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U World Step 2 > Endocrine, Diabetes, & Metabolism > Flashcards

Endocrine, Diabetes, & Metabolism Flashcards

1
Q

Common causes of Cushing Syndrome

  1. Etiology
  2. Pathologic findings
A
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2
Q

Primary hyperaldosteronism

  1. Etiology
  2. Clinical features
  3. Diagnosis
  4. Treatment
A
  1. Treatment

Unilateral adenoma: adrenalectomy

Bilateral adrenal hyperplasia: Aldosterone antagonists (spironolactone, eplenerone)

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3
Q

Administration of a thiazide diuretic in primary hyperaldosteronism

A

After administering diuretics, potassium can fall rapidly:

Muscle weakness

Leg cramps

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4
Q

Hypercalcemia of malignancy

  1. Causes
  2. Clinical features
  3. Diagnosis
A
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5
Q

Diagnosis of hypercalcemia

A
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6
Q

Complications of Roux-en-Y gastric bypass surgery

  1. Early
  2. Late
A
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7
Q

Features of Cushing syndrome

  1. Clinical manifestations
  2. Diagnosis
A
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8
Q

Differentiating between ACTH-dependent and ACTH-independent hypercortisolism

A

ACTH-dependent (ACTH-secreting pituitary adenoma, ectopic ACTH production)

High ACTH can cause hyperpigmentation due to co-secretion of MSH and direct stimulation by MSH receptors.

ACTH increases androgen production from the zona reticularis of the adrenal cortex, leading to androgenic symptoms

ACTH-independent (e.g. exogenous glucocorticoids, adrenal adenoma)

No hyperpigmentation, no androgen excess

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9
Q

Lifestyle modifications for prevention of future gout attacks

A
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10
Q

Indications for medications to lower serum urate in patients with gout

A

Repeated and disabling attacks of gouty arthritis

Tophi suggesting chronic disease

X-ray evidence of chronic gouty joint disease

Uric acid kidney stones

Renal insufficiency

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11
Q

Oral colchicine

A

Treatment for gouty arthritis

Can be used for short-term therapy (<6 months) to prevent gouty attacks while patients start urate lowering drugs (e.g., allopurinol).

Can cause neuropathy or myopathy, especially in patients taking statins.

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12
Q

Allopurinol

Febuxostat

A

Xanthine oxidase inhibitors

Decrease uric acid production.

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13
Q

Probenecid

A

Increases uric acid excretion in the kineys

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14
Q

Pheochromocytoma

A

Hypertension

+

Classic triad: headaches, tachycardia, diaphoresis

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15
Q

Pheochromocytoma

  1. Pathogenesis
  2. Symptoms
  3. Rule of 10s
  4. Diagnosis
A
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16
Q

Medical management of pheochromocytoma

A

Alpha blockade (phenoxybenzamine), then beta blockade

Unopposed beta blockade should be initiated first because administration of beta blockers alone can cause unopposed alpha adrenergic effects, leading to severe peripheral vasoconstrction and a paradoxical rise in blood pressure

Definitive treatment is adrenalectomy

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17
Q

High anion gap metabolic acidosis (mnemonic)

A
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18
Q

Calculating anion gap

A

Sodium - [Cl- + HCO3-]

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19
Q

Renal tubular acidosis Type I

Renal tubular acidosis Type II

A

Both cause non-anion gap metabolic acidosis

Type I: Impaired urine acidification in the distal renal tubules

Tyle II: Impaired urine acidification in the distal renal tubules occurs in RTA type I

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20
Q

When to give insulin + dextrose in DKA

A

If blood glucose <250

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21
Q

Diabetic ketoacidosis in children

  1. Clinical features
  2. Laboratory
  3. Workup
  4. Management
  5. Complications
A
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22
Q

Clinical manifestations of Graves disease

  1. General
  2. Eyes
  3. Skin
  4. Cardiovascular
  5. Nails
  6. Endocrine
  7. GI
  8. Neurology
A
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23
Q

Evaluation of secondary amenorrhea

A

Hypothyroidism can cause a variety of menstrual abnormalities anormalities, including amenorrhea, irregular menses, menorrhagia. Can also cause hyperprolactinemia with associated galactorrhea.

