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FM MED II GENERAL > ENDOCRINE > Flashcards

ENDOCRINE Flashcards

1
Q

What regulates Ca homeostasis?

A

Parathyroid hormone

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2
Q

What stimulates the release of PTH?

A

Lox Ca levels

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3
Q

What can often occur after having neck surgery or surgery for thyroid cancer?

A

Hypoparathyroidism

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4
Q

If a pt is having significant muscle spasm, paresthesia, Chvostek sign (tapping on the face that causes facial twitching), or trousseau sign (inflating the BP cuff causes tetany) -dx?

A

Hypoparathyroidism

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5
Q

How do you dx hypoparathyroidism?

A

Decreased PTH, Serum Ca, and increased Phosphorus

EKG – prolonged QT interval

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6
Q

How do you treat hypoparathyroidism?

A

replace Ca and Mg

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7
Q

If you elevated PTH and serum Ca, and low phosphate – dx?

A

HYperparathyroidism

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8
Q

What is the MC cause hyperparathyroidism?

A

Single adenoma

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9
Q

If a pt has renal stones, nausea, constipation, and decreased bone mineral density – dx?

A

Hyperaparthyroidism

“Bones, stones, and groans”

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10
Q

What will you see on EKG with hyperparathyroidism?

A

short QT interval

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11
Q

If PTH is low with elevated Ca – dx?

A

Need to think of other causes (aka malignancy)

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12
Q

How do you treat hyperparathyroidism?

A

Surgery for symptomatic patients

Asymptomatic + serum Ca over 1.0, reduced CrCl, osteoporosis, and under 50 – go to surgery

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13
Q

What would secondary hyperparathyroidism be caused from? Tx?

A

Chronic renal failure and Vit D deficiency

Tx – Replace Vit D or dietary phosphate restriction

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14
Q

What’s more common, hyper or hypothyroidism?

A

Hypothyroidism

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15
Q

Hashimoto’s is associated with what?

A

Hypothyroidism

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16
Q

What is grave’s disease associated with?

A

Hyperthyroidism

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17
Q

If a pt has constipation, weight gain, fatigue, hair loss, and cold intolerance – dx?

A

Hypothyroidism

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18
Q

What would the labs show for hypothyroidism?

A 
TSH = High
T4 = Low
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19
Q

How do we treat hypothyroidism?

A

Levothyroxine (take on an empty stomach and wait 4 hours before taking Ca or Fe)

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20
Q

What are the causes of hyperthyroidism?

A

Grave’s Dz (autoimmune that leads to TSH receptor antibodies)
Subacute Thyroiditis = post-infectious, tender thyroid
Silent thyroiditis = occurs post-partum
Toxic nodular goiter – nodular felt on exam
Pituitary adenoma – nothing in particular in Hx or exam

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21
Q

If a pt has heat intolerance, weight loss, palpitations, hyper defication, and anxiety – dx?

A

Hyperthyroidism

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22
Q

What will the labs look like with hyperthyroidism?

A

TSH – suppressed

T4 – elevated

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23
Q

What if free T4 is also elevated, along with T4, and TSH is suppressed – what should you do?

A

Pituitary adenoma – get an MRI

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24
Q

How do you treat a thyroid storm?

A

PTU or methimazole

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25
Q

How do you treat an adenoma?

A

surgical resection

26
Q

How do you treat someone who is preggo with hyperthyroidism?

A

PTU in 1st tri, methimazole in 2nd and 3rd

27
Q

What’s the definitive treatment for hyperthyroidism?

A

Radioactive iodine

  • Methimazole can lead to leukopenia/agranulocytosis
  • PTU can cause hepatotoxicity
28
Q

A pt presents with a fixed hard mass in the throat, cervical lymphadenopathy, and vocal cord paralysis -dx?

A

Thyroid cancer

29
Q

How do you move forward with a thyroid nodule?

A

Always draw a TSH

If normal, do an U/S

30
Q

What If a pt has a thyroid nodule and the TSH is low, what do you do?

A

Do a radionucleotide iodine uptake scan
Non-functioning (cold) à BIOPSY
Hyper-functioning (warm) à serial ultrasounds

31
Q

When should we always biopsy a thyroid nodule?

A

Solid nodule greater than 1 cm

Cystic nodule greater than 2cm

32
Q

What are the 2 types of adrenal insufficiency?

A

Cushing Syndrome

Cushing Disease

33
Q

What is Cushing syndrome?

A

Increased cortisol levels from any source

34
Q

What is Cushing disease?

