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PANCE Prep/ Green Book > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Which “ast” does PTH stimulate?

A

osteoclast

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2
Q

What 2 places can absorb calcium?

A

bowel

kidney

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3
Q

MC cause of primary hyperparathyroidism?

A

benign parathyroid adenoma

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4
Q

causes of hypercalcemia?

A 
hyperparathyroidism
kidney failure
malignancy
milk-alkali
TB
sarcoidosis
multiple myeloma
meds (thiazides, lithium)
prolonged bed rest
adrenal insufficiency
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5
Q

What are the clinical manifestations of hypercalcemia?

A

stones (kidney)
bones (jaw fracture)
groans (psych)
moans (abd)

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6
Q

Dx to confirm primary hyperparathyroidism?

A

increased PTH and ca

phosphorus is normal

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7
Q

what can cause secondary hyperparathyroidism?

A

decreased vit D/ca
hyperphosphatemia
renal failure

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8
Q

hypercalcemia can cause what heart changes?

A 
prolonged PR (contraction)
shortened QT  (repolarization)
asystole
bradycardia
heart block
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9
Q

what is a congenital cause of hypothyroidism

A

digeorge

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10
Q

what is cvhostek sign?

A

tap on the facial nerve => eye, nose, mouth spasm

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11
Q

what sort of reflexia does hypocalcemia cause

A

hyperreflexia

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12
Q

troussea sign?

A

spasm of the hand/wrist with compression of the forearm from hypocalcemia

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13
Q

what are symptoms of hypocalcemia?

A 
lethargy
anxiety
parkinsoniansim
mental R
personality change
blurred vision
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14
Q

EKG change of hypocalcemia

A

prolonged qt

t wave changes

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15
Q

tx of tetany?

A

airway

slow IV of calcium gluconate

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16
Q

what is PTH used to tx?

A

osteoporosis

not for hypoparathyroidism

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17
Q

level of TSH in primary hypothyroid?

A

high

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18
Q

causes of hyperthyroid

A 
graves #1
toxic multinodular goiter #2
hashimoto
amiodarone
excess I
pituitary tumor
pregnancy
exogenous thyroid hormone
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19
Q

what antibodies are in graves?

A

peroxidase

thyroglobulin

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20
Q

can radio-iodine therapy be done in pregnancy

A

no

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21
Q

initial tx for hyperthyroid symptoms

A

bb

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22
Q

PTU or methimazole is used in pregnancy? which is generally preferred

A

PTU

methimazole

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23
Q

tx afibb in hyperthyroid?

A

need to be euthyroid to be able to fix it

digoxin
bb with caution
need to anticoagulate

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24
Q

what is a thyroid storm?

A

hyperthyroidism triggered by stress

ie pregnancy, illness, surgery, trauma

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25
Q

what antibodies are in hypothyroidism

A

anti-tsh

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26
Q

30% of what pts have hypothyroidism?

A

down

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27
Q

best screening test for hypothyroidism?

A

tsh

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28
Q

before init levothyroxine what should you check for?

A

angina and adrenal insufficiency

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29
Q

mc cause of thyroiditis? (infection)

A

staph aureus

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30
Q

what is subacute painful thyroiditis?

A

peaks in summer

young, middle aged F

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31
Q

course of subacute painful thyroiditis?

A

thyrotoxicosis => hypothyroid => euthyroid in <12 months

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32
Q

tx for subacute painful thyroiditis?

A

aspirin

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33
Q

drug => thyroiditis in 20% of patients

A

amiodarone

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34
Q

an asymptomatic, hard woody thyroid?

A

fibrous thyroiditis

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35
Q

which thyroid cysts are painful?

A

suppurative ie staph

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36
Q

how common are thyroid nodules?

A

1/12-15 of young women have them

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37
Q

ant pituitary releases what?

A 
TSH
ACTH
prolactin
GH
LH
TSH
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38
Q

post pituitary releases what?

A

oxytocin

ADH

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39
Q

what inhibits prolactin?

A

dopamine

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40
Q

what inhibitis TSH and GH?

A

somatostatin

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41
Q

what does TRH release?

