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Clin Med II Disease Key Notes > Endocrine (Exam #4) > Flashcards

Endocrine (Exam #4) Flashcards

1
Q

Overweight is…

A

BMI of 25% to 29.9%

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2
Q

Obese is…

A

BMI of 30+%

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3
Q

What waist circumference in men is associated with increased cardiometabolic risk? In women?

A
  • 40+ inches in men

- 35+ inches in women

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4
Q

What condition involves chronic disease where increased body fat promotes adipose tissue dysfunction?

A

OBESITY

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5
Q

What is a negative energy balance and what is it associated with?

A

Obesity

- Increasing activity and decreasing calories consumed

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6
Q

What are the three “best diets” for obese patients?

A
  • Mediterranean
  • DASH
  • Flexitarian
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7
Q

Intermittent fasting has been shown to promote weight loss, improve lipids, reduce BP/BS/HbA1c independent of what?

A

Independent of exercise

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8
Q

What is an important modifiable risk factor associated with obesity?

A

Physical activity

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9
Q

Physical inactivity is linked to what?

A

Reduced life expectancy

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10
Q

Who should be screened for obesity?

A

ALL adults

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11
Q

What is the recommended treatment for obesity (BMI of 30+)?

A

Intensive, multicomponent behavioral intervention

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12
Q

What are the 5 A’s of nutritional counseling? Which is the rate limiting step?

A
  • Ask/address
  • Advise
  • Assess = RLS
  • Assist
  • Arrange
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13
Q

For what group is diet and exercise to prevent weight gain an appropriate treatment?

A

Low risk

- BMI 25-29.9 WITHOUT CVD risks or other comorbidities

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14
Q

For what two groups is intensive, multicomponent behavioral intervention, maybe drug therapy an appropriate treatment?

A

Moderate risk
- BMI 25-29.9 WITH 1+ CVD risks or other comorbidities
OR
- BMI 30-34.9

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15
Q

For what two groups is intensive, multicomponent behavioral intervention +/- drug therapy/bariatric an appropriate treatment?

A

High risk
- BMI 35-40

Very High risk
- BMI 40+

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16
Q

What is ALWAYS the first line treatment for obesity?

A

Comprehensive lifestyle changes

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17
Q

Which obesity drug therapy is associated with “unpleasant” GI side effects?

A

Orlistat (Alli)

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18
Q

Which obesity drug therapy may decrease absorption of fat-soluble vitamins?

A

Orlistat (Alli)

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19
Q

Which obesity drug therapy is daily SQ injection; common choice in Type II DM?

A

Liraglutide (Victoza)

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20
Q

Which obesity drug therapy is a selective Serotonin agonist?

A

Lorcaserin (Belviq)

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21
Q

Which obesity drug therapy decreases appetite?

A

Lorcaserin (Belviq)

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22
Q

Which two obesity drug therapies should NOT be used in patients with HTN, CA, hyperthyroidism?

A
  • Phentermine/Topiramate (Qsymia)

- Phentermine

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23
Q

Which obesity drug therapy is most widely prescribed?

A

Phentermine

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24
Q

Which obesity drug therapy is only approved for short-term use because more AEs/potential for abuse?

A

Phentermine

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25
Q

When should bariatric surgery be considered as treatment for obesity (3)?

A
  • BMI 40+
  • BMI 35-39.9 + 1 comorbidity
  • BMI 30-34.9 + uncontrolled Type II DM
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26
Q

How does weight loss occur with bariatric surgery (4)?

A
  • Restriction
  • Malabsorption
  • Decreased appetite
  • Improve metabolism
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27
Q

Proper bariatric care includes…

A

LIFELONG surveillance

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28
Q

What is the recommended exercise for adults (2)? What other component is recommended?

A
  • 150-300 min/week of moderate intensity
  • 75-150 min/week of vigorous intensity
    PLUS muscle strengthening 2+ days/week
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29
Q

How does function of the anterior pituitary differ from the posterior pituitary?

A

BOTH secrete, but anterior pituitary also synthesizes hormones

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30
Q

What is the function of Luteinizing Hormone (LH) in females (2)? In males?

A
  • Females = trigger ovulation and corpus luteum

- Males = T by Leydig cells

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31
Q

What is the function of Follicle-Stimulating Hormone (FSH) in females? In males?

A
  • Females = growth of ovarian follicles

- Males = formation of secondary spermatocytes

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32
Q

What is the function of Prolactin in females? In males?

A
  • Females = milk production

- Males = with LH + T, increase reproductive function

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33
Q

What six hormones are synthesized and secreted from the anterior pituitary?

A
  • ACTH
  • TSH
  • LH
  • FSH
  • GH
  • Prolactin
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34
Q

What two hormones are secreted from the posterior pituitary?

