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PANCE > Endocrine 6% > Flashcards

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
Q

Antimicrosomial Ab seen in

A

Hashimoto’s Hypothyroidism

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26
Q

Post viral hypothyroidism =

Presentation =

Hallmark dx findings =

Tx =

A

De Quervain’s (Granulomatous)

PAINFUL neck/thyroid
Clinical HYPERthyroidism –> hypothyroid

Increased ESR
NO thyroid Ab

Tx: Aspirin, NO anti-thyroid meds

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27
Q

Medications that may induce HYPOthyroidism

A

Amiodarone*
Lithium*
Alpha interferon

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28
Q

MC cause of hypothyroidism in US =

MC cause of hypothyroidism worldwide =

A

Hashimoto’s

Iodine deficiency

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29
Q

Myxedema crisis =
MC in ___

Tx =

A

Extreme form of HYPOthyroidism

MC in elderly women w/ long standing hypothyroidism in cold weather

IV Levothyroxine
PASSIVE warming
Supportive

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30
Q

Best initial test to evaluate a thyroid nodule

A

Fine Needle Aspiration w/ Biopsy

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31
Q

MC type of benign thyroid nodule

A

Thyroid adenoma

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32
Q

MC type of thyroid carcinoma

A

Papillary

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33
Q

type of thyroid carcinoma MC associated w/ MEN2

A

Medullary

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34
Q

type of thyroid carcinoma MC after radiation exposure

MC in ___

A

Papillary

Young females

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35
Q

type of thyroid carcinoma MOST aggressive

MC in ___

A

Anaplastic

Males > 65 y/o

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36
Q

type of thyroid carcinoma w/ good prognosis

A

Papillary, Follicuar

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37
Q

type of thyroid carcinoma that commonly mets to local/cervical lymph nodes

A

Papillary

Early Medullary

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38
Q

type of thyroid carcinoma that commonly mets to distant areas via vascular invasion of lung, neck, brain, bone, liver, skin

A

Follicular

Late Medullary

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39
Q

____ used to monitor if residual dz present after tx or detect recurrence of MEDULLARY thyroid cancer.

A

Calcitonin levels

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40
Q

HYPERcalcemia stimulates ____

A

increased calcitonin secretion –> decreases blood Ca via decreased GI/kidney absorption and increased bone mineralization

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41
Q

Symptomatic tx of hyperthyroidism

A

beta blocker (propranolol)

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42
Q

IV methylprednisolone used to tx ___

A

Ophthalmopathy in hyperthyroidism

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43
Q

Ab that CAUSES hypothyroidism

A

Anti-TSH ab

Antiperoxidase, antithyroglobulin ab are disease markers

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44
Q

MC type of thyroid adenoma

A

Follicular

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45
Q

Osteopenia: T-score =

A

-1 to -2.5

46
Q

Osteoporosis: T-score =

A

< -2.5

47
Q

Recommended repeat DEXA scan scheduled based on T-score

A
  • 1.0 to -1.5: Q 5 years

- 1.5 to -2.0: Q 3-5 years

48
Q

Genetic mutation of type 1 collagen =

Associated w/:

A

Osteogenesis Imperfecta

Severe osteoporosis, *spontaneous fractures in childhood, *blue sclerae, *presenile deafness

49
Q

Cystic brown tumors

A

Seen in renal osteodystrophy
NOT an actual tumor

Seen on biopsy d/t appearance of hemosiderin depositis

50
Q

Osteitis Fibrosis Cystica d/t ___

Xray

A

d/t osteoclast activity from increased PTH in hypocalcemia in chronic kidney disease

Periosteal erosions
Bony cysts
“salt and pepper” appearance of skull

51
Q

Looser lines (zones)

A

Rickets/Osteomalacia in Vit D deficiency

= transverse “pseudo fracture” lines

52
Q

Osteomalacia:
(Increased/decreased) Ca
(Increased/decreased) Phosphate
(Increased/decreased) ALP