A

TSH

prolactin

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42
Q

screen test for GH excess?

A

serum IGF-1

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43
Q

imaging choice for increased GH?

A

MRI

looking for pituitary adenoma

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44
Q

if you are checking IGF-1 for excess GH what are you also checking for?

A

prolactin

common for a pituitary adenoma to secrete both GH and prolactin

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45
Q

tx of increased GH?

A

somatostatin analog

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46
Q

what is pegvisomat?

A

GH receptor antagonist

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47
Q

what causes diabetes insipidus?

A

loss of ADH or insensitivity to it

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48
Q

central DI responds to what?

A

desmopressin

vasopressin ie ADH analog

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49
Q

what is osmolality in DI?

A

serum is high

urine is low

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50
Q

tx of nephrogenic DI

A

indomethacin alone or with

HCTZ, desmopressin analog, amiloride

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51
Q

what criteria are a part of metabolic syndrome?

A 
low HDL
high trigs
increased waist
insulin resistance
BP
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52
Q

% of diabetics that have retinopathy

A

30%

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53
Q

complications of DM

A 
retinopathy
neuropathy
nephropathy
CAD
poor healing
(more)
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54
Q

1 unit of insulin is roughly how many carbs

A

15 grams

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55
Q

where is regular insulin most rapidly absorbed

A

abdomen

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56
Q

how long does regular insulin

A

last 5-8 hours

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57
Q

at what Cr is metformin CI?

A

> 1.5

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58
Q

pioglitazone is associated with what?

A

bladder cancer

is a thiazoliredione

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59
Q

GLP-1 SE?

A

pancreatitis

nausea

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60
Q

whipple triad?

A

hypoglycemia symptoms
(sweating, palp, anx, tremulousness)
immediate recovery with glucose
BS < 45

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61
Q

xanthelasma =

A

xanthoma affecting the eyelid

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62
Q

USPSTF recommends lipid screening at what age?

A

45

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63
Q

what do you monitor with statins?

A

liver enzymes

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64
Q

cushing disease is caused by what?

A

ACTH secreting adenoma (pituitary)

syndrome = signs of excess cortisol

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65
Q

most specific signs of cushing syndrome

A

proximal muscle wasting
pigmented striae
backache, HA

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66
Q

dx cushings

A

1) cortisol excess by dexamethasone test

<5 ug/dL excludes cushings

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67
Q

MC cause of addison’s

A

autoimmune destruction of gland

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68
Q

what infection can cause addison’s?

A

tb

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69
Q

does addisons or cushings cause hyperpigmentation

A

addisons

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70
Q

electrolytes in addisons?

A 
hyperkalemia
hyponatremia
low glucose
increased calcium
decreased BUN
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71
Q

how would addisonian crisis present?

A

hypotensive
pain (abd/back)
v/d
altered mental status

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72
Q

dx addison’s

A

low 8 am cortisol < 3 ug/dL and increased ACTH

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73
Q

what is DHEA used to tx?

A

dehydroepiandrosterone

Addisons

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74
Q

tx of addisonian crisis?

A

IV saline
glucose
glucocorticoids

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75
Q

mc presentation of hyperparathyroidism is what

A

asymptomatic

76
Q

klinefelter syndrome has what genetic abnormality?

A

extra x

77
Q

symptoms of severe cramps, extremity parasthesias, lethargy- think what electrolyte which direction?

A

hypocalcemia

could be hypoparathyroidism

78
Q

enlargement of the thyroid gland in graves looks like what?

A

diffuse enlargement

79
Q

for a pt on a steroid for adrenal insufficiency…
how do you dose it during an illness?
how do you dose during a surgery?

A 
illness = double
surgery = 5-10 fold
80
Q

tx for diabetes insipidis?

A

desmopressin

81
Q

a tophus represents what?

A

underlying gout

82
Q

what insulin do you give a diabetic in ketoacidosis?

A

regular insulin

83
Q

what EKG waves are associated with hyperkalemia?

