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my NPLEX II > endocrine > Flashcards

endocrine Flashcards

1
Q

acromegaly lab first line diagnostic test

A

Elevated insulin like growth factor (IGF-1)

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2
Q

Pituitary adenoma stimulation tests

A

triple bolus test of hypopituitarism

  1. Rapid IV infusion of insulin, GnRH, and TRH
  2. Insulin bolus leads to hypoglycemia which increases GH and ACTH/cortisol
  3. GnRH IV push increases LH and FSH
  4. TRH IV push increases TSH and PRL
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3
Q

lab increased in Grave’s disease

A

thyroid stimulating IMMUNOGLOBULIN (TSI)

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4
Q

HLA associations with Graves

A

HLA-B8 and HLA-DR3

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5
Q

hyperparathyroidism is usually caused by what?

A

parathyroid adenoma

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6
Q

lab for adrenal hyperfunction

A

24 hour urinary free cortisol

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7
Q

Serum ACTH is high or low in what conditions

A

high - primary adrenal insufficiency

low - secondary “ “

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8
Q

Tx for adrenocortical insufficiency (addison’s disease)

A
  • IV normal saline or D5W in large volumes

- Hydrocortisone 100mg IV every 6-8 hours for 24 hours, then taper

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9
Q

Electrolyte findings in adrenocortical insufficency (addisons)

A

hyponatremia
hyperkalemia
metabolic acidosis

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10
Q

lab findings in adrenocortical insufficency (addisons)

A
  • ACTH stimulation test shows NO inc in cortisol
  • electrolyte findings (low Na, high K)
  • high ACTH
  • low urinary cortisol
  • fasting hypoglycemia
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11
Q

Waterhouse-Friderichsen syndrome and anticoagulation therapy (neisseria mening) can cause what

A

acute adrenocortical insufficiency (adrenocortical hypofunction)

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12
Q

Cushing’s disease is excess cortisol due to what

A

ACTH-secreting pituitary adenoma

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13
Q

Labs for Cushing’s disease

A
  • elevated 24 hour urinary cortisol
  • increased cortisol after low dose of Dexamethasone suppression test
  • decreased cortisol after HIGH dose dexamethasone
  • subnormal total lymphocytes, low eosinophils, hyperinsulinemia, Abnormal OGTT, increased serum Ca+
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14
Q

what is hyperaldosteronism

A
  • inc aldosterone secretion leading to DIASTOLIC HTN WITHOUT EDEMA, decreased renin secretion, and metabolic alkalosis (b/c aldosterone increases H+ secretion)
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15
Q

Hyperaldosteronism is typically caused by

A

Conn’s syndrome (aldosterone-producing adrenal adenoma)

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16
Q

pheochromocytoma classic triad Sx

A
  1. episodic pounding H/A
  2. palpitations
  3. drenching sweats
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17
Q

food ingredient that can trigger pheochromocytoma Sxs

A

tyramine

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18
Q

labs for pheochromocytoma

A
  • urine catecholamines (increased VMA, HVA)
  • inc plasma metanephrines (MOST SENSITIVE)
  • plasma catecholamines (inc plasma epi unsuppressed by clonidine is DIAGNOSTIC)
  • hyperglycemia
  • CT abdomen
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19
Q

diagnostic medication for pheochromocytoma

A

Clonidine (epi is unsuppressed)

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20
Q

Type 1 DM HLA

A

HLA DR3 and DR4

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21
Q

pancreatic tumor (insulinoma) labs/imaging

A
  • increased serum insulin and C-peptide
  • Abdominal US
  • CT scan (not sensitive)
22
Q

Multiple Endocrine Neoplasia 1 (MEN I) common Sxs

A
  • kidney stones, stomach ulcers, Sxs of hyperparathyroidism and insulinoma
23
Q

MEN II common Sxs

A
  • Sxs related to medullary thyroid cancer (secretes calcitonin), hyperparathyroidism, or pheochromocytoma, scaly skin rash
24
Q

MEN I signs

A
  • gastrinoma (PUD, esophagitis)
  • glucagonoma (rare)
  • hyperparathyroidism (nephrolithiasis, bone abnormalities, MSK complaints)
  • pituitary tumor (HA, prolactinoma, acromegaly)
25
Q

MEN II signs

A
  • medullary thyroid cancer (goiter, LAD)

- pheochromocytoma (elevated BP, classic triad of pounding HA, palpitations, sweats)

26
Q

MEN I labs/imaging

A
  • elevated serum gastrin (after IV secretin- for gastrinoma)
  • elevated PTH (hyperparath)
  • examine GH, prolactin, blood glucose
  • MRI
27
Q

MEN II labs/imaging

A
  • calcitonin levels (medullary thyroid carcinoma)
  • Serum Ca and PTH levels (hyperpara)
  • urine catecholamines, VNA, metanephrines (pheochromocytoma)
  • CT or MRI on adrenals
28
Q

Tx of MEN I

A

PPI for gastrinoma

Bromocriptane (dopamine agonist) to suppress prolactin

29
Q

Tx of MEN II

A

surgery

  • alpha blocker for pheochromocytoma pre-operatively
  • hydration for hypercalcemia, consider calcitonin, IV bisphosphonates for hypercalcemia
30
Q

rehydration Tx of ketoacidosis from DM

A
  • 1 L/hr normal saline (0.9%NaCl) in first 2 hours
  • then 300-400 ml/hr 0.45 NS
  • when BG reaches 13.9, switch to D5W to maintain blood glucose
31
Q

when to add HCO3 for ketoacidosis rehydration

A

add to .45%NS if pH < 7 or Pt has hypotension, arrythmia, coma

32
Q

what drugs can mask signs of and prolong recovery from hypoglycemia

A

beta blockers

33
Q

what drugs can increase insulin requirements

A

thiazides and steroids

34
Q

what can decrease insulin requirements

A

alcohol, most NSAIDs, sulfonylureas, warfarin

35
Q

Pioglitazone may reduce levels of what

A

OCPs

36
Q

what drug can increase levothyroxine requirement

A

estrogens

37
Q

what drug can decrease levothyroxine absorption

A

Bile acid sequestrants

38
Q

Lugols solution interacts with what drugs

A
  • ACE-I’s
  • ARBs
  • diuretics
  • lithium
  • drugs with potassium in them
39
Q

Isotretinoin decreases efficacy of what

A

microdosed progesterone (use 2 forms of contraception)

40
Q

Isotretinoin may increase risk of bone loss/osteoperosis with what drugs

A

phenytoin, steroids

41
Q

Terbanafine (antifungal) increases effects of what drugs

A

SSRIs, Beta blockers, MAOI, warfarin; increases hepatotoxicity with hepatotoxic drugs

42
Q

What herb interacts with furosemide

A

Licorice (may cause rapid potassium loss)

43
Q

what drug does nitroglycerin increase effect of

A

sildenafil (viagra)

44
Q

antiHTN effect of HCTZ may be decreased with what drugs

A

steroids, NSAIDs

45
Q

HCTZ may enhance nephrotoxicity of what drug

A

NSAIDs

46
Q

HCTZ combined with what drugs may cause orthostatic hypotension

A

opioids, barbituates, alcohol

47
Q

Beta blockers decrease effect of what hormone

A

dopamine

48
Q

carbamazepine shortens half life of what drug

A

doxycycline

49
Q

carbamazepine reduces tolerance of what

A

alcohol

50
Q

carbamazepine reduces efficacy of what

A

OCPs

my NPLEX II (28 decks)

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