A
  • ADH

- Oxytocin (OT)

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35
Q

Which hormone acts via positive feedback? How does this work?

A

Oxytocin (OT)

- Increase uterine contractions, promote stretching of cervix and uterus in labor

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36
Q

What causes the release of ADH? What is the result?

A

Released with hypertonicity

- Kidneys reabsorb water and salt → concentrates urine and reduces urine output

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37
Q

What is the primary hormone synthesized and secreted from the intermediate pituitary?

A

Melanocyte-Stimulating Hormone (MSH)

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38
Q

What is the most common symptom associated with Sellar Masses? What other symptom is often associated?

A 
Bitemporal hemianopsia (visual impairments)
- Also, diplopia
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39
Q

Why are visual impairments common with Sellar Masses?

A

Compress optic chiasm

- Due to suprasellar extension of adenoma

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40
Q

Are Pituitary Adenomas more commonly benign or malignant? What are the two subtypes?

A

Pituitary Adenomas = BENIGN

  • Microadenoma (<1 cm)
  • Macroadenoma (1+ cm)
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41
Q

What are the five cell types associated with Pituitary Adenomas, and what type of hormone does each secrete? With which cell type is hormone secretion NOT changed?

A
  • Gonadotroph = LH and FSH (NO CHANGE IN SECRETION)
  • Thyrotroph = high TSH
  • Corticotroph = high ACTH
  • Lactotroph = high prolactin
  • Somatotroph = high GH
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42
Q

What are two of the most common causes of HIGH Prolactin?

A
  • Tumor

- Pregnancy

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43
Q

What is the most common type of pituitary tumor?

A

Prolactinoma

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44
Q

In what group do Prolactinomas present with amenorrhea, infertility; prolactin of 30+?

A

PREmenopausal women

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45
Q

In what group do Prolactinomas present with HA, impaired vision; 20+?

A

POSTmenopausal women

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46
Q

How can you differentiate sxs in a PREmenopausal vs POSTmenopausal woman with a Prolactinoma? How do labs differ for each?

A

PRE = sex related (amenorrhea, infertility)
- Prolactin is 30+

POST = non-sex related (HA, impaired vision
- Prolactin about 20+

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47
Q

In men, high prolactin causes a decrease in what hormone, and how does this present symptomatically?

A

High prolactin → Low T

- Decreased libido, impotence, infertility

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48
Q

What is the treatment for Prolactinoma? What non-pharm treatment can be considered?

A

Cabergoline

- Surgery = transsphenoidal resection

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49
Q

What is the most common etiology for HIGH GH?

A

Pituitary macroadenoma of somatotrophs

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50
Q

What condition involves in adults; onset in 30’s; excess IGF-1?

A

Acromegaly

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51
Q

In patients with Acromegaly, what three conditions are they at increased risk for?

A
  • DM
  • HTN
  • CAD
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52
Q

What is the gold standard test to evaluate for Acromegaly? What other two tests can be used?

A

OGTT = gold standard

  • Serum IGF-1
  • MRI
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53
Q

What is the treatment for Acromegaly?

A

Transsphenoidal resection

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54
Q

What is the most common etiology for LOW GH?

A

Pituitary macroadenoma of somatotrophs

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55
Q

What condition involves decreased QOL, lean body mass, BMD; increased CV disease?

A

Low GH

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56
Q

What is the recommended treatment for LOW GH?

A

GH therapy if hx of GH deficiency as child

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57
Q

What hormone is LOW with Male Hypogonadism? What are the two subtypes, and what hormone can be tested to differentiate the two?

A

LOW T

  • Primary (Hypergonadotrophic Hypogonadism): HIGH FSH, LH
  • Secondary (Hypogonadotrophic Hypogonadism): LOW FSH, LH
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58
Q

What condition presents with ED, hot flashes, gynecomastia, infertility; low energy, low libido, low muscle mass, less body hair?

A

Male Hypogonadism

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59
Q

What treatment is recommended for Male Hypogonadism? When is this contraindicated?

A

T replacement via IM injections or transdermal
- Pellets SC every 3 months

CI IF PROSTATE CA

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60
Q

For treatment of Male Hypogonadism with T replacement, what is the one contraindication?

A

CI IF PROSTATE CA

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61
Q

What are two possible causes of Pan-Hypopituitarism, and which is more common?

A
  • Radiation therapy = more common

- Sheehan Syndrome (rare)

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62
Q

What condition involves postpartum pituitary necrosis, and what is it associated with? What is the initial symptom?

A

Sheehan Syndrome = possible etiology of Pan-Hypopituitarism

- Initial sxs: lactation difficulties

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63
Q

What condition involves ALL 6 Anterior Pituitary hormones LOW?