A

u waves

84
Q

initial dx study for a thyroid nodule

A

FNA

85
Q

tx of hyperkalemia

A

calcium

loop diuretic

86
Q

In tertiary disorder which organ is the problem (endocrine)? Secondary? Primary?

A

3) hypothalamus
2) pituitary
1) target organ

87
Q

best thyroid screening test?

A

TSH

88
Q

which antibody is specific for graves?

A

thyroid stimulating antibody

89
Q

in a pt with subclinical hypothyroidism when must you tx with levothyroxine?

A

if pt develops hyperlipidemia
if the TSH increases over 20
they have symptoms of hypthyroidism

90
Q

what is cretinism and how do you manage it?

A

developmental hypothyroidsim

manage with levothyroxine

can be from mom hypothyroid or from infant hypopituitarism

91
Q

what is a euthyroid?

A

abnormal thyroid levels but thyroid gland is normal

seen with illness, surgery, sepsis, cardiac disease

92
Q

how does a person in a thyroid storm present?

A

hypermetabolic state:

palpitations, afibb, fever, nausea, vomiting, psychosis, tremors, tachy,

93
Q

management of thyroid storm:

A

1) PTU IV or methimazole (PTU inh peripheral conversion)
2) beta blocker, iv sodium iodide (decreases coversion)
3) IV glucocorticoids (decreases conversion), fluids, cardiac monitoring, cooling blankets

94
Q

what do you avoid giving in a thyroid storm for fever?

A

aspirin

because it increases 4-3 conversion

95
Q

management of myxedema crisis:

A

levothyroxine IV
passive warming
normal saline
in adrenal insufficiency give steroids

96
Q

what is commonly seen with older women with long standing hypothyroidism in the winter?

A

myxedema crisis

97
Q

what does RAIU test show for graves?

A

diffuse uptake

98
Q

If you see ophthalmopathy and a hyperthyroidism what is the cause of the hyperthyroidism?

A

graves

will see lid lag and proptosis

99
Q

Besides opthalmopathy what manifestation is exclusive to graves?

A

pretibial myxedmea

ie nonpitting, edematous pink to brown plaques/nodeuls on the shin

100
Q

tx of graves

A

radioactive iodine- will need hormone replacement
if pregnant- PTU (iodine ablation CI)
bb for symptoms
if unresponsive thyroidectomy

101
Q

why can a toxic adenoma cause dyspnea, dysphagia, stridor and hoarseness?

A

it can cause laryngeal compression

102
Q

SE of PTU and methimazole

A

agranulocytosis

hepatitis

103
Q

what hyperthyroid disorder can cause bitemporal hemianopsia

A

pituitary adenoma

104
Q

antibodies present in hashimoto’s?

A

thyroid antibody:
thyroglobulin ab
antimicrosomial
thyroid peroxidase ab

same antibodies present in silent lymphocytic thyroiditis, post-partum thyroiditis

105
Q

treatment for lymphocytic thyroiditis

A

aspirin

lasts for 12-18 months whereas hashimoto’s is permanent

106
Q

what is the cause of de quervain’s thyroiditis

A

mc post-viral

107
Q

which hypothyroid disorders are painful

A

de quervain’s

acute (supportive) thyroiditis

108
Q

pt with increased ESR, a painful thyroid, no thyroid ab, and hyperthyroid.

A

de quervain’s

109
Q

what are three meds that can cause thyroiditis?

A

amiodarone
lithium
alpha interferon

110
Q

tx of medication induced thyroiditis

A

stop med

can do steroids

111
Q

mc cause of acute thyroiditis?

A

staph aureus

112
Q

riedel’s thyroid is what kind of thyroid?

A

fibrous thyroid

113
Q

what med may increase t4 requirements?

A

cholestyramine

prevents reabsorption of bile

114
Q

best initial test for thyroid nodule

A

FNA

115
Q

mc type of thyroid nodular?

A

follicular adenoma

follicular = frumpy

116
Q

what % of thyroid nodules are benign?

A

90%

117
Q

what do you do if a FNA of a thyroid nodule is undeterminate? (10% are)
benign?
malignant?

A

radioactive uptake scan
benign- prob needs meds in a couple years
malignant- excise

118
Q

how often do you check a suspicious thyroid nodule?

