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SmartyPance:Endocrine > Endocrine Comp - Sheet1 (1) > Flashcards

Endocrine Comp - Sheet1 (1) Flashcards

1
Q

What is Somogyi effect?

A

Somogyi is AM hyperglycemia triggered by insulin related hypoglycemia

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2
Q

Define Dawn effect.

A

AM hyperglycemia triggered by physiological release of cortisol growth hormone and catecholamines

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3
Q

Which lipid lowering medication should be avoided in a patient who has gout?

A

Niacin

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4
Q

Define metabolic syndrome.

A

Metabolic Syndrome: 3 or more of the following: Abdominal obesity - Increased triglycerides - Decreased HDL - HTN - Hyperglycemia

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5
Q

What endocrine disorder can Tolvaptan cause?

A

Nephrogenic diabetes insipidus

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6
Q

What are increased levels of beta-hydroxybutyrate diagnostic of?

A

Diabetic Ketoacidosis (DKA)

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7
Q

What is Sipple syndrome?

A

MEN 2a (Hyperparathyroid - Medullary thyroid cancer - Pheochromocytoma)

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8
Q

What is Wermer’s syndrome?

A

MEN 1 (Parathyroid tumors - Pituitary - Pancreatic)

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9
Q

Is central or nephrogenic diabetes insipidus more likely to respond to desmopressin?

A

Central (Nephrogenic is resistant to ADH and desmopressin is an ADH analog)

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10
Q

In a patient with secondary corticoadrenal insufficiency, what would happen to cortisol levels after a cosyntropin stimulation?

A

Cortisol levels would increase

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11
Q

What does no change in cortisol levels after initiation of a cosyntropin stimulation indicate?

A

Primary corticoadrenal insufficiency

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12
Q

What is cosyntropin?

A

ACTH

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13
Q

How does hyperpigmentation differentiate hypocortisol states?

A

Hyperpigmentation occurs with primary corticoadrenal insufficiency (Addison’s disease)

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14
Q

How does Trousseau’s sign differ from Trousseau sign of malignancy?

A

Trousseau’s sign: Carpopedal spasm with inflation of BP cuff > SBP for > 3 minutes - Trousseau sign of malignancy: Migratory thrombophlebitis + GI or lung CA

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15
Q

Nodular goiter with hyperthyroidism without exophthalmos?

A

Plummer’s disease

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16
Q

What specific type of thyroiditis is Hashimoto’s thyroiditis?

A

Chronic lymphocytic thyroiditis

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17
Q

Initial hyperthyroidism which may occur with Hashimoto’s thyroiditis?

A

Hashitoxicosis

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18
Q

What is the only lipid lowering medication which has been shown to cause angioedema?

A

Ezetimibe

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19
Q

Which lipid lowering medication may cause flushing pruritus and nausea?

A

Niacin

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20
Q

Which DM medication is contraindicated in NYHA class III or IV heart failure?

A

Pioglitazone

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21
Q

Pancreatitis is a side effect of what two classes of oral DM medications?

A

DPP-4 inhibitors - GLP-1 analogs

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22
Q

Fruity or “acetone” breath is consistent with which hyperglycemic state?

A

Diabetic ketoacidosis

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23
Q

Which cholesterol medication may cause constipation and metabolic acidosis?

A

Bile sequestration agents

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24
Q

Which cholesterol medication may cause increase in blood glucose levels?

A

Niacin

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25
Q

Which cholesterol medications are best for LDL control?

A

Statins

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26
Q

Which medications commonly cause hyperlipidemia?

A

Protease inhibitors - Thiazide diuretics

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27
Q

What common endocrine disorder is associated with hyperlipidemia?

A

Hypothyroidism

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28
Q

List two long acting insulins

A

Insulin glargine - Insulin detemir

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29
Q

List three rapid acting insulins.

A

Insulin glulisine - Insulin lispro - Insulin aspart

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30
Q

What class of oral diabetic medication should not be given to patients with G6PD?

A

Sulfonylureas

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31
Q

Nausea and diarrhea are common side effects of which oral diabetic medication?

A

Metformin

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32
Q

List the risk factors for gestational diabetes.

A

Obesity - Maternal age - Family HX DM - Prior macrosomal birth

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33
Q

What are the two recommended treatment options for gestational diabetes?

