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step 2 ck > ENDOCRINE > Flashcards

ENDOCRINE Flashcards

1
Q

rapid onset hirsutism suggests…

hirsutism in general should make you think…

A

high androgen levels due to androgen secreting neoplasm

pcos

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2
Q

tumor in kids that causes precocious puberty with estrogen secretion

A

granulosa cell tumors

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3
Q

botulism vs GBS

A

botulism is descending paralysis with early cranial involvement and pupillary changes

GBS is ascending symmetrical paralysis over days

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4
Q

what level do you treat hypercalcemia?

A

> 14 mg/dL

treat with NS hydration plus calcitonin

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5
Q

niacin deficiency
sx?
tx?

A

B3 deficiency
PELLAGRA ( dementia, dermatitis, diarrhea)

niacin replacement

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6
Q

thiamine (B1) deficiency

A

beri beri or wenicke-korsakoff

ass with alcoholics or weight loss surgery

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7
Q

riboflavin deficiency

A

B2 deficiency

cheilosis, glossitis, seborrheic dermatitis

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8
Q

pyridoxine deficiency

A

B6

irritability, depression, dermatitis, stomatitis

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9
Q

B12 deficiency

A

cyanocobalamin deficiency

macrocytic anemia and peripheral neuropathy

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10
Q

what can be elevated in a patient with B12 deficiency?

A

methylmalonic acid

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11
Q

kallman syndrome

A

decreased GnRH and decreased FSH/LH

anosmia +/- renal agenesis

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12
Q

ADH deficiency is known as…

A

central diabetes insipidus

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13
Q

2 hormones of the posterior pituitary

A

ADH and oxytocin

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14
Q

central DI vs nephrogenic DI

presentation of DI?

A

central is decreased ADH production
nephrogenic is decreased response to ADH in kidneys

high volume urine output and excessive thirst resulting in volume depletion and hypernatremia -> can lead to confusion, lethargy

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15
Q

classically what medication can cause nephrogenic DI?

A

lithium

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16
Q

best diagnostic test to determine central vs nephrogenic DI

A

vasopressin (desmopression) stimulation test

central = urine V will decrease and urine osmolality will increase

nephro = no effect

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17
Q

treatment for central and nephro DI?

A

central = vasopressin

nephro = tx underlying cause + HCTZ, amiloride, and NSAIDs

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18
Q

acromegaly

usually caused by?
presentation?
dx?
tx?

A

overproduction of GH

usually d/t pituitary adenoma
enlarging soft tissue = increased hat, ring sizes, carpal tunnel, OSA, body odor, coarsening of facial features, deep voice, big tongue

best initial test is IGF-1
most accurate test is glucose suppression test (glucose should suppress GH)

tx: transphenoid resection of the pituitary
or meds
-ocreotide (somatostatin will suppress GH)
-pegvisomant (GH receptor antagonist)

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19
Q

should a head MRI ever be an initial diagnostic test?

A

NO!! never first test for endocrine disorders

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20
Q

if prolactin is elevated, next tests?

A

pregnancy test
thyroid function tests
BUN/Cr (kidney disease can elevate prolactin)

21
Q

best first initial test for thyroid issues

A

TSH

22
Q 
findings and tx for hyperthyroid dz:
1 graves dz
2 subacute thyroiditis
3 painless silent thyroiditis
4 exogenous thyroid hormone use
5 pituitary adenoma
A

1 proptosis, TSH receptor abs, low TSH, high RAIU –> tx with radioactive iodine (ablation)

2 tender thyroid, low TSH, decreased RAIU –> tx with aspirin

3 normal exam, low TSH, decreased RAIU –> no tx

4 involuted/nonpalpable gland, low TSH, decreased RAIU –> stop exogenous use!

5 HIGH TSH, MRI of head –> surgery

23
Q

thyroid nodules must be biopsied when?

A

must FNA nodule if it is >1 cm if they have normal thyroid function

24
Q

cardiac sx of hypercalcemia?

