Endocrine 6% Flashcards

1
Q

Primary Hyperparathyroidism =

MC cause =

A

excess (inappropriate) PTH production

Parathyroid Adenoma

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2
Q

MEN I

MEN IIa

A

MEN I = HyperPTH, Pituitary Tumors, Pancreatic Tumors

MEN IIa = HyperPTH, Pheochromocytoma, Medullary Thyroid Carcinoma

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3
Q

Secondary Hyperparathyroidism =

MC cause =

A

Increased PTH in response to hypocalcemia or vit D deficiency

Chronic kidney failure: d/t hyperphosphatemia –> increased ionized Ca, decreased renal production of active vit D

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4
Q
Primary hyperparathyroidism:
(Increased/decreased) DTR
(Increased/decreased) Ca
(Increased/decreased) PTH
(Increased/decreased) phosphate
(Increased/decreased) 24 hr urine calcium excretion 
Increased/decreased) vit D
A
Primary hyperparathyroidism:
DECREASED DTR
INCREASED Ca
INCREASED PTH
DECREASED phosphate
INCREASED 24 hr urine calcium excretion 
INCREASED vit D
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5
Q

Tx of primary hyperparathyroidism

Tx of secondary hyperparathyroidism

A

Primary: Parathyroidectomy

Secondary: Vit D, Ca supplementation

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6
Q

MC causes of hypoparathyroidism (2)

A

Postsurgical

Autoimmune

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7
Q
Hypoparathyroidism:
(Increased/decreased) DTR
(Increased/decreased) Ca
(Increased/decreased) PTH
(Increased/decreased) phosphate
A

INCREASED DTR
DECREASED Ca
DECREASED PTH
INCREASED phosphate

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8
Q

Hypocalcemia causes ____ on EKG.

Hypercalcemia causes ____ on EKG.

A

Hypo: Prolonged QT interval

Hyper: Shortened QT interval

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9
Q

Tx of hypercalcemia

Avoid ___

A

1st line: Loop diuretics (Furosemide)
Severe: Calcitonin, Bisphosphonates

HCTZ–> caused increased Ca

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10
Q

Elevated calcium, low PTC indicates ___

A

Secondary HYPERPTH –> malignancy

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11
Q

All pts should be screened for ____ with ____ for ____ before treating hyperparathyroidism

A

Familial benign hypoclaciuric hypercalcemia

24 hr urine for Ca and Cr

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12
Q

DiGeorge Syndrome

Features (3)

A

Congential cause of hypocalcemia

Parathyroid hypoplasia
Thymic hypoplasia
Outflow tract defects of heart

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13
Q

Avoid ____ in hypocalcemia

A

Phenothiazine

Furosemide

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14
Q

Thyroid stimulating Ab

A

Graves dz (hyperthyroidism)

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15
Q

Abs in Hashimoto’s OR autoimmune thyroiditis

A

Antithyroid peroxidase Ab

Anti-Thyroglobulin Ab

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16
Q

Decreased radioactive iodine uptake

A

Thyroiditis

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17
Q

Diffuse radioactive iodine uptake

A

Grave’s Dz

Pituitary Adenoma

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18
Q

Low TSH, Low FT4

A

(rare) 2ry/3ry hypothyroidism
Usually pituitary
Drugs: dobutamine, octreotride, high-dose glucocorticoids

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19
Q

Riedel’s thyroiditis =
Presentation =
Tx =

A

Normal thyroid stroma replaced by fibrotic tissues

Painless fixed nodular that may grow rapidly

Steroids, tamoxifen, levothyroxine

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20
Q

Opthalmopathy w/ lid lag, exophthalmos/proptosis is exclusively seen in ___

A

Grave’s Dz

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21
Q

Pretibial myxedema =

Seen in__

A

nonpitting, edematous, pink-brown plaques/nodules on shins

Grave’s Dz

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22
Q

Methimazole and PropylThioUracil (PTU) used to tx ____
SE ____
Safe in pregnancy?

