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Step 2/Level 2 > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

Diagnostic criteria for DM?

A
  • Random >200 with symptoms
  • Fasting >126
  • 2 hour (75g) oral glucose tolerance test >200
  • Hemoglobin A1c >6.5%
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2
Q

What antibodies can you check for DM1?

A
  • anti-insulin antibodies (IAA)
  • anti-islet cell cytoplasm antibodies (ICA)
  • Anti-glutamic acid decarboxylase antibodies (GAD)
  • anti-tyrosine phosphatase antibodies
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3
Q

What is the endpoint for IV insulin treatment in DKA?

A

When the anion gap closes

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4
Q

What is the endpoint for IV insulin treatment in HHS?

A

when the high plasma osmolality returns to normal (normally >320 in HHS)

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5
Q

What is the serum potassium level in a patient presenting with DKA? Why?

A

-it appears high 2/2 shifts from the acidemia but is actually low.

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6
Q

What is the recommendation for statin therapy in diabetics?

A
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7
Q

What is the treatment for proliferative diabetic retinopathy?

A

-photocoagulation

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8
Q

Who should you not give TZDs (esp pioglitazone) to?

A

patients with heart failure –> causes issues with fluid balance

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9
Q

Risk of metformin?

A

lactic acidosis.

do not use in renal failure

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10
Q

How do sulfonylureas work? (Glipizide, Glimepiride, Glyburide)

A
  • Increase insulin release from the beta cells

* can cause hypoglycemia

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11
Q

MOA of the GLP-1 agonists? (Eventide, liraglutide, dulaglutide, albiglutide)

A

Delayed gastric emptying –> lots of GI SEs

can cause weight loss

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12
Q

MOA of acarbose? SE?

A

blocks absorption of carbs in the intestine–> increased excretion in stool
-Lots of GI SE (diarrhea, flatulence, etc)

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13
Q

DM Medication that increases tissue glucose uptake and improves insulin sensitivity?

A

TZDs (-glitazones)

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14
Q

DM Medication that inhibit DPP-4?

A

–gliptins

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15
Q

DM Medications that mimics GLP-1?

A 
--glutides 
Exenatide
Liraglutide
Dulaglutide
Albiglutide
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16
Q

DM Medication that should not be used in renal dysfunction?

A
  • SGLT2 inhibitors (-flozins)

- metformin

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17
Q

DM medication that is OK in mild to moderate renal disease?

A
  • TZDs (-glitazones)

- DPP-4 inhibitors (-gliptins)

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18
Q

DM med that can cause hypoglycemia?

A

Sulfonylureas (Glipizide, Glyburide, Glimepirid)

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19
Q

Mechanism of action of gastric bypass?

A

-malabsorption and restriction

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20
Q

What is Whipple’s triad?

A
  • Sx of hypoglycemia

- low plasma glucose (

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21
Q

How can you differentiate an insulinoma from sulfonylurea use?

A
  • both will have high insulin, high c-peptide and high pro-insulin
  • sulfonylurea screen only + in sulfonylurea use
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22
Q

What is reactive hypoglycemia? How do you test for it?

A
  • excessive insulin production in response to the amount of BG present–> normally 1-3 hours after a high carb meal
  • Can do a mixed meal tolerance test to see if you can induce hypoglycemia
  • can be seen in gastric bypass patients (who are used to over-producing insulin)
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23
Q

What is alcohol-induced hypoglycemia? What care should be taken in the treatment of hypoglycemia in an alcoholic?

A
  • decreased gluconeogenesis 2/2 NADPH being depleted to metabolize EtOH.
  • Make sure to give thiamine before glucose to alcoholics to prevent Wernickes
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24
Q

Hypothyroidism with a painless goiter?

A

Hashimoto’s thyroiditis

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25
Q

Antibodies in Hashimoto thyroiditis?

A

antithyroglobulin and antimicrosomal

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26
Q

Thyroid disorder that increases risk of B-cell lymphoma of the thyroid gland?

A

Hashimotos

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27
Q

Hypothyroidism with a painful goiter?

A

-Subacute thyroiditis (AKA De Quervian and Granulomatous thyroiditis)

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28
Q

Young patient with fixed, hard, rock-like painless thyroid with either euthyroid or hypothyroidism?

A

Riedel’s thyroiditis (chronic inflammation leads to replacement with fibrous tissue)

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29
Q

Meds that can cause hypothyroidism?

A

Lithium, amiodarone, tyrosine kinase inhibitors (imatinib)

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30
Q

Neonate with lethargy, poor feeding, thick, protruding tongue, constipation, umbilical hernia, moderate to severe intellectual disability?

A

Congenital hypothyroidism

Inc TSH and dec T3/T4 soon after birth

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31
Q

How can hypothyroidism affect lipids?

A

Increase LDL and total cholesterol

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32
Q

Radioiodine uptake study for subacute thyroiditis?

A

Low uptake

33
Q

How does thyroid function tests change with pregnancy?

A
  • mildly decreased TSH
  • increased total T4
  • normal free T4 (increase in thyroid binding globulin)
34
Q

What two iatrogenic sources of iodine might cause thyrotoxicosis?

A

Amiodarone

IV contrast dye

35
Q

Thyroid nodule US characteristics that are concerning for malignancy?

A
  • hypoechoic
  • irregular margins
  • microcalcificaitons
  • taller than wide
36
Q

Most common thyroid cancer? Tx?

A

Papillary

-surgical +/- lymph node dissection +/- radiation

37
Q

Which thyroid cancer can spread hematogenously?

A

Follicular

38
Q

Cancer of the parafollicular C cells? What does the patient need to be screened for before surgery?

A
  • Medullary carcinoma

- screen for pheochromocytoma (risk for MEN II Syndrome)

39
Q

What blood test can you follow to determine remission of medullary carcinoma?