A

short QT and htn

25
Q

tx for acute hypercalcemia

A

saline hydration at high volume
and
bisphosphonates (aledronate, pamidronate, zeledronic acid)

if that doesnt bring ca down, you can use calcitonin

26
Q

labs seen in primary hyperparathyroidism

A 
high PTH
high serum Ca
low phosphate
ekg with short QT
alk phos may be elevated due to bone effects
27
Q

tx for primary hyperparathyroidism

A

surgical removal of parathyroid glands
or
cinacalcet if nonoperable

28
Q

labs seen in hypocalcemia due to low albumin

A

low albumin causes a decrease in total calcium
but free calcium is normal
= no sx

29
Q

signs of hypocalcemia

A 
chvosek sign (facial nerve hyperexcitable)
carpopedal spasm
perioral numbness
mental irritability
seizures
tetany (treausseau sign)
prolonged QT
30
Q

tx for hypocalcemia

A

replace ca and vit D
orally if mild sx
IV if severe

31
Q

HPA axis

A

hypothalamus –> CRH –> pituitary gland —> ACTH —> adrenal glands —> cortisol

32
Q

cushings syndrome

4 main causes

A

hypercortisolism!

pituitary overproduction of ACTH (cushing disease)
adrenals
unknown source
extopic ACTH (cancer, carcinoid)

33
Q

dx tests for hypercortisol/cushings

A

best initial test = 24 hr urine cortisol (second best option is overnight dexamethasone suppression)

if 24 hr urine is elevated = confirms hypercortisolism
if suppression on dexa test occurs, can rule out hypercortisolism

ACTH testing is best test to identify the SOURCE of hypercortisolism

  • -low ACTH means adrenal source
  • -high ACTH means either pituitary of ectopic

–> scan brain with MRI if high ACTH and nonsuppressible

34
Q 
addisons disease
aka?
presentation?
dx?
tx?
A

chronic hypoadrenalism

weakness, ams, n/v, hypoNa, HyperK, hyperpigmentation

hypoglycemia, hyperK, met. acidosis, hypoNa, high BUN, EOSINOPHILIA

if pituitary failure = ACTH is low
if primary adrenal failure = ACTH high

cosyntropin test (synthetic ACTH) –> if normal should cause a rise in cortisol

tx steroids

35
Q

acute adrenal crisis
presentation?
first step?

A

profound hypotension, fever, confusion, coma
high eosinophils, hyperK, hypoNa, hypoglycemia

draw cortisol level and give HYDROCORTISONE

**hydrocortisone is more important than diagnosis in acute adrenal crisis

36
Q 
primary hyperaldosteronism
main causes?
presentation?
dx?
tx?
A

solitary adenoma or bilateral hyperplasia

high BP despite low renin and hypokalemia

best initial test is ratio of aldosterone to renin
only do a CT if testing shows: 1) low K, 2) high aldosterone, and 3) low renin

adenoma = surg laparotomy
bil, hyperplasia = tx w eplerenone or spironolactone

37
Q

pheochromocytoma
presentation?
dx?
tx?

A

nonmalignant autonomous lesion of adrenal medulla that produces catecholamines despite high BP

episodic htn, headache, sweating, and palpitations

best initial test is free plasma metanephrines and 24 hr urine metanephrines
then do CT

tx phenoxybenzamine (alpha blocker) –> surg removal

38
Q

DM diagnosis

A

2 fasting BG >125
single glucose >200 with symptoms
or
increased glucose on oral glucose tolerance testing
or hgA1c>6.5% (best test to follow therapy effect)

39
Q

how does exercise help in DM

A

exercising muscle does not need insulin so it decreases insulin requirement/decreases insulin resistance by decreasing adipose tissue

40
Q

best initial med for DM?
mech?

but it is contraindicated in?

A

metformin - it bocks gluconeogenesis (does not increase weight gain and does not cause hypoglycemia)

contraindicated in renal dysfunction (can accumulate and cause met acidosis)

41
Q

sulfonylureas

A

not first line for DM since they increase insulin release from pancreas and increase weight gain

42
Q

if oral agents are not controlling DM, start patient on…

A

insulin

insulin glargine = 1x/day long acting
NPH would be 2x/day long acting
+
lispro or aspart (short acting)

goal is hgba1c<7%

43
Q

DKA tx

A

large volume saline and insulin

44
Q

best indicator of severity of DKA?

A

serum bicarbonate

**if very low (big anion gap), there is risk of death

45
Q

all DM patients should receive

A 
pneumococcal vaccine
yearly eye exam
yearly foot exam
statin if LDL>100
acei/arb if BP >140/90 or if urine + microalbuminuria
aspirin if >30yo
46
Q

tx for DM associated gastroparesis (decreased bowel mobility due to decreased stretch feedback)

A

metoclopromide and erythromycin (increase gastric mobility)

47
Q

retinopathy seen w DM?

tx?

A

nonproliferative retinopathy –> tighter gluc control

proliferative retinopathy (vitreous hemorhage and neovascularizatuion) –> laser photocoagulation

48
Q

to dx amyloidosis

A

abdominal fat pad biopsy

step 2 ck (16 decks)

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