
44
Q

Testing for adrenal insufficiency?

A

1) Cosyntropin stimulation
2) If cortisol fails to rise, ACTH level?
- low cortisol and high ACTH–>primary (addison)
- Low cortisol and low ACTH –> secondary (glucocorticoids)

45
Q

Best initial test/most accurate for primary hyperaldosteronism?

A

Best initial-Plasma aldosterone/plasma renin (increased aldosterone, low renin)
Most accurate-Venous blood draining adrenal (increase aldosterone level)

46
Q

What test should you never start with in endocrinology?

A

Scan

47
Q

Tx. of primary hyperaldosteronism?

A

Unilateral adenoma resected via laparoscopy

Bilateral adenoma-eplerenone or spironolactone

48
Q

Tx of pheochromo?

A

Phenoxybenzamine (alpha blocker) before Ca2+ blocker/B-prior to B-blocker

49
Q

3 tests used to defined diabetes?

A

1) 2 FBG readings >125
2) Single >200 w/ symptoms (eg polyuria, polyphagia, polydipsia)
3) HbAlc>6.5

50
Q

How does wt. loss affect DM and insulin?

A

Wt loss–> less adipose–> less insulin resistance b/c decreased insulin needed for decreased adipose

51
Q

MOA DPP-IV inhibitors (sitagliptin, saxagliptin, linagliptin, alogliptin)?

A

Block incretin (increased insulin release and decrease glucagon release from pancrease) METABOLISM.

52
Q

What are names of incretins?

A

Glucose-insulinotropic peptite (GIP) and glucagon-like peptide (confusing because it actually suppresses glucagon)

53
Q

DPP-IV inhibitors/Incretin mimetics side effect?

A

slow down GI motility. Incretin mimetics also help DECREASE WEIGHT!!

54
Q

Side effect of glitazones (eg thiazoladinediones)?

A

Contraindicated in CHF because they increase fluid overload?

55
Q

Looking for drug with similar MOA to sulfonlyurea but patient has sulfa allergy?

A

Nateglinide and repaglinide

56
Q

Alpha glucosidase inhibitors MOA?

A

Block glucose absorption in bowel. So can cause flatus, diarrhea, and abdominal pain.

57
Q

Pramlintide MOA?

A

Analog of protein called amylin that is secreted normally with insulin. Amylin decreases gastric emptying, decreases glucagon levels and decreases appetite

58
Q

What electrolyte is used to determine the severity of metabolic acidosis?

A

bicarbonate .

59
Q

Health maintainence diabetes?
Meds?
Vaccine?
Exam?

A

Aspirin >30
Statin >70 LDL
ACEi (BP>130/80 or urine positive for microalbuminuria)
Vaccine-Pneumococcal
Exam-Eye exam, foot exam for neuropathy and ulcers

60
Q

Tx. for gastroparesis as complication of DM?

A

Metoclopramide and erythromycin

61
Q

Tx. for neuropathy that causes pain?

A

Pregabalin, gabapentin, TCA

62
Q

Difference in DKA and hyperosmolar hyperglycemic state in terms of symptoms??

A

DKA-MORE hyperventilation and abdominal pain along with more rapid onset of hyperglycemic symptoms. LESS prounounced altered mentation. Increased anion gap (

63
Q

When can you switch fluids from 0.9% NS to 0.5% dextrose?

A

Serum glucose

64
Q

When can you switch from IV to SQ (basal bolus insulin)?

A

1) Patient able to eat

2) Glucose 15

65
Q

When do you add potassium vs hold insulin if potassium is too low?

A

IV potassium if serum K

66
Q

When should you consider replacing HCO3-?

A

pH

67
Q

Which are best markers indicating resolution of DKA?

A

Serum anion gap and B-hydroxybutyrate levels

68
Q

Adverse effects thionamides (eg methimazole, PTU)?

A

Both-Agranulocytosis
Methimazole-1st semester teratogen, cholestasis
PTU-Hepatic failure, ANCA-associated vasculitis

69
Q

What dz you treat with radioiodine ablation and what are side effects?

A

Graves; side effects include permanent hypothyroidism and possible worsening of ophthalmopathy and possible radiation side effects

70
Q

2 ways to differentiate toxic adenoma vs. graves?

A

1) No ophthalmopathy

2) Radioiodine uptake in only one are of nodule

71
Q

What unique lab value may be elevated and be asymptomatic in patients with hypothyroidism?

A

Creatine kinase

72
Q

What is euthyroid sick syndrome?

A

Fall in total/free T3 levels, with NORMAL levels of T4 and TSH. Due to decreased peripheral 5’-deiodination of T4 due to caloric deprivation, elevated glucocorticoid and inflammatory cytokine levels

73
Q

When is parathyroidectomy indicated for hypercalcemic patients?

A

A) symptomatic (eg bones, groans, stones, psych overtone)

B) Age 1 above upper limit normal, DEXA 250)

74
Q

Best initial/most accurate test for GH levels?

A

Best initial: IGF-1

Most accurate: 75 g oral glucose load (still shows increased serum GH levels)

75
Q

What asymptomatic patients need screening for diabetes?