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24
Q

First line treatment for severe hypertriglyceridemia secondary to familial dysbetalipoproteinemia

A

Fibric acid derivatives

e.g., fenofibrate

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25
Q

Hypopituitarism with a mild to moderate increase in prolactin

A

Nonfunctioning (gonadotroph) adenoma

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26
Q

Common causes of hypogonadism in men

  1. Primary (testicular)
  2. Secondary (pituitary/hypothalamic)
  3. Combined (primary and secondary)
A
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27
Q

Autonomous thyroid hormone production

A

Occurs without stimulation by TSH

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28
Q

Evaluation of hyperthyroidism

29
Q

Steroid hormone synthesis pathways

30
Q

Differentiating between types of CAH

  1. Enzyme deficiency
  2. Hormonal abnormalities
  3. Symptoms
31
Q

Milk-alkali syndrome

  1. Pathophysiology
  2. Symptoms
  3. Laboratory findings
  4. Treatment
32
Q

Common causes of myopathy

  1. Connective tissue diseases
  2. Endocrine/metabolic
  3. Drugs/toxins
  4. Miscellaneous
33
Q

Thyrotoxicosis with increased versus decreased radioactive iodine uptake (RAIU)

34
Q

Management of hyperprolactinemia in premenopausal women

35
Q

Diagnosis of hypercalcemia

36
Q

PTH, vitamin D, and calcium axis

37
Q

Euthyroid sick syndrome

A

“Low T3 syndrome”

Characterized by a fall in total and free T3 levels with normal T4 and TSH

Any patient with an acute, severe illness may have abnormal thyroid function tests

38
Q

GLP-1 agonists & DPP-IV inhibitors

39
Q

Oral Diabetes Medications

  1. Medication
  2. Decrease in A1C
  3. Points to remember
40
Q

Pathogenesis of refeeding syndrome

A

Refeeding syndrome is the constellation of pathologic derangements resulting from a surge in insuline activity as the body resumes anabolism. Carbohydrate ingestion causes pancreastic insulin secretion and cellular uptake of phosphorus, potassium, and magnesium.

Phosphorus is required for energy (ATP)

Deficiencies in potassium and magnesium potentiate cardiac arrhythmias and cardiopulmonary failure).

41
Q

Workup for hypertension and hypokalemia

A

Primary hyperaldosteronism: Prone to diruetic-induced hypokalemia

Metabolic alkalosis

Mild hypernatremia

No edema bc of aldosterone escape

42
Q

Drugs for neuropathic pain

  1. Drug
  2. Mechanism of action
43
Q

Chronic primary adrenal insufficiency

  1. Etiology
  2. Clinical features
  3. Diagnosis
A

Autoimmune adrenalitis is responisble for >90% of cases of PAI in developed countries

44
Q

Evaluation of suspected hyperaldosteronism

45
Q

Differential diagnosis of hyperandrogenism in females

  1. Diagnosis
  2. Clinical features
46
Q

Clinical features of primary hyperaldosteronism

  1. Clinical presentation
  2. Diagnosis
  3. Treatment
47
Q
A

Signs of hypocalcemia

High-volume blood transfusion can cause symptomatic hypocalcemia due to chelation of ionized calcium ions by citrate in transfused blood. Patients with impaired hepatic function are at increased risk due to decreased clearance of citrate by the liver.

48
Q

Acute hypocalcemia

  1. Causes
  2. Clinical features
  3. Treatment
49
Q

Carcinoid tumors

A

Slow-growing tumors most commonly in the distal small intestine, proximal colon, lung.

Secrete histamine, serotonin, vasoactive intestinal peptide (all metabolized in liver)

GI carcinoid tumors often metastasize to liver, and then these hormones are released into systemic circulation without being metabolized.