A

Increased cortisol levels from a pituitary adenoma

35
Q

How does a pt present with Cushing?

A

Central obesity, proximal weakness, striae, moon face, buffalo hump, HTN, DM.

36
Q

How can we diagnose cushing?

A

Need 2 positives showing elevated cortisol levels

24 hour urine free cortisol, low dose dexamethasone (1mg), or late night salivary test

THEN measure ACTH (normal pituitary function = low ACTH)

37
Q

So, when testing for Cushing what do you do when the ACTH comes back as low?

A

Low ACTH = ATCH independent à CT the adrenals

If it’s not the adrenals, then it’s exogenous use (prednisone)

38
Q

So, when testing for Cushing what do you do when the ACTH comes back as high?

A

High ACTH = ACTH dependent à pituitary adenoma or tumor in lungs

High dose dexamethasone (8mg) – if cortisol is suppressed = pituitary adenoma à get an MRI of pituitary
If no suppression = tumor à get MRI or CT chest

39
Q

In general, how do we treat Cushing?

A

Pituitary adenoma or adrenal tumors are treated with surgery

40
Q

What are some of the risk factors to Type 2 diabetes?

A

Over the age of 45, BMI greater than 25, DM in a 1st degree relative, sedentary lifestyle, gestational DM, Hx of delivering a child 9lbs or heavier, dyslipidemia, PCOS

41
Q

When do we screen for diabetes?

A

Aged 40-70 with BMI greater than 25, every 3 years

42
Q

What would indicate diabetes?

A

Fasting glucose greater than 126 or
One glucose greater than 200 or
HA1c greater than 6.5 or
Positive 2-hr oral glucose tolerance test

43
Q

Give an example and time frame for a rapid acting insulin:

A

Rapid Acting – lispro, aspart, glulisine (onset 5-15 min; peak 1 hr; lasts 4 hours)

44
Q

Give an example and time frame for a fast acting insulin:

A

Fast Acting – Regular (onset 30-60mins, peaks 2 hours, last 6 hours)

45
Q

Give an example and time frame for a Intermediate acting insulin:

A

Intermediate – NPH – onset 2 hours, peak 6 hours, lasts 14 hours

46
Q

Give an example and time frame for a Long-acting insulin:

A

Long-acting – glargine (onset 1-2 hours, no peak, lasts 24 hours)

47
Q

Where do we start when someone is pre-diabetic or has a slightly positive A1c?

A

Weight loss, proper nutrition, and exercise

48
Q

What is first line medication for diabetes?

A

Metformin

49
Q

What can we add if Metformin is not enough?

A

Sulfonylureas

50
Q

If oral’s aren’t working to control diabetes, then what?

A

Basal insulin, can add an rapid acting as well

51
Q

If an A1c is greater than 9%, what do we do?

A

They must start insulin

52
Q

What should a diabetic have done yearly?

A

Eye exam, urine for microalbumin, LDL (statin), BP less than 140/90 (ACE or ARB first line), ASA if 10 year risk is greater than 10% or greater than 30 years of age

53
Q

What are some of the risk factors to hypercholesterolemia?

A

HTN, Smoking, DM, obesity, age over 45 (males; 65 for females), and Family Hx

54
Q

How and when do we screen for hypercholesterolemia?

A

HDL, LDL, total cholesterol, and trigs

High risk males over 25 and females over 35

Non-high risk males over 35 and females over 45

55
Q

How do we treat hypercholesterolemia?

A

Diet, exercise, weight loss, and no tobacco products

LDL is greater than 190 = high statin

DM ages 40-75 with LDL between 70-180 = moderate statin

CVD or DM w/ LDL between 70-189 and a 10year risk of atherosclerotic dz >7.5% = moderate to high statin

56
Q

Why would we treat hypertriglyceridemia?

A

To reduce CV risk

If levels are greater than 1,000 pts at risk of pancreatitis

57
Q

What’s the difference between acromegaly and gigantism?

A 
Acromegaly = adults
Gigantism = kids (before fusion of growth plates)
58
Q

How do we diagnose acromegaly and gigantism?

A

Increased Insulin-growth factor
If high, draw growth hormone after giving oral glucose load
Normally, glucose should completely suppress growth hormone, If HIGH = + test à get an MRI

59
Q

A pt with low urine osmolality and high serum osmolality – what should you think of?

A

Diabetes insipidus

60
Q

What is occurring in diabetes insipidus?

A

ADH is not made or does not work

FM MED II GENERAL (6 decks)

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