A

Lifestyle changes and insulin

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34
Q

What values during a 24-28 week gestation 75 gm 2 hour GTT are diagnostic of DM?

A

One hour > 180 mg/dl - Two hour > 153 mg/dl

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35
Q

What fasting blood glucose level is diagnostic of gestational diabetes at any time during pregnancy?

A

> 92 mg/dl

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36
Q

List the four ADA recommended agents to add to metformin if needed.

A

Insulins (Basal first) - Sulfonylureas - Pioglitazone - GLP-1 agonists

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37
Q

What is the initial treatment strategy for type 2 DM as per the ADA?

A

Metformin + lifestyle changes

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38
Q

What is the BP goal for diabetic patients?

A

< 130/80

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39
Q

Which vaccines are recommended for diabetic patients?

A

Influenza vaccine annually and pneumococcal vaccination every 5-7 years

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40
Q

List the recommended screening for diabetics.

A

HbA1C Q 6 months - Annual: Monofilament testing for neuropathy - Dilated retinal exam - UA microalbumin - Lipid screening - PVD screening

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41
Q

Polydipsia polyuria with a blood glucose of 842 mg/dl without metabolic acidosis suggests?

A

Hyperosmolar non-ketotic hyperglycemia

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42
Q

What are the relative contraindications to metformin use?

A

Heart failure - Liver disease - EtOH abuse - Hypo-perfusion states

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43
Q

What are the absolute contraindications to metformin?

A

Serum creatinine > 1.5 Men > 1.4 women

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44
Q

What is the primary treatment strategy for type 1 diabetes?

A

Insulin therapy

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45
Q

At least one of the four diagnostic criteria must be present to diagnose DM. List all four.

A

Fasting BG > 126 mg/dl - HbA1C > 6.5% - BG > 200 @ 2 hours on GTT - Random BG > 200 plus signs and symptoms

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46
Q

What do bitemporal hemianopsia and galactorrhea suggest?

A

Pituitary tumor

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47
Q

What disorder is most likely with Polydipsia, polyuria, increased serum osmolality and decreased Urine osmolality?

A

Diabetes insipidus

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48
Q

Which disorder causes osteoporosis, bone pain, renal calculi GI symptoms and psychosis?

A

Hyperparathyroidism

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49
Q

How does Ezetimibe work?

A

Blocks intestinal absorption of cholesterol

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50
Q

What laboratory test can be drawn to confirm myalgia is due to statin therapy?

A

Serum creatine phosphokinase

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51
Q

What is the most common cause of gynecomastia in adults?

A

Medication or drugs

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52
Q

Treatment of choice for central diabetes insipidus (DI) and DI associated with pregnancy?

A

Desmopressin

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53
Q

What is the treatment of choice for Cushing’s Disease?

A

Trans sphenoidal resection of the pituitary adenoma or surgical resection of ectopic cortisol producing tumor and cortisol (hydrocortisone or fludrocortisone) replacement if needed

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54
Q

What is the most likely cause of acromegaly?

A

Pituitary adenoma

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55
Q

What is the HDL level which is considered to be protective?

A

HDL over 60 mg/dL

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56
Q

What does a fasting glucose of 100-125 indicate?

A

Impaired glucose tolerance

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57
Q

What fetal effects does gestational diabetes produce?

A

Macrosomia

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58
Q

Which type of thyroiditis has fever pain redness and neck mass?

A

Suppurative Thyroiditis - Most common cause staph or strep

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59
Q

What is the preferred test to set initial dosing of thyroid replacement?

A

TSH

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60
Q

What is the treatment for Hashimoto’s thyroiditis?

A

Lifetime replacement of thyroxine (T4) (levothyroxine or liothyronine)

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61
Q

What is the drug of choice to treat a pregnant/breast feeding patient with hyperthyroidism?

A

PTU in the first trimester then methimazole for rest of pregnancy (both are OK for nursing)

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62
Q

Decreased growth hormone from infancy results in which condition?

A

Dwarfism

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63
Q

Frontal bossing, tall stature and macroglossia represent which disorder?

A

Acromegaly

64
Q

What are the cardinal signs and symptoms of Cushing syndrome or disease?

A

Buffalo hump - Moon face - Blue abdominal striae - Truncal obesity - Hyperglycemia - Hypertension

65
Q

List four drugs which cause thyroiditis.