50
Q

Features of carcinoid syndrome

  1. Clinical

Skin

GI

Cardiac

Pulmonary

Misc

2. Diagnosis

  1. Treatment
A

Carcinoid cells cause increased production of serotonin form tryptophan (required for niacin synthesis), resulting in niacin deficiency (i.e. dermatitis, diarrhea, dementia)

51
Q

Important gluconeogenesis substates & steps

52
Q

Clinical features of osteomalacia

  1. Causes
  2. Symptoms/signs
  3. Diagnosis
A

Osteomalacia is due to defective mineralizaton of the organic bone matrix.

53
Q

Primary hyperthyroidism

  1. Calcium
  2. Phosphate
  3. Parathyroid hormone
A
  1. Calcium: Low
  2. Phosphate: Low
  3. Parathyroid hormone: High
54
Q

Osteoperosis and Paget’s disease

  1. Calcium
  2. Phosphate
  3. Parathyroid hormone
A
  1. Calcium: Normal
  2. Phosphate: Normal
  3. Parathyroid hormone: Nromal
55
Q

Common clinical features of acromegaly

  1. Local tumor effect
  2. Musculoskeletal/skin
  3. Cardiovascular
  4. Pulmonary/GI
  5. Englarged organs
  6. Endocrine
56
Q

Differential diagnosis of myopathy (Disorder, clinical features, ESR, CK)

  1. Glucocorticoid-induced myopathy
  2. Polymyalgia rheumatica
  3. Inflammatory myopathies
  4. Statin-induced myopathy
  5. Hypothyroid myopathy
A

Glucocorticoids cause muscle atrophy

57
Q

Late-onset (nonclassic) congential adrenal hyperplasia

A

21 hydroxylase deficiency

Manifests in late childrhood with signs of androgen excess

Advanced bone age, coarse axillary and pubic hair, severe cystic acne

58
Q

Maternal thyroid testing in pregnancy, first trimester

(Hormone, change, mechanism)

  1. Total T4
  2. Free T4
  3. TSH
59
Q

Potassium iodide

A

Inhibits thyroid horone synthesis and release

Used mainly in preparation for thyroidectomy in Graves disease and treating thyroid storm

60
Q

Choice of treatment in Graves hyperthyroidism

1. Antithyroid drugs

  1. Radioactive iodine
  2. Thyroidecotmy
A
  1. Antithyroid drugs: propylthiouracil, methimazole
61
Q

Screening for diabetes

A

Adults with blood pressure >135/90

Age >= 45

BMI >25 + additional risk factors

62
Q

Screening tests for diabetes mellitus (Test, interpretation)

  1. A1C
  2. Fasting blood glucose
  3. Fandom glucose levels
  4. Oral glucose tolerance test
63
Q

Pneumococcal vaccice guidelines

A

All adults >=65: PCV13, followed by PPSV23 6-12 months later

All adullts <65 with certain very high risk conditions: PCV13, followed by PPSV23 6-12 months later

Adults <65 who are current smokers or who have chronic medical conditions: PPSV23 alone

64
Q

Lung Cancer Screening Recommendations

A

Annual low-dose CT screening for lung cancer in adults age 55-80 with a >=30 pack-year smoking history who currently smoke or have quit in the last 14 years.

65
Q

Diabetic foot ulcers

  1. Risk factors
  2. Location
  3. Management
66
Q
A

Follicular thyroid cancer

Peak incidence 40-60

Firm thyroid nodule

Invasion of the tumor capsule/blood vessels

67
Q
A

Papillary thyroid cancer

Large cells with ground glass cytoplasm

Pale nuclei with inclusion bodies and central grooving

Psammoma bodies (grainy, lamellated calcifications)

68
Q

Fever and sore throat in a patient taking

Propylthiouracil

Methimazole

A

Suspect agranulocytosis

Stop drug and check WBC

69
Q

Diagnostic approach to hypocalcemia

U World Step 2 (22 decks)

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