A

Decreased Ca
DECREASED phosphate
Increased ALP

53
Q

Renal osteodystrophy:
(Increased/decreased) Ca
(Increased/decreased) Phosphate
(Increased/decreased) ALP

A

= osteomalacia and osteitis firbrosis cystica in pts w/ CKD
Decreased Ca
INCREASED phosphate
Increased ALP

54
Q

3 zones of adrenal gland and what they produce

A 
Zona Glomerulosa (outer) --> aldosterone 
Zona Fasciculata (middle) --> cortisol
Zona Reticularis (inner) --> androgen/estrogen
55
Q

Addison’s Disease =

Deficiency in ____

(Hyper/hypo)natremia
(Hyper/hypo)kalemia
(non/anion gap)metabolic (acidosis/alkalosis)
(Hyper/hypo)glycemia

A

PRIMARY adrenocortical insufficiency –> adrenal gland destruction

cortisol AND aldosterone

HYPOnatremia
HYPERkalemia
NON anion gap metabolic ACIDOSIS
HYPOglycemia

56
Q

2ndary adrenal insufficiency

MC cause =

Deficiency in ____

A

PITUITARY failure of ACTH secretion

MC caused by exogenous steroid

LOW cortisol, NORMAL aldosterone

57
Q

Dx of chronic adrenocortical insufficiency

A

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
Q

Tx of Addison’s

A

Glucocorticoid + mineralocorticoid =

Hydrocortisone + fludrocortisone

59
Q

MC cause of Adrenal (addisonian) Crisis

Presentation

Tx

A

Abrupt withdrawal of glucocorticoids

Shock, hypotension, hypovolemia

Normal saline
Dexamethasone (undiagosed) or Hydrocortison (addison’s)
Fludrocortisone

60
Q

SCREENING tests for dx of Cushing’s Syndrome (Hypercortisolism)

A

LOW-dose Dexamethasone Suppression test –> NO suppression = Cushing’s syndrome

Increased 24 hr urinary free cortisol

Increased salivary cortisol levels (night time)

61
Q

DIFFERENTIATING tests for causes of Cushing’s Syndrome

A

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
Q

Cushing’s Disease =

A

Cushing’s syndrome caused by PITUITARY increased ACTH secretion

HYPERcortisol

63
Q

Cushing’s disease tx:

Ectopic/adrenal tumor tx:

A

Cushing’s: Transsphenoidal sx

Ectopic/adrenal tumor: tumor removal. Ketoconazole if inoperable

64
Q 
Primary hyperaldosteronism caused by =
Is renin (independent/dependent)
A

Idiopathic
Idiopathic bilateral adrenal hyperplasia (60%)
Conn Syndrome = Adrenal aldosteronoma

Renin INDEPENDENT

65
Q 
Secondary hyperaldosteronism caused by =
Is renin (independent/dependent)
A

Renal artery stenosis
Decreased renal perfusion (CHF, hypovolemia, nephrotic syndrome)

Renin DEPENDENT: Increased Renin –> increased aldosterone via RAAS

66
Q

Hyperaldosteronism:
(Hyper/hypo)kalemia
(Hyper/hypo)tension
Metabolic (alkalosis/acidosis)

A

HYPOkalemia
HYPERtension: DBP more elevated than SBP
Metabolic ALKALOSIS (d/t dumping of K+ and H+ in exchange for Na+)

67
Q

Screening test for Hyperaldosteronism

Primary aldosteronism:
ARR = ___ ; plasma aldosterone = ___ ; (high/low) plasma renin

A

Aldosterone:Renin ratio

Primary: ARR > 20, plasma aldosterone > 20, LOW plasma renin

High plasma renin = 2ndary

68
Q

Conn’s syndrome tx

A

Excision of adrenal aldosteronomas + spironolactone

69
Q

Adrenal hyperplasia hyperaldosteronism tx:

A

Spiranolactone, ACEI, CCB

70
Q

Pheochromococytoma = ____ secretes ____

Presentation:

Dx:

Tx:

A

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
Q

T/F: Transsphenoidal sx is 1st line tx of prolactinomas.