A

1) Sustained BP >135/80
2) All patients >45
3) ANY age with additional risk factors (eg physical inactivity, first degree relatives, women whose child >9 lb. hx gest dm, HTN, PCOS, dyslipidemia)

76
Q

3 derangements leading to formation of diabetic foot ulcers?

A

1) Neuropathy
2) Microvascular insufficiency
3) Relative immunosuppression

77
Q

What are criteria for metabolic syndrome and how many needed?

A

1) Abdominal obesity (Men>40, Women>35)
2) FBG>100-110; insulin resistance typical
3) BP>130/80
4) Triglycerides>150
5) HDL (

78
Q

clinical electrolyte feature of primary polydipsia?

A

Serum Na

79
Q

Desmopressin effect on osmolality if patient has CDI?

A

Urine osmolality >50% increase

80
Q

Best screening test for virilizing neoplasm?

A

Serum testosterone and DHEAS b/c helps delineate site of excess androgen production!

  • Elevated testosterone and normal DHEAS-ovarian source
  • Elevated DHEAS and normal testosterone-adrenal source
81
Q

What happens to alkaline phosphotase, PTH, calcium and phosphorum in osteomalacia?

A

Increase ALP/PTH, decrease calcium and decrease phosphorus

82
Q

Diagnosis paget disease?

A

Elevated ALP, normal gamma-glutamyl transpeptidase. Ca2+, phosphorus, PTH all NORMAL.

83
Q

Tx. paget disease?

A

Bisphosphonates

84
Q

What is hypercalcemia due to immobilization?

A

Iincreased osteocalstic bone resportion increased risk with immobilized patinets

85
Q

How you differentiate hypercalcemia of malignancy vs. PTH hypercalcemia?

A

Hypercalemia of malignancy generally have much higher (>13 mg/dL)!!

86
Q

3 common causes of hypocalcemia?

A

1) Neck surgery
2) Low Mg2+ (especially in alcoholics)
3) CKD (decreased conversion to 125OHvit d)

87
Q

Why will vit. D deficiency have low calcium and low phosphate?

A

Because vit D mediates absorption of both

88
Q

PCOS diagnostic criteria?

A

Need 2 of 3

1) Androgen excess: biochemical or clinical (hirsutism, acne, androgenic alopecia)
2) Oligo or anovulation
3) PC ovaries on US>12 follicles

89
Q

PCOS tx?

A

1) Wt. loss
2) Combined OCP
3) Clomiphene citrate
4) Metformin for coexisting DMII

90
Q 
Leydig cell tumor findings?
Choriocarcinoma finding?
Teratoma finding?
Seminoma finding?
Yolk sac (endodermal sinus tumor) finding?
A
  • Increased estrogen/testosterone
  • Increase B-hCG
  • AFP and/or B-hCG elevation
  • Elevated B-hCG
  • Elevated Serum AFP
91
Q

Patient with preexisting Hashimoto thyroiditis at increased risk for what?

A

Thyroid lymphoma

92
Q

Skin side effect of systemic/topical corticosteroids?

A

Acneiform eruption characterized by monomorphous follicular papules in absence of comedones

93
Q

What decreases levothyroxine absorption?

A

Bile acid resins (eg cholestyramine), iron, calcium, aluminum hydroxide, PPI, sucralfate

94
Q

What increases TBG concentration?

A

Estrogen (oral), tamoxifen, raloxifen, heroin, methadone

95
Q

What decreases TBG concentration?

A

Corticosteroids, androgens, anabolic steroids, slow-release nicotinic acid

96
Q

What increases thyroid hormone metabolism?

A

Rifampin, phenytoin, carbamazepine

97
Q

Patients with positive RET oncogene in setting of MEN undergo what?

A

Total thyroidectomy

98
Q

What do you need to check when patients come to hospital with new onset AFIB?

A

TSH

99
Q

Short term (acute) vs. long term (curative) hyperthyroid treatment?

A

Short-term–>Methimazole/PTU

Long-term–>Radioactive iodine ablation; surgery preferrred in pregnant

100
Q

MCC hypoadrenalism

A

Secondary (iatrogenic) because of steroid tx.

101
Q

Symptoms of McCune-Albright syndrome in females?

A

1) Ovarian cysts, pseudoprecocious puberty, polyostotic fibrous dysplasia of bone, and cafe au lait spots.

102
Q

Goals of treatment in terms of glucose levels?

A

Postprandial levels

103
Q

What measures can be done to prevent ARF from contrast in patients with diabetes/renal insufficiency?

A

1) Hydrate patient well

2) Acetylcysteine and bicarbonate (may decrease risk of contrast induced nephropathy)

104
Q

What is somogyi effect?

A

Body rxn to hypoglycemia. Too much NPH at dinnertime, so glucose level at 3 AM next morning will be low and body reacts to hypoglycemia with stress hormones that cause high glucose at 7 AM

105
Q

What is dawn phenomenon?

A

Hyperglycemia from normal GH secretion in morning. Glucose is high at 7 AM and normal or high at 3 AM so trick is to increase evening (NPH) insulin.

106
Q

What is risk of giving B-blocker to diabetic?

A

May mask classic symptoms of hypoglycemia (tachycardia, diaphoresis) which are caused by catecholamine release

107
Q

First treatment DM2

A

Wt loss

Step 2 CK (16 decks)

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