A

q 6-12 months

119
Q

mc type of thyroid cancer

A

papillary carcinoma

“papillary= popular”

120
Q

put the 4 types off thyroid carcinomas in increasing order of worse prognosis

A

papillary
follicular
medullary
anaplastic

121
Q

which thyroid cancer is associated with MEN2?

radiation? iodine deficiency?

A

MEN2- medullary
radiation- papillary
iodine- follicular

122
Q

which thyroid cancer secretes calcitonin?

A

medullary

123
Q

which thyroid cancer requires radiation and chemo and is not amenable to surgical resection?

A

anaplastic

124
Q

mc cause of primary hyperparathyroidism? secondary?

A

parathyroid adenoma

secondary- kidney failure from lack of vit d=> ca

125
Q

what are reflexes in hyperparathyroidism

A

decreased deep tendon

126
Q

dx of 1 hyperparathyroidism?

A

hypercalcemia
increased PTH
decreased phosphate
calcium in urine (24 hour collection)

127
Q

tx of hypercalcemia

A

iv fluids

furosemide

128
Q

signs of hypoparathyroidism?

A

decreased calcium
decrease PTH
increased phosphate

increased deep tendon reflexes, tetany
carpopedal spasms
trousseau’s sign- flexed hand
chvostek’s sign- facial spasm with tapping

129
Q

mc pathologic fracture of osteoporosis?

A

vertebral

130
Q

what are the risks of tx osteoporosis with estrogen in women?

A 
stroke
CAD
endometrial cancer
breast cancer
DVTs
131
Q

blue-tinted sclerae and presenile deafness goes with what disease?

A

osteogenesis imperfecta

132
Q

chronic renal disease causes what bone pathologies?

A

osteitis fibrosis cystica
osteomalacia

from lack of conversion of vit D

133
Q

why does CKD cause bone pathologies?

A

kidney don’t convert vit D to active form, decreased ca absorption and ca levels, which increased PTH

PTH causes osteoclasts to release ca into the blood bone is weakened

134
Q

what labs are off in CKD in relation to bones?

A

decreased Ca
increased phosphate P04 because it can’t excrete it
increased PTH

135
Q

how do you manage renal osteodystrophy?

A

phosphate binders
Ca
active vit D
cinacalcet lowers PTH levels

136
Q

how is osteomalacia different than osteoporosis?

A

osteomalacia= lack of vit D, corticol thinning (osteoid demineralization) “soft”

osteoporosis= bone breakdown > bone formation, mineral and matrix loss proportional “brittle”

137
Q

tx of osteomalacia

A

vit D ergocalciferol

d2

138
Q

MC of adrenocortical insufficiency overall? primary?

A

exogenous use

primary ie adrenal gland problem = addison’s = autoimmune

2ry and 3ry are uncommon

139
Q

what infections causes adrenal insufficiency?

A

TB
HIV
(cause calcification)
there are others

140
Q

in 2ry and 3ry adrenal insufficiency why is aldosterone normal but cortisol low?

A

RAAS system provides aldosterone and it’s just converted by the adrenal gland (which is still working because the problem is 2ry or 3ry)
so symptoms are due to lack of cortisol

remember aldosterone controls salt

141
Q

in primary adrenal insufficiency what causes the symptoms?

A

lack of
aldosterone
sex hormones
increased ACTH

142
Q

first line tx in established 2ry adrenal insufficiency?

A

hydrocortisone

interferes with testing so use prednisone/dexamethasone if not dx

aldosterone maintained by RAAS

143
Q

tx for addisons?

A

glucocorticoid + mineralcorticoid

hydrocortisone + fludrocortisone

144
Q

mc cause of cushing’s overall?

A

exogenous

145
Q

mc endogenous cause of cushings?

A

pituitary adenoma

146
Q

a low dose dexamethasone test does what?

A

dx cushings

ie there is no suppresion

147
Q

a high dose dexamethasone test does what?

