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PANCE > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Adrenal Insufficiency

- MCC primary

A

autoimmune adrenalitis in US

infectious such as TB worldwide

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2
Q

Adrenal insufficiency

- drug cases of primary

A

ketoconazole

mitotane

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3
Q

Adrenal Crisis

- clinical

A
  • vasodilatory shock
  • fatigue
  • weakness
  • abdominal pain
  • nausea / vomiting
  • weight loss
  • confusion
  • lethargy
  • coma.
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4
Q

Primary Adrenal insufficiency

- clinical

A
  • fatigue
  • weakness
  • malaise
  • weight loss
  • hyperpigmentation
  • abd pain
  • n/v
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5
Q

Secondary adrenal insufficiency

  • MCC
  • clinical
A

abrupt cessation in steroids

  • fatigue
  • weakness
  • malaise
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6
Q

Adrenal insufficiency

- lab findings

A
  • hyponatermia
  • hyperkalemia
  • hypoglycemia
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7
Q

Adrenal insufficiency

- Screening test

A

serum cortisol: if normal or high can r/o

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8
Q

Adrenal insufficiency

- test to distinguish between primary and secondary

A

Plasma corticotropin level (ACTH)

  • primary: high
  • secondary: low

*corticotropin stim test can be used to support dx of primary - cortisol levels will not increase

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9
Q

Klinefelter Syndrome

- describe

A
  • MC sex chromosome abnl
  • causes primary hypogonadism
  • 47, xxy karyotype
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10
Q

Klinefelter Syndrome

- clinical

A
  • present after puberty
  • gynecomastia
  • infertility
  • decreased body hair, energy, libido, and muscle mass
  • Small, firm testes
  • tall stature
  • long limbs
  • Sparse facial hair.
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11
Q

Klinefelter Syndrome

- labs

A
  • testosterone: low

- FSH/LH: normal

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12
Q

Klinefelter Syndrome

- at risk for 3 things

A
  1. testicular cancer
  2. autism spectrum disorders
  3. Social challenges
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13
Q

PTH

- 3 functions

A
  1. release of Ca from bone
  2. Increase of intestinal Ca absorption BY increasing production of calcitriol (active vitamin D)
  3. Increases tubular reabsorption of Ca in distal renal tubules
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14
Q

Hyperparathyroidism

- MCC

A

parathyroid adenoma

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15
Q

Hyperparathyroidism and MEN1

- risk for what

A

parathyroid adenomas and carcinomas

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16
Q

Hyperparathyroidism

  • MC presenting sx
  • other sx
A

None :)

- signs of hypercalcemia: bones, stones, moans, and groans

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17
Q

Thyroid storm

- pharm management in order

A
  1. beta blocker
  2. Thionamide (PTU/methimazole): blocks thyroid hormone synthesis
  3. Iodine: inhibits release of stored thyroid hormone
  4. steroids: decreases peripheral conversion of T4 to T3
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18
Q

Pheochromocytoma

- dx testing

A
  • Fractionated metanephrines and catecholamines in 24 hour urine collection
  • Plasma fractionated metanephrines
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19
Q

Pheochromocytoma

- mgmt

A
  • sx resection
  • pre-surgical alpha and beta-adrenergic blockade to prevent hemodynamic swings (PHEnoxyenzamine and PHEntolamine first, then BB)
20
Q

Dyslipidemia

- Screening if higher risk (RF to look for and age range by sex)

A

RF: HTN, DM, Cigs, fam hx of premature coronary heart disease.
Men: initiate 25-30
Female: initiate 30-35

21
Q

Dyslipidemia

- Screening if not high risk

A
  • Men: start at 35
  • Females: start at 45
  • not recommended to screen once >75 yo
22
Q

Diabetes insipidus

- 2 types

A
  • central: decreased secretion of antidiuretic hormone (ADH)

- nephrogenic: decreased sensitivity to ADH in the kidneys

23
Q

Central Diabetes insipidus

  • Dx
  • tx
A
  • Vasopressin challenge test: > 50% increase in urine osmolality and decrease urine volume
  • Intranasal DDAVP
24
Q