A

Pan-Hypopituitarism

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64
Q

What condition involves extensive hormone replacement (Levothyroxine (TSH), Dexamethasone (ACTH), T in males vs. E in females, GH; calcium)?

A

Pan-Hypopituitarism

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65
Q

What hormones results in concentrated urine, reduced urine output?

A

ADH

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66
Q

How can you differentiate Central Diabetes Insipidus from SIADH?

A
  • Central Diabetes Insipidus = LOW ADH

- SIADH = HIGH ADH

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67
Q

What is the most common cause of Central Diabetes Insipidus?

A

Idiopathic

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68
Q

What condition involves dilute urine and polyuria?

A

Central Diabetes Insipidus

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69
Q

What condition involves LOW urine osmolality and HIGH serum osmolality?

A

Central Diabetes Insipidus

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70
Q

What condition involves concentrated urine and decreased UO? What other finding may be seen?

A

SIADH

- Also, hyponatremia

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71
Q

What is the recommended treatment for SIADH?

A

Fluid restriction

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72
Q

What condition involves HIGH urine osmolality and LOW serum osmolality?

A

SIADH

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73
Q

What two groups of hormones are produced by the adrenal gland?

A
  • Steroids (aldosterone, cortisol, androgens/DHEA)

- Catecholamines (NE, Epi)

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74
Q

What are three results of high ADH?

A
  • Increase BP
  • Increase Na+ reabsorption
  • Increased K+ excretion
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75
Q

What condition involves etiology of bilateral idiopathic adrenal hyperplasia vs. unilateral aldosterone-secreting tumor?

A

Primary Hyperaldosteronism (Conn’s Syndrome)

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76
Q

What are the two primary symptoms associated with Primary Hyperaldosteronism (Conn’s Syndrome)?

A
  • HTN

- Hypokalemia

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77
Q

What three lab findings will be seen with Primary Hyperaldosteronism (Conn’s Syndrome)?

A
  • High Aldosterone
  • Low Renin
  • Hypokalemia
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78
Q

What is the recommended treatment for bilateral idiopathic Primary Hyperaldosteronism (Conn’s Syndrome)?

A

Spironolactone

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79
Q

What is the recommended treatment for unilateral tumor Primary Hyperaldosteronism (Conn’s Syndrome)?

A

Surgery

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80
Q

What are three results of high cortisol?

A
  • Increase blood glucose
  • Anti-inflammatory
  • Lower Ca
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81
Q

What hormone is released in a circadian rhythm?

A

Cortisol

- HIGHEST at 8 AM

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82
Q

What are the two subtypes of Cushing’s Syndrome, and how can you differentiate the two based on labs? Which is more common?

A

ACTH-Dependent = HIGH ACTH
- More common

ACTH-Independent = LOW ACTH

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83
Q

What are two possible causes of ACTH-Dependent (high ACTH) Cushing’s Syndrome?

A
  • Cushing’s disease = pituitary hypersecretion of ACTH

- Non-pituitary origin (SCLC)

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84
Q

What is the most common possible cause of ACTH-Independent Cushing’s Syndrome?

A

Excessive synthetic steroids

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85
Q

What condition presents with amenorrhea, striae, hyperpigmentation, central obesity (moon face, buffalo hump), HTN?

A

Cushing’s Syndrome

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86
Q

What is the gold standard test for evaluating Cushing’s Syndrome? What other test might be used?

A

24-hour urine collection = gold standard

- Low-Dose Dexamethasone Suppression Test

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87
Q

What can the Low-Dose Dexamethasone Suppression Test be used to determine? What is a positive test for Cushing’s?

A

Cushing’s Syndrome vs. non-Cushing’s

  • If cortisol 5+ mcg/dL = Cushing’s
  • Normal is normal/low cortisol
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88
Q

What can the High-Dose Dexamethasone Suppression Test be used to determine?

A

Cushing’s Syndrome vs. Cushing’s Disease

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89
Q

For treatment of Cushing’s Syndrome, what is recommenced if the etiology is…

  • Synthetic steroids?
  • Pituitary adenoma?
  • Adrenal tumor?
  • Adrenal hyperplasia/inoperable tumor/CA?
A
  • Synthetic steroids: taper steroids
  • Pituitary adenoma: surgery (transsphenoidal resection)
  • Adrenal tumor: surgery (adrenalectomy)
  • Adrenal hyperplasia/inoperable tumor/CA: medication = Ketoconazole vs. Mitotane
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90
Q

What is the recommended treatment for an adrenal hyperplasia/inoperable tumor/CA with Cushing’s Syndrome?