A

differentiates cushing’s from an adrenal/ectopic ACTH releasing tumor

148
Q

cushing disease vs syndrome

A

disease = from pituitary increased ACTH ie 1 specific cause

syndrome = increased cortisol ie general

149
Q

what are two common causes of hyperaldosteronism?

A 
renal artery stenosis (from increased renin)
adrenal aldosteronoma (conn's syndrome)
150
Q

what are the 2 main clinical manifestations of hyperaldosteronism?

A

hypertension

hypokalemia

151
Q

how to dx hyperaldosteronism?

A
  1. hypokalemia with metabolic alkalosis (losing K and H for Na)
  2. saline infusion test- will not suppress aldosterone = definitive test
  3. aldosterone to renin ration: if aldo> R is >20 its 1ry
    if renin levels are high then its 2ry
  4. CT/MRI to look for extra-adrenal mass
152
Q

what are the symptoms of pheochromocytoma?

A 
htn
PHE
palpiations
headache
excessive sweating
153
Q

how do you dx pheochromocytoma?

A

24 hour urinary catecholamines

154
Q

what do you give perioperatively when removing a pheochromocytoma?

A

phenoxybenzamine or phentolamine
ie alpha blockers
also “phe”

155
Q

how often are pheochromocytoma’s benign?

A

90%

156
Q

tsh deficiency in infancy is called what?

A

cretinism

157
Q

mc type of anterior pituitary tumor

A

prolactinoma

158
Q

study of choice to look for anterior pituitary tumors

A

MRI

159
Q

primary tx for prolactinoma?

A

medical

bromocriptine or cabergoline (dopanie agonists inh prolactin)

160
Q

name 2 dopamine agonists

A

cabergoline

bromocriptine

161
Q

what does dopamine inhibit

A

prolactin

162
Q

gynecomastia is due mainly to what hormones?

A

increased estrogen

decreased androgens

163
Q

how do you dx gynecomastia

A

its clinical

164
Q

medical tx of gynecomastia?

A

SERMs ie tamoxifen
or
aromatase inh

165
Q

mc cause of end stage renal disease =

A

dm

166
Q

tx for unconscious diabetic?

A

IV bolus D50
or
inject glucagon SQ

167
Q

when do you start an ACE in DM?

A

if microabluminuria

168
Q

rapid acting insulins: onset and duration

A

novolog
humalog

15-30 min
3-4 hours

169
Q

short acting insulin: onset and duration

A

regular

30-1hr
4-6 hour

170
Q

intermediate insulin: onset and duration

A

NPH

2-4 hours
16-20 hrs

171
Q

long acting insulin: onset and duration

A

lantus, levemir

4 for lantus
6-8 for levemir

24-36 hours

172
Q

dawn phenomenon

A

rise in glucose between 2-8 am

needs bedtime NPH and avoid carbs at night

173
Q

somogyi effect

A

hypoclycemia at night followed by hyperglycemia from growth hormone surge

avoid NPH at night, have snack

174
Q

management of DKA?

A
  1. fluid of NS .9% until hypotension resolves, then .45% normal saline, then D5 1/2 NS when blood glucose gets to 250
  2. regular insulin
  3. K replacement
175
Q

MEN 1 has what tumors?

A

the P’s

pancreas, parathyroid, pituitary

176
Q

what tumors are in MEN2?

A

parathyroid
medullary thyroid
pheochromocytoma

parathyroid is in 1 & 2

177
Q

what drug is a common cause of nephrogenic diabetes insipidus?

A

lithium

178
Q

Is central or nephrogenic Diabetes insipidus MC?

A

central

head trauma
decreased ADH production

179
Q

what differentiates between central or nephrogenic DI?

A

desmopressin test

180
Q

tx of nephrogenic DI?

A

hydrochlorothiazide

181
Q

mc symptom of paget’s disease?

A

bone pain

182
Q

what lab is elevated in paget’s disease?

A

ALP

183
Q

tx for paget’s disease?

A

bisphosphonates

it inh osteoclast activity which stop bone remodeling

184
Q

SE of bisphosphonates

A

esophagitis

femur fracture

185
Q

what hormone primarily regulates water?

A

ADH

PANCE Prep/ Green Book (9 decks)

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