A

Lithium - Amiodarone - Interferon alpha - Interleukin-2

66
Q

Salt craving hyperpigmentation of skin and fatigue represent which disorder?

A

Addison’s

67
Q

What does a cold nodule on thyroid uptake scan likely represent?

A

Malignancy

68
Q

List two common presentations which are consistent with pituitary adenoma?

A

Temporal field loss of vision - Galactorrhea

69
Q

What is the most common cause of acromegaly?

A

Pituitary adenoma

70
Q

List three medications which may be used for Cushing patients who can not have surgical correction?

A

Mitotane - Metyrapone - Ketoconazole

71
Q

What screening should long term Cushing syndrome or disease patients have?

A

DEXA (Osteoporosis common in long term hyper-cortisol states)

72
Q

Decreased ACTH and high cortisol levels in a high dose dexamethasone suppression test is diagnostic for which disorder?

A

Cushing syndrome (primary) will result in decreased ACTH from the dexamethasone

73
Q

Increased ACTH result from a high dose dexamethasone suppression test is diagnostic for which disorder?

A

Cushing disease (secondary) will continue with increased ACTH despite the dexamethasone

74
Q

What result is expected with a low dose dexamethasone suppression test?

A

Decreased cortisol = Normal - Cushing disease or syndrome will result in persistent increased cortisol

75
Q

List three causes of Cushing syndrome?

A

Adrenal adenoma - Adrenal hyperplasia - Adrenal cancer

76
Q

Is Cushing’s disease or syndrome more common?

A

70% of patients have secondary (Cushing’s disease) from ACTH secreting tumors

77
Q

What test other than the dexamethasone suppression test can be used for Cushing disease?

A

Serum ACTH will be increased in Cushing’s disease (secondary)

78
Q

What test other than the dexamethasone suppression test can be used for Cushing syndrome or disease?

A

24 hour urine for cortisol will be increased in both

79
Q

What is the difference between Cushing syndrome and Cushing’s disease?

A

Syndrome is primary - Disease is secondary

80
Q

What happens to glucose blood pressure inflammation and metabolism in Cushing’s syndrome or disease?

A

Increased glucose - Increased blood pressure - Decreased inflammation - Increased metabolism

81
Q

What is the treatment for corticoadrenal insufficiency?

A

Hydrocortisone or fludrocortisone

82
Q

List four less common causes of primary corticoadrenal insufficiency?

A

Tuberculosis - Adrenal infection - Metastasis to adrenal gland - Adrenal trauma

83
Q

What is the most common cause of primary corticoadrenal insufficiency?

A

Addison’s disease

84
Q

What symptoms may result from abrupt withdrawal of long term high dose steroids?

A

Severe N/V/D - Significant hyponatremia - Hyperkalemia - Hypoglycemia

85
Q

A patient has decreased ACTH and increased cortisol. Is this primary or secondary disease?

A

Primary

86
Q

What basic metabolic panel finding might one find in a patient with Addison’s disease?

A

Hyponatremia

87
Q

What CBC finding might one find in a patient with Addison’s disease?

A

Eosinophilia

88
Q

List three osteoporosis treatments.

A

Bisphosphonates - Denosumab - Teriparatide

89
Q

What screening should hyperparathyroid patients undergo?

A

DEXA for osteoporosis

90
Q

What medication can be used for hyperparathyroidism?

A

What medication can be used for hyperparathyroidism?

91
Q

What is the most common treatment for primary hyperparathyroidism?

A

Surgical removal

92
Q

Are renal calculi are more common with hypo or hyperparathyroidism?

A

Hyperparathyroidism due to increased urinary excretion of calcium from the high serum calcium levels

93
Q

List the five hallmark signs and symptoms of hyperparathyroid disease.

A

Osteoporosis - Renal calculi - Bone pain - GI symptoms - Depression/psychosis

94
Q

What happens to serum and urinary calcium in hyperparathyroidism?

A

Increased PTH = increased Serum Ca++ and decreased Urine Ca++ initially but increased Urine Ca++ chronically

95
Q

Prolonged hypoparathyroidism can produce symptoms which mimic which neurological disorder?

A

Parkinson’s

96
Q

Prolonged hypoparathyroidism can result in what acute neurological event?

A

Seizure

97
Q

What is the treatment for hypoparathyroidism?