A

Grave dz, Toxic multinodular goiter (Plummer Dz)

SE: agranulocytosis, hepatitis –> monitor w/ CBC

PTU safe in pregnancy

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23
Q

Elevated TSH, High FT4

Presentation:
RAIU:

A

TSH secreting pituitary adenoma

Bitemporal hemianopsia

Diffuse uptake

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24
Q

MC therapy for Grave’s Dz and Plummer Dz

A

Radioactive Iodine

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25
Antimicrosomial Ab seen in
Hashimoto's Hypothyroidism
26
Post viral hypothyroidism = Presentation = Hallmark dx findings = Tx =
De Quervain's (Granulomatous) PAINFUL neck/thyroid Clinical HYPERthyroidism --> hypothyroid Increased ESR NO thyroid Ab Tx: Aspirin, NO anti-thyroid meds
27
Medications that may induce HYPOthyroidism
Amiodarone* Lithium* Alpha interferon
28
MC cause of hypothyroidism in US = | MC cause of hypothyroidism worldwide =
Hashimoto's Iodine deficiency
29
Myxedema crisis = MC in ___ Tx =
Extreme form of HYPOthyroidism MC in elderly women w/ long standing hypothyroidism in cold weather IV Levothyroxine PASSIVE warming Supportive
30
Best initial test to evaluate a thyroid nodule
Fine Needle Aspiration w/ Biopsy
31
MC type of benign thyroid nodule
Thyroid adenoma
32
MC type of thyroid carcinoma
Papillary
33
type of thyroid carcinoma MC associated w/ MEN2
Medullary
34
type of thyroid carcinoma MC after radiation exposure MC in ___
Papillary Young females
35
type of thyroid carcinoma MOST aggressive MC in ___
Anaplastic Males > 65 y/o
36
type of thyroid carcinoma w/ good prognosis
Papillary, Follicuar
37
type of thyroid carcinoma that commonly mets to local/cervical lymph nodes
Papillary Early Medullary
38
type of thyroid carcinoma that commonly mets to distant areas via vascular invasion of lung, neck, brain, bone, liver, skin
Follicular Late Medullary
39
____ used to monitor if residual dz present after tx or detect recurrence of MEDULLARY thyroid cancer.
Calcitonin levels
40
HYPERcalcemia stimulates ____
increased calcitonin secretion --> decreases blood Ca via decreased GI/kidney absorption and increased bone mineralization
41
Symptomatic tx of hyperthyroidism
beta blocker (propranolol)
42
IV methylprednisolone used to tx ___
Ophthalmopathy in hyperthyroidism
43
Ab that CAUSES hypothyroidism
Anti-TSH ab Antiperoxidase, antithyroglobulin ab are disease markers
44
MC type of thyroid adenoma
Follicular
45
Osteopenia: T-score =
-1 to -2.5
46
Osteoporosis: T-score =
< -2.5
47
Recommended repeat DEXA scan scheduled based on T-score
- 1.0 to -1.5: Q 5 years | - 1.5 to -2.0: Q 3-5 years
48
Genetic mutation of type 1 collagen = Associated w/:
Osteogenesis Imperfecta Severe osteoporosis, *spontaneous fractures in childhood, *blue sclerae, *presenile deafness
49
Cystic brown tumors
Seen in renal osteodystrophy NOT an actual tumor Seen on biopsy d/t appearance of hemosiderin depositis
50
Osteitis Fibrosis Cystica d/t ___ Xray
d/t osteoclast activity from increased PTH in hypocalcemia in chronic kidney disease Periosteal erosions Bony cysts "salt and pepper" appearance of skull
51
Looser lines (zones)
Rickets/Osteomalacia in Vit D deficiency = transverse "pseudo fracture" lines
52
Osteomalacia: (Increased/decreased) Ca (Increased/decreased) Phosphate (Increased/decreased) ALP
Decreased Ca DECREASED phosphate Increased ALP
53
Renal osteodystrophy: (Increased/decreased) Ca (Increased/decreased) Phosphate (Increased/decreased) ALP
= osteomalacia and osteitis firbrosis cystica in pts w/ CKD Decreased Ca INCREASED phosphate Increased ALP