Nephrogenic Diabetes Insipidus

  • Dx
  • tx
A
  • water deprivation test: no change in urine osmolality

- Hctz, amiloride, indomethacin

25
Q

Diabetes insipidus

- labs

A
  • increase in plasma osmolality

- decrease in urine osmolality

26
Q

Metabolic syndrome

- mgmt

A
  • Lifestyle: healthy diet, regular physical activity

- Meds: orlistat, liraglutide, lorcaserin (phentermine and topiramate), phentermine mono therapy

27
Q

Metabolic syndrome

- Pros/Cons to each med

A
  • Liraglutide: good for T2DM, reduces risk of MI in people with DM
  • Orlistat: GI ADR
  • Lorcaserin: Similar to orlistat with fewer ADR
  • phentermine: CI in uncontrolled HTN
28
Q

What is the most important modifiable risk factor for type II diabetes in the US?

A

Obesity

29
Q

Bisphosphonates

- MOA

A

inhibit osteoclast activity (reduces bone reduction and turnover)

30
Q

Osteoporosis

- MC fx

A
  • vertebral body compression fractures
31
Q

Myxedema coma

- tx

A
  • thyroid hormone (levothyroxine AND liothyronine)
  • glucocorticoids (until coexisting adrenal insufficiency is ruled out)
  • supportive care
32
Q

Thyroid nodule

- first step in workup

A

TSH

  • if nl/high: hypothyroidism
  • subnormal/low: hyperthyroidism and hyperfunctioning nodule
33
Q

Thyroid nodule with low TSH

- next steps in w/u

A
  • Thyroid scinigrpahy

- If cold or indeterminate then FNA bx

34
Q

Turner Syndrome

- overview

A
  • sex chromosome disorder
  • females
  • 45, XO
35
Q

Turner Syndrome

- clinical

A
  • MC short stature with stocky appearance
  • shield chest
  • widely spaced nipples
  • short, webbed neck
  • small mandible
  • high arched palate
  • low set ears
  • low hairline
    scoliosis and kyphosis
  • premature ovarian failure
  • no breast development
  • primary amenorrhea (can have normal puberty)
36
Q

Turner sydnrome

- MC cardio issues

A
  • coarctation of aorta
  • bicuspid aortic valve
  • dyslipidemia
  • HTN
37
Q

Thyroid nodule

- characteristics that increase likelihood of malignancy

A
  • irregular margins
  • taller than wide
  • microcalcification
  • diameter >1 cm
  • heterogeneous nodule echogenicity
38
Q

Thyroid Cancer

- 4 types

A
  • Papillary (MC), best prognosis
  • Follicular
  • medullary
  • anaplastic, worst prognosis/most aggressive
39
Q

Medullary thyroid cancer-

A

neuroendocrine tumors

  • produce calcitonin
  • may be part of MEN
40
Q

Thyroid cancer

- dx

A
  • initial: US

- Confirmation: FNA bx

41
Q

Subacute thyroiditis

- progression

A
  • damage to thyroid cells
  • hyperthyroid first as thyroid hormone is released
  • hypothyroid second until thyroid cells regenerate and can produce thyroid hormone again
42
Q

Subacute thyroiditis

- mgmt

A
  • Analgesia: NSAIDs, prednisone
  • BB: hyperadrenergic sx if present
  • Levothyroxine in some cases but usu not needed
  • thionamides have no role!
43
Q

Cushings

- dx

A
  • 24 hour urinary free cortisol excretion
  • late night salivary cortisol
  • low-dose dexamethasone suppression test
  • ACTH levels
44
Q

Cushings

- MCC

A

ACTH-secreting pituitary tumor

45
Q

T2DM

- screening for nephropathy

A
  • urine albumin-to-creatinine ratio
  • yearly beginning at time of dx
  • nl: <30
  • Persistent: 30-300, severe >300
46
Q

Diabetic nephropathy

- tx

A
  • ACE-i/ARB
  • tight glycemic control
  • BP control

PANCE (14 decks)

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