A

Oral calcium and vitamin D to keep serum calcium > 8

98
Q

What happens to serum and urinary calcium in hypoparathyroidism?

A

Decreased PTH = Decreased Serum Ca++ and increased Urine Ca++

99
Q

What are the three systems which parathyroid hormone affects to change calcium levels?

A

Intestinal absorption - Bone resorption - Renal reabsorption

100
Q

What is the sign? Ipsilateral facial contraction with tapping anterior to ear.

A

Chvostek’s sign

101
Q

What is the sign? Carpopedal spasm with inflation of BP cuff > systolic pressure for > 3 minutes.

A

Trousseau’s sign

102
Q

List two signs which can occur with hypoparathyroidism.

A

Trousseau’s sign - Chvostek’s sign

103
Q

Hypoparathyroidism may be caused by chronic depletion of which electrolyte?

A

Magnesium

104
Q

What is the most common cause of hypoparathyroidism?

A

Surgical removal

105
Q

In a patient with a cold thyroid nodule what procedure should be performed for definitive diagnosis?

A

Fine needle aspiration (FNA) biopsy

106
Q

List three genetic risk factors for thyroid cancer.

A

Familial medullary thyroid CA - MEN - Familial adenomatous polyposis

107
Q

What is the most common risk factor for thyroid cancer?

A

Radiation exposure

108
Q

List four etiologies for painless thyroiditis.

A

Postpartum - Drug induced - Chronic lymphocytic - Fibrous

109
Q

List four etiologies for painful thyroiditis.

A

Subacute thyroiditis - Radiation induced - Traumatic - Infectious

110
Q

What instructions regarding food should be given to a patient taking levothyroxine?

A

Take on an empty stomach many foods decrease absorption.

111
Q

Which medications can cause hyper or hypothyroidism?

A

Amiodarone and lithium

112
Q

List three medications which can cause hyperthyroidism.

A

Levothyroxine - Amiodarone - Lithium

113
Q

A hypothyroid patient has an increased TSH and an decreased Free T4. Is this primary or secondary disease?

A

Primary

114
Q

List three non-autoimmune causes of hyperthyroidism.

A

Toxic adenoma or multinodular goiter - Thyroiditis - Iatrogenic

115
Q

A hypothyroid patient has an decreased TSH and an decreased Free T4. Is this primary or secondary disease?

A

Secondary

116
Q

What is the most common cause of secondary hyperparathyroidism?

A

End stage renal failure

117
Q

Which antibodies are positive in both Hashimoto’s and Grave’s?

A

Anti-Thyroglobulin antibody and Antithyroid Peroxidase antibody

118
Q

What hyperthyroid condition can cause weight gain?

A

Heart failure due to high cardiac output

119
Q

List three non-autoimmune causes of hypothyroidism.

A

Thyroidectomy - Radioactive iodine - Medication (e.g. lithium amiodarone)

120
Q

Treatment of acute thyroid storm?

A

Beta blockers first then: Oral iodine compounds - Thioamides (methimazole, carbimazole, PTU)

121
Q

End stage kidney failure leads to what parathyroid problem?

A

Secondary hyperparathyroidism

122
Q

What do lithium and hyperparathyroidism have in common?

A

Calcium kidney stones

123
Q

What is the disorder? Anti- Thyroid Peroxidase antibody and + TSH receptor antibody

A

Grave’s disease

124
Q

Which thyroid problem most commonly causes weight gain?

A

Hypothyroidism

125
Q

Most common cause of hypothyroidism?

A

Autoimmune Hashimoto’s Thyroiditis

126
Q

Which class of HIV medication can cause hyperlipidemia?

A

Protease inhibitors

127
Q

Very high levels of which type of cholesterol may lead to pancreatitis?

A

Triglycerides > 500 may lead to pancreatitis

128
Q

What side effects should the patient be counseled on when starting niacin?

A

Flushing - Pruritus - Nausea - Vomiting - Diarrhea

129
Q

What is the only lipid medication which can cause angioedema?

A

Ezetimibe

130
Q

What are the two classes of lipid medication which can cause rhabdomyolysis?

A

Statins and fenofibrates - Chance for rhabdomyolysis increases when combined

131
Q

A 45 year old male is found on review of laboratory to have a fasting blood glucose of 116 and a HbA1c of 6.8. Can he be diagnosed with diabetes?