54
3 zones of adrenal gland and what they produce
``` Zona Glomerulosa (outer) --> aldosterone Zona Fasciculata (middle) --> cortisol Zona Reticularis (inner) --> androgen/estrogen ```
55
Addison's Disease = Deficiency in ____ (Hyper/hypo)natremia (Hyper/hypo)kalemia (non/anion gap)metabolic (acidosis/alkalosis) (Hyper/hypo)glycemia
PRIMARY adrenocortical insufficiency --> adrenal gland destruction cortisol AND aldosterone HYPOnatremia HYPERkalemia NON anion gap metabolic ACIDOSIS HYPOglycemia
56
2ndary adrenal insufficiency MC cause = Deficiency in ____
PITUITARY failure of ACTH secretion MC caused by exogenous steroid LOW cortisol, NORMAL aldosterone
57
Dx of chronic adrenocortical insufficiency
1st: High dose ACTH (Cosyntropin) Stimulation test --> adrenal insufficiency --> little/no increase in cortisol levels 2nd: CRH stimulation test: Differentiates causes --> Primary/Addision: High ACTH, LOW cortisol Secondary (pituitary): Low ACTH, Low cortisol Teritary (hypothalamus): delated, prolonged, exaggerated ACTH response
58
Tx of Addison's
Glucocorticoid + mineralocorticoid = | Hydrocortisone + fludrocortisone
59
MC cause of Adrenal (addisonian) Crisis Presentation Tx
Abrupt withdrawal of glucocorticoids Shock, hypotension, hypovolemia Normal saline Dexamethasone (undiagosed) or Hydrocortison (addison's) Fludrocortisone
60
SCREENING tests for dx of Cushing's Syndrome (Hypercortisolism)
LOW-dose Dexamethasone Suppression test --> NO suppression = Cushing's syndrome Increased 24 hr urinary free cortisol Increased salivary cortisol levels (night time)
61
DIFFERENTIATING tests for causes of Cushing's Syndrome
HIGH dose Dexamethasone Suppression Test --> Suppression = Cushing's disease NO suppression = adrenal or ectopic ACTH producing tumor ACTH levels --> Decreased ACTH = adrenal tumor (b/c produce high levels of cortisol --> suppress ACTH levels via HPA axis) Normal/increased ACTH = Cusing's disease or ectopic ACTH producing tumor (b/c secrete ACTH independent of HPA axis)
62
Cushing's Disease =
Cushing's syndrome caused by PITUITARY increased ACTH secretion HYPERcortisol
63
Cushing's disease tx: Ectopic/adrenal tumor tx:
Cushing's: Transsphenoidal sx Ectopic/adrenal tumor: tumor removal. Ketoconazole if inoperable
64
``` Primary hyperaldosteronism caused by = Is renin (independent/dependent) ```
Idiopathic Idiopathic bilateral adrenal hyperplasia (60%) Conn Syndrome = Adrenal aldosteronoma Renin INDEPENDENT
65
``` Secondary hyperaldosteronism caused by = Is renin (independent/dependent) ```
Renal artery stenosis Decreased renal perfusion (CHF, hypovolemia, nephrotic syndrome) Renin DEPENDENT: Increased Renin --> increased aldosterone via RAAS
66
Hyperaldosteronism: (Hyper/hypo)kalemia (Hyper/hypo)tension Metabolic (alkalosis/acidosis)
HYPOkalemia HYPERtension: DBP more elevated than SBP Metabolic ALKALOSIS (d/t dumping of K+ and H+ in exchange for Na+)
67
Screening test for Hyperaldosteronism Primary aldosteronism: ARR = ___ ; plasma aldosterone = ___ ; (high/low) plasma renin
Aldosterone:Renin ratio Primary: ARR > 20, plasma aldosterone > 20, LOW plasma renin High plasma renin = 2ndary
68
Conn's syndrome tx
Excision of adrenal aldosteronomas + spironolactone
69
Adrenal hyperplasia hyperaldosteronism tx:
Spiranolactone, ACEI, CCB
70
Pheochromococytoma = ____ secretes ____ Presentation: Dx: Tx:
Catecholamine-secreting adrenal tumor; Norepinephrine, epinephrine Palpitation, HA, Excessive sweating HTN Increased 24 hr urinary catecholamines including metabolites (metanephrine, vanillylmandelic acid) Complete adrenalectomy Preoperative nonselective alpha blockade (phenoxybenzamine, phentolamine x 7-14 days) --> beta blockers/CCB **DO NOT initiate BB before alpha blockade
71
T/F: Transsphenoidal sx is 1st line tx of prolactinomas.
False: medical tx for prolactinomas. Cabergoline OR bromocriptine (dopamine agonists inhibit prolactin) TSS for Active or compressive pituitary tumors EXCEPT prolactinomas.
72
Tx of Acromegaly
Transsphenoidal sx + Bromocriptine (dopamine agonist --> decreases GH production) Octreotride: somatostatin analogue that inhibits GH secretion
73
Gold standard of dx for DM Other dx of DM
Fasting plasma glucose >126 mg/dL HA1C >6.5% Plasma glucose >220 GGT: 2 hr plasma glucose >200
74
Gold standard of dx for gestational DM
3hr oral glucose tolerance test | Plasma glucose > 200 mg/dL
75
Screening of DM recommended for:
Pts >45 y/o w/ BP > 135/80 Younger adults w/ BMI >25 >1 additional RF: FHX, low HDL, Polycystic ovarian syndrome, NON-caucasian
76
1st sign of diabetic nephropathy
Microalbuminuria
77
Kimmelstiel-Wilson
Nodular glomerulosclerosis; pink hyaline material* around glomerular capillaries Seen in DM
78
Type of insulin: Lispro (Humalog) Aspart (Novolog) Insulin coverage? Onset? Peak? Duration?
Rapid-acting Given at same time of meals Onset: 5-15 min Peak: 1 hr Duration: 3 hrs
79
Type of insulin: Ultralente (U) Insulin Glargine (Lantus) Detemir (Levemir) Insulin coverage? Onset? Peak? Duration?
Long acting Covers insulin 1 full day (basal insulin) Onset: 6-8 hr Peak: 12-16 hr Duration: 20-30 hrs
80
T/F: Lantus (insulin glargine) causes more hypoglycemic episodes than NPH. T/F: Lantus should not be mixed with other types of insulin
False. Causes less. True.
81
Type of insulin: REgular (humulin-R) Insulin coverage? Onset? Peak? Duration?
Short-acting Given 30-60 mins prior to meals Onset: 30 min-1 hr Peak: 2-3 hr Duration: 4-6 hrs
82
Type of insulin: NPH Lente Insulin coverage? Onset? Peak? Duration?
Intermediate Overs 1/2 day (or overnight) Onset: 2-4 hrs Peak: 4-12 hrs Duration: 16-20 hrs
83
Dawn phenomenon = d/t ___ Management:
Normal glucose until 2-8 am when it rises d/t decreased insulin sensitivity and nightly surge of counter regulatory hormones Bedtime injection of NPH Avoid carbohydrate snake late at night
84
Somogyi effect = d/t ___ Management:
nocturnal hypoglycemia followed by rebound hyperglycemia d/t surge in growth hormone Decrease nighttime NPH dose OR give bedtime snack
85
Insulin waning = Management:
Progressive rise in glucose from bed to morning Move insulin dose to bedtime or increase dose
86
Biguanides = MOA: SE: T/F: Causes hypoglycemia and weight gain. T/F: Decreases HDL
Metformin, Phenformin MOA: - decrease hepatic glucose production ** - increase peripheral glucose utilization ** - decrease GI intestinal glucose absorption - increase insulin sensitivity SE: - Lactic acidosis* --> do not give in hepatic/renal impaired pts - Macrocytic anemia - Metallic taste False: Does not effect pancreatic beta cells False: Decreases triglycerides
87
Tolbutamide, Chlorpropramide Glipizide, Glyburide, Glimepiride = MOA: SE:
Sulfonylureas (1st gen, 2nd gen) Stimulates pancreatic beta cell insulin release SE: - Hypoglycemia** - Disulfuram reaction (sulfa allergy) - Weight gain - Cardiac dysrhythmias
88
Repaglinide, Nateglinnide = MOA: SE:
Meglitinides Stimulates pancreatic beta cell insulin release SE: - Hypoglycemia (< sulfonylureas) - Weight gain
89
Acarbose, Miglitol = MOA: SE: Caution in pts w/ ___