A

False: medical tx for prolactinomas. Cabergoline OR bromocriptine (dopamine agonists inhibit prolactin)

TSS for Active or compressive pituitary tumors EXCEPT prolactinomas.

72
Q

Tx of Acromegaly

A

Transsphenoidal sx + Bromocriptine (dopamine agonist –> decreases GH production)

Octreotride: somatostatin analogue that inhibits GH secretion

73
Q

Gold standard of dx for DM

Other dx of DM

A

Fasting plasma glucose >126 mg/dL

HA1C >6.5%
Plasma glucose >220
GGT: 2 hr plasma glucose >200

74
Q

Gold standard of dx for gestational DM

A

3hr oral glucose tolerance test

Plasma glucose > 200 mg/dL

75
Q

Screening of DM recommended for:

A

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
Q

1st sign of diabetic nephropathy

A

Microalbuminuria

77
Q

Kimmelstiel-Wilson

A

Nodular glomerulosclerosis; pink hyaline material* around glomerular capillaries

Seen in DM

78
Q

Type of insulin:
Lispro (Humalog)
Aspart (Novolog)

Insulin coverage?
Onset? Peak? Duration?

A

Rapid-acting

Given at same time of meals

Onset: 5-15 min
Peak: 1 hr
Duration: 3 hrs

79
Q

Type of insulin:
Ultralente (U)
Insulin Glargine (Lantus)
Detemir (Levemir)

Insulin coverage?
Onset? Peak? Duration?

A

Long acting

Covers insulin 1 full day (basal insulin)

Onset: 6-8 hr
Peak: 12-16 hr
Duration: 20-30 hrs

80
Q

T/F: Lantus (insulin glargine) causes more hypoglycemic episodes than NPH.

T/F: Lantus should not be mixed with other types of insulin

A

False. Causes less.

True.

81
Q

Type of insulin:
REgular (humulin-R)

Insulin coverage?
Onset? Peak? Duration?

A

Short-acting

Given 30-60 mins prior to meals

Onset: 30 min-1 hr
Peak: 2-3 hr
Duration: 4-6 hrs

82
Q

Type of insulin:
NPH
Lente

Insulin coverage?
Onset? Peak? Duration?

A

Intermediate

Overs 1/2 day (or overnight)

Onset: 2-4 hrs
Peak: 4-12 hrs
Duration: 16-20 hrs

83
Q

Dawn phenomenon =
d/t ___

Management:

A

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
Q

Somogyi effect =
d/t ___

Management:

A

nocturnal hypoglycemia followed by rebound hyperglycemia
d/t surge in growth hormone

Decrease nighttime NPH dose
OR give bedtime snack

85
Q

Insulin waning =

Management:

A

Progressive rise in glucose from bed to morning

Move insulin dose to bedtime or increase dose

86
Q

Biguanides =
MOA:
SE:

T/F: Causes hypoglycemia and weight gain.
T/F: Decreases HDL

A

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
Q

Tolbutamide, Chlorpropramide
Glipizide, Glyburide, Glimepiride =

MOA:
SE:

A

Sulfonylureas (1st gen, 2nd gen)

Stimulates pancreatic beta cell insulin release

SE:

  • Hypoglycemia**
  • Disulfuram reaction (sulfa allergy)
  • Weight gain
  • Cardiac dysrhythmias
88
Q

Repaglinide, Nateglinnide =

MOA:
SE:

A

Meglitinides

Stimulates pancreatic beta cell insulin release

SE:

  • Hypoglycemia (< sulfonylureas)
  • Weight gain
89
Q

Acarbose, Miglitol =

MOA:
SE:
Caution in pts w/ ___

A

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
Q

Pioglitazone, Rosiglitazone =

MOA:
SE:

A

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
Q

Exenatide, Liraglutide =

MOA:
SE:
CI in:

A

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
Q

Sitagliptin (Januvia), Linagliptin =

MOA:
SE:

A

DPP-4 Inhibitor

Inhibitior of degradation of GLP-1

SE:

  • Pancreatitis
  • Renal failure
  • GI sx
93
Q

Canagliflozin, Dapagliflozin =

MOA:
SE:

A

SGLT-2 Inhibitor
(SGLT = Sodium-glucose transport)

-Lowers renal glucose threshold –> Increase urinary glucose excretion **

SE:
-Thirst, Nausea, Abd pain, UTIs

94
Q

(Hyper/hypo)kalemia is DKA and HHS

A

HYPOkalema

*Despite serum K levels, patient is always total body potassium deficient

95
Q

MEN1 =
MEN2a =
MEN2b =

A

MEN1 = Parathyroid, Pancreas, Pituitary

MEN2a = Medullary thyroid carcinoma, Pheochromocytoma, Hyperparathyroidism

MEN2b = Medullary thyroid carcinoma, Pheochromocytoma, Neuromas/Marfanoid

96
Q

Gene involved in MEN1:

Gene involved in MEN2:

A

MEN1: menin gene

MEN2: RET proto-oncogene

97
Q

Necrolytic migratory erythema associated w/ ___

A

Glucagonomas (MC @ head of pancreas)

Seen in MEN1 (pancreatic tumor)

98
Q

MC presenting feature of MEN1

A

Hyperparathyroidism

vs. MEN2a

99
Q

MC presenting feature of MEN2

A

Medullary thyroid carcinoma

100
Q

VIPomas =

Presentation:

A

Vasoactive INtestinal peptide tumors

Watery diarrhea, HYPOkalemia, Achlorhydria
Hypovolemia
Dehydration

Seen in MEN1 (pancreatic tumor)

101
Q

USPSTF recommends screening for hyperlipidemia in ____.

National Cholesterol Education Program recommends screening for hyperlipidemia in ____.

A

35 y/o if no evidence CVD and no other RF

20 y/o regardless of RF

102
Q

Monitor recurrence of papillary thyroid cancer with ___

A

Neck US
Whole body scan
Serum thyroglobulin

103
Q

Tx of choice for multinodular goiter

A

Iodine ablation

104
Q

Type 1 DM may present with ____abs

A

Beta cell ab: insulin ab, glutamic acid decarboxylase

Islet cell ab

105
Q

Catecholamines are synthesized in ____

A

adrenal medulla

106
Q

Low testosterone w/ low gonadotropin (LH/FSH) suggests ___

A

secondary hypogonadism = pituitary and/or hypothalamus dysfunction

107
Q

Low testosterone w/ elevated gonadotropin (LH/FSH) suggests ___

A

Primary hypogonadism (testicular dysfunction)

108
Q

SE of carbamazepine include ____

A

SIADH –> enhance release/potentiate effects of ADH

109
Q

Tx of Paget disease of bone

A

Bisphosphate*

Tiludronate

110
Q

Screening dx of gigantism and acromegaly w/ ____.

A

Insulin-like growth hormone factor 1 (IGF-1)

GH is pulsatile –> bad for random level check

111
Q

Pts w/ DM1 w/ recurrent hypoglycemic spells and goor glycemic control despite attention to dietary intake and insulin administration should be evaluated for ___

A

Celiac disease

Kids w/ DM1 commonly have coexisting Celiac disease

112
Q

Orthostatic hypotension w/o compensatory increase in heart rate when BP decreases is indicative of ____. MC caused by ___.

A

Sympathetic autonomic dysfunction

Diabetic autonomic neuropathy

PANCE (20 decks)

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