A

Yes - Criteria are fasting blood glucose >126 OR HbA1c > 6.5

132
Q

A patient with medullary thyroid cancer develops hypertension resistant to treatment. What secondary hypertension cause should be ruled out?

A

Pheochromocytoma - MEN 2a or MEN 2b

133
Q

A patient has polyuria, polydipsia and nocturia. Blood glucose and HbA1c are both normal. What labs should be checked to further investigate?

A

Serum sodium and osmolality (increased in diabetes insipidus) - Urine osmolality(decreased in diabetes insipidus)

134
Q

Will desmopressin (an ADH analog) successfully treat nephrogenic diabetes insipidus?

A

No - The kidneys are resistant to ADH in nephrogenic diabetes insipidus

135
Q

What lab value can assist in distinguishing hypernatremia from dehydration versus hypernatremia due to diabetes insipidus?

A

Urine osmolality - Diabetes insipidus: urine osmolality will be low - Dehydration: urine osmolality will be high

136
Q

A 42 year old male presents with galactorrhea and visual changes which consist of temporal field loss. What imaging is appropriate?

A

MRI to look for pituitary adenoma

137
Q

What is the specific type of procedure used to surgically treat acromegaly from a pituitary adenoma?

A

Trans-sphenoidal resection of pituitary

138
Q

What is the cause of 95% of acromegaly?

A

Pituitary adenoma

139
Q

A 21 year old male who is 6’8”, has acral enlargement and a BP of 160/95 mmHg presents. What imaging study would be appropriate as part of your work up?

A

MRI for pituitary adenoma

140
Q

How will height be affected in an patient who develops acromegaly in adulthood?

A

Height does not change if the acromegaly develops after the growth plates have closed

141
Q

How does the decreased growth hormone in pituitary dwarfism affect the growth plates?

A

Growth plates fibrose early but close later in children with pituitary dwarfism

142
Q

What are you concerned about in a patient who has no change in ACTH levels and has increased cortisol levels on a high dose dexamethasone suppression test?

A

Ectopic source of ACTH - e.g. lung tumor

143
Q

What is the best way to test cortisol levels in a patient with a suspect hypercortisol state?

A

24 hour urine cortisol

144
Q

Are increased cortisol levels with a cosyntropin test consistent with primary or secondary corticoadrenal insufficiency?

A

Secondary

145
Q

Is hyperpigmentation a sign of primary or secondary corticoadrenal insufficiency?

A

Primary

146
Q

A dialysis patient begins to complain of vague abdominal cramping, worsening fatigue and bone pain. What disorder is likely?

A

Secondary hyperparathyroidism

147
Q

Which type of parathyroid disorder are osteoporosis and abdominal cramping consistent with?

A

Hyperparathyroidism

148
Q

Chronic low serum levels of which electrolyte can lead to hypoparathyroidism?

A

Chronic hypomagnesemia can lead to hypoparathyroidism

149
Q

What three organ systems affect calcium levels in response to parathyroid hormone levels?

A

Intestinal absorption - Bone resorption - Renal excretion

150
Q

Which parathyroid disorder is Trousseau’s and Chvostek’s sign indicative of?

A

Hypoparathyroidism

151
Q

What findings on thyroid uptake scan would support the possibility of malignancy and warrant a fine needle aspiration of the nodule?

A

Cold nodule

152
Q

A patient presents with radiation induced thyroiditis. Do you expect to find a tender or non-tender thyroid on exam?

A

Tender

153
Q

A 34 year old female presents in thyroid storm with a BP of 210/110 mmHg and a heart rate of 124 bpm. What medication should be used first line?

A

Beta blockers are first line to deal with the emergent symptoms

154
Q

What is the preferred laboratory test to establish initial dosing in hypothyroidism?

A

TSH

155
Q

What term describes the initial hyperthyroidism that may occur prior to subsequent hypothyroidism in the beginning stages of Hashimoto’s thyroiditis?

A

Hashitoxicosis

156
Q

List two medications which may cause either hypothyroidism or hyperthyroidism.

A

Amiodarone and lithium

157
Q

A patient has weight gain, fatigue and brittle, dry hair. Her general screening labs find a TSH of 0.28. What is the most likely disorder?

A

Secondary hypothyroidism

SmartyPance:Endocrine (7 decks)

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