Alpha-glucosidase inhibitors Delays intestinal glucose absorption Inhibits pancreatic alpha amylase and intestinal alpha-glucosidase hydrolase - Does NOT affect insulin secretion SE: - Hepatitis (increase LFTs) - Flatulence, diarrhea, abd pain - Caution in pts w/ gastroparesis, IBD
90
Pioglitazone, Rosiglitazone = MOA: SE:
Thiazolidinediones Increase insulin sensitivity at peripheral receptor site adipose and mm. -NO effect on pancreatic beta cells SE: - Fluid retention, edema** Cardiovascular toxicity w/ Rosiglitazone (MI)** Hepatotoxicity, Bladder CA, Fractures
91
Exenatide, Liraglutide = MOA: SE: CI in:
Glucagon-like peptide 1 (GLP-1) Agonists - Lowers bloos sugar by mimicking incretin - Increase insulin secretion, decrease glucagon secretion - Delays gastric emptying SE: - Hypoglycemia - Pancreatitis CI if h/o gastroparesis*
92
Sitagliptin (Januvia), Linagliptin = MOA: SE:
DPP-4 Inhibitor Inhibitior of degradation of GLP-1 SE: - Pancreatitis - Renal failure - GI sx
93
Canagliflozin, Dapagliflozin = MOA: SE:
SGLT-2 Inhibitor (SGLT = Sodium-glucose transport) -Lowers renal glucose threshold --> Increase urinary glucose excretion ** SE: -Thirst, Nausea, Abd pain, UTIs
94
(Hyper/hypo)kalemia is DKA and HHS
HYPOkalema *Despite serum K levels, patient is always total body potassium deficient
95
MEN1 = MEN2a = MEN2b =
MEN1 = Parathyroid, Pancreas, Pituitary MEN2a = Medullary thyroid carcinoma, Pheochromocytoma, Hyperparathyroidism MEN2b = Medullary thyroid carcinoma, Pheochromocytoma, Neuromas/Marfanoid
96
Gene involved in MEN1: Gene involved in MEN2:
MEN1: menin gene MEN2: RET proto-oncogene
97
Necrolytic migratory erythema associated w/ ___
Glucagonomas (MC @ head of pancreas) Seen in MEN1 (pancreatic tumor)
98
MC presenting feature of MEN1
Hyperparathyroidism | vs. MEN2a
99
MC presenting feature of MEN2
Medullary thyroid carcinoma
100
VIPomas = Presentation:
Vasoactive INtestinal peptide tumors Watery diarrhea, HYPOkalemia, Achlorhydria Hypovolemia Dehydration Seen in MEN1 (pancreatic tumor)
101
USPSTF recommends screening for hyperlipidemia in ____. National Cholesterol Education Program recommends screening for hyperlipidemia in ____.
35 y/o if no evidence CVD and no other RF 20 y/o regardless of RF
102
Monitor recurrence of papillary thyroid cancer with ___
Neck US Whole body scan Serum thyroglobulin
103
Tx of choice for multinodular goiter
Iodine ablation
104
Type 1 DM may present with ____abs
Beta cell ab: insulin ab, glutamic acid decarboxylase | Islet cell ab
105
Catecholamines are synthesized in ____
adrenal medulla
106
Low testosterone w/ low gonadotropin (LH/FSH) suggests ___
secondary hypogonadism = pituitary and/or hypothalamus dysfunction
107
Low testosterone w/ elevated gonadotropin (LH/FSH) suggests ___
Primary hypogonadism (testicular dysfunction)
108
SE of carbamazepine include ____
SIADH --> enhance release/potentiate effects of ADH
109
Tx of Paget disease of bone
Bisphosphate* | Tiludronate
110
Screening dx of gigantism and acromegaly w/ ____.
Insulin-like growth hormone factor 1 (IGF-1) GH is pulsatile --> bad for random level check
111
Pts w/ DM1 w/ recurrent hypoglycemic spells and goor glycemic control despite attention to dietary intake and insulin administration should be evaluated for ___
Celiac disease Kids w/ DM1 commonly have coexisting Celiac disease
112
Orthostatic hypotension w/o compensatory increase in heart rate when BP decreases is indicative of ____. MC caused by ___.
Sympathetic autonomic dysfunction Diabetic autonomic neuropathy