A

-calcitonin levels

40
Q

Elderly patient with a rapidly growing, rock-hard thyroid?

A

Anaplastic carcinoma

41
Q

Hoarseness after thyroidectomy?

A

Damage to the recurrent laryngeal nerve

42
Q

What are the indication for surgical paratyroidectomy in primary hyperparathyroidism?

A
  • symptoms of hypercalcemia
  • Serum calcium >1.0 above normal
  • creatinine clearance
43
Q

Most common cause of secondary hyperparathyroidism?

A

Chronic renal disease

44
Q

Autosomal dominant GNAS1 gene mutation with maternal imprinting causes what?

A

pseudohypoparathyroidism –> decreased responsiveness of the PTH receptors
-“Albright’s hereditary osteodystrophy (AHO)”

45
Q

Short stature, shortening of the 4th metacarpal, developmental delay, obesity, hypocalcemia (only in females)?

A

Albright’s hereditary osteodystrophy (AHO)
==> pseudohypoparathyroidism
-Low Ca2+, High PTH, High Phosphate (PTH Rs not working)

46
Q

High PTH, high calcium, low phosphate, normal vitamin D?

A

primary hyperparathyroidism

47
Q

Vit D deficiency labs?

A

low vitamin D, high PTH, low calcium, low phosphate

48
Q

High PTH, low calcium, high phosphate, low 1,25 vitamin D?

A

Secondary hyperparathyroidism (2/2 renal disease)

49
Q

Low 1,25 vitamin D, low PTH, low calcium, high serum phosphate?

A

Hypoparathyroidism

50
Q

High PTH, low calcium, high phosphate?

A

pseudohypoparathyroidism

51
Q

What other endocrine disorder can lead to hyperprolactinemia?

A

hypothyroidism

52
Q

Bitemporal hemianopia?

A

can occur 2/2 pituitary tumor (esp prolactinoma)

53
Q

What is the first line in the treatment of a prolactinoma?

A

Cabergoline > bromocriptine (DA agonist)

54
Q

How does acromegaly present different in children?

A

Get gigantism because their growth plates have not closed yet

55
Q

How do you screen for acromegaly?

A

IGF-1

56
Q

What test is done to confirm diagnosis of acromegaly?

A

Oral glucose suppression test.

glucose should suppress GH but if it doesn’t –> acromegaly

57
Q

Tx for a non-resectible GH adenoma?

A

Somatostatin analog –> inhibits GH secretion

58
Q

Postpartum patient with hemorrhage and hypotension that then can’t lactate, weight loss, lethargy?

A

Sheehan syndrome (low levels of all hormone)

59
Q

Most common symptom of hyperprolactinemia?

A

hypogonadism

60
Q

2yo with painless rectal bleeding?

A

Meckel’s diverticulum

61
Q

What tests can be used to diagnose Cushings?

A
  • 24 hour urinary cortisol
  • late-night salivary cortisol
  • dexamethasone suppression test
  • need 2 abnormal tests*
62
Q

How do you perform inferior petrosal sinus sampling?

A

a sample of blood is taken from the inferior petrosal sinus and compared to the rest of the body…if there if an elevated level of ACTH from the inferior petrosal sinus compared to the other locations, it is likely a pituitary adenoma

63
Q

High dose dexamethasone will suppress ACTH from which location?

A

a pituitary source.

-ectopic sources are likely from cancers and will not respond to anything because cancer does what it wants

64
Q

Hypertension, hypokalemia, metabolic alkalosis?

A

hyperaldosteronism

65
Q

suspected patient with Cushing’s. Low dose dexamethasone does not decrease the morning cortisol. What is the next best step?

A

ACTH level

66
Q

Cushing disease refers to excess cortisol production from what source?

A

Pituitary adenoma

67
Q

Most specific lab finding for primary hyperaldosteronism?

A

high aldosterone: renin ratio

68
Q

What type of adrenal insufficiency is associated with increased skin pigmentation?

A

Primary adrenal insufficiency. Addisons. 2/2 elevated ACTH precursor (POMC) and inc MSH

69
Q

What test can you use for Addison disease?

A

-Cosyntropin test (in addison, cortisol will not rise with administered cosyntropin like it should)

70
Q

Tx for Addisons? Does it differ for secondary or tertiary adrenal insufficiency?

A
  • Addison: glucocorticoid and mineralocorticoid and inc stress steroids
  • secondary: only glucocorticoid
71
Q

HTN, and ambiguous genetalia in girls?

A

11-beta hydroxylase deficiency

72
Q

Hypotension, salt wasting (low Na+. high K+), virilization in girls?

A

21 alpha hydroxylase deficiency

73
Q

HTN, ambiguous genetalia in boys?

A

17 alpha hydroxylase deficiency

74
Q

What is the short cut to congenital adrenal hyperplasia?

A
  • if the first digit is a 1, there will be HTN

- If the 2nd digit is a 1, there will be virilization./masculinization (increase in androgens)

75
Q

What meds do you give for a pheochromocytoma prior to surgery?

A
  • alpha blocker (phenoxybenzamine) then beta blocker

- OR can give a beta blocker with weak alpha blocking effects (carvedilol and labetalol)

76
Q

Parathyroid, pituitary and pancreas tumors?

A

MEN1 (3Ps)

77
Q

Parathyroid, pheochromocytoma, Medullary thyroid cancer?

A

MEN2A (PPM)

78
Q

Pheochromocytoma, Medullary Thyroid Cancer, Mucosal Neuromas?

A

MEN2B (PMM)

79
Q

RET proto-oncogene asociale with what?

A

MEN2A and MEN2B

Step 2/Level 2 (18 decks)

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