A

Ketoconazole

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91
Q

What condition involves entire adrenal dysfunction = ALL HORMONES LOW (low aldosterone, low cortisol, low androgens)? What hormone level will be HIGH?

A

Primary Adrenocortical Insufficiency (Addison’s Disease)

- HIGH ACTH

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92
Q

What is the most common cause of Primary Adrenocortical Insufficiency (Addison’s Disease)?

A

Autoimmune destruction of adrenal cortex

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93
Q

What three symptoms are often seen with Primary Adrenocortical Insufficiency (Addison’s Disease)?

A
  • Hypotension
  • Salt craving
  • Hyperpigmentation
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94
Q

What condition involves hypotension, salt craving, hyperpigmentation?

A

Primary Adrenocortical Insufficiency (Addison’s Disease)

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95
Q

How can you differentiate Primary Adrenocortical Insufficiency from Secondary or Tertiary (2)?

A
  • Primary = HIGH ACTH, LOW Aldosterone

- Secondary/Tertiary = LOW ACTH, normal Aldosterone

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96
Q

What condition involves etiology of abrupt cessation of synthetic steroids?

A

Secondary Adrenocortical Insufficiency

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97
Q

How can you differentiate Secondary Adrenocortical Insufficiency from Tertiary? What two hormone levels are the same in these conditions?

A
  • Secondary: high CRH
  • Tertiary: LOW CRH (problem from the very top)

BOTH: LOW ACTH, normal Aldosterone

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98
Q

What two diagnostic tests can be used to evaluate Adrenocortical Insufficiency?

A
  • Serum AM cortisol

- ACTH stimulation test via Cosyntropin

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99
Q

For what diagnostic test is Cosyntropin used, and how can it be used to diagnose Primary Adrenocortical Insufficiency (Addison’s Disease)?

A

ACTH stimulation test (Cosyntropin = synthetic ACTH)

- Tests ability of adrenal gland to respond to ACTH; cortisol does NOT increase = Addison’s

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100
Q

What are the three recommended treatments for Adrenocortical Insufficiency?

A
  • Mineralocorticoid (Fludrocortisone)
  • Short-acting steroids (Hydrocortisone) vs. long-lasting steroids (Dexamethasone or Prednisone)
  • Oral DHEA in women
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101
Q

What condition involves a catecholamine-secreting tumors from adrenal medulla? Is this often benign or malignant?

A

Pheochromocytoma

- Often BENIGN

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102
Q

What condition involves the classic triad of episodic HA, tachycardia, sweating?

A

Pheochromocytoma

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103
Q

What is the classic triad associated with Pheochromocytoma?

A
  • Episodic HA
  • Tachycardia
  • Sweating
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104
Q

Besides the class triad, what other two symptoms/findings are suspicious for Pheochromocytoma?

A
  • Refractory HTN

- FH of Pheochromocytoma

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105
Q

What is the gold-standard test for Pheochromocytoma?

A

24-hour urine collection for catecholamines & metanephrines

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106
Q

Besides 24-hour urine, what other test can be used to evaluate for Pheochromocytoma? What is a positive finding?

A

Clonidine Suppression Test

- If catecholamines still HIGH after Clonidine administration = Pheochromocytoma

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107
Q

What radiologic test can be used to evaluate for Pheochromocytoma?

A

CT without contrast

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108
Q

What is the recommended treatment for Pheochromocytoma (2)?

A

SURGERY

- “Chemical sympathectomy” until surgery (alpha-blockers, beta-blockers)

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109
Q

What condition involves adrenal mass 1+ cm in diameter; high prevalence but often non-problematic?

A

Adrenal Incidentaloma

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110
Q

What two conditions should be ruled out with Adrenal Incidentaloma?

What if HTN is also present?

A
  • Pheochromocytoma
  • Cushing’s Syndrome

HTN also, R/O Primary Hyperaldosteronism (Conn’s Syndrome)

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111
Q

What diagnostic test should NEVER be performed for Adrenal Incidentaloma if known CA elsewhere?

A

NO biopsy

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112
Q

What is the leading cause of ESRD?

A

DM

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113
Q

What type of DM is prone to other autoimmune disorders?

A

Type I DM

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114
Q

What type of DM involves o genetic predisposition → immunologic trigger?

A

Type I DM

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115
Q

What condition involves the 3 P’s (polyuria, polydipsia, polyphagia)?

A

Type I DM

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116
Q

Which type of DM is family history more associated with?

A

Type II DM

117
Q

What condition involves peripheral insulin resistance → impaired glucose tolerance (IGT) → overt then beta cell failure = pancreatic “burn out”?

A

Type II DM

118
Q

What type of DM is often asymptomatic?

A

Type II DM

119
Q

What condition involves acanthosis nigricans?

A

Type II DM

120
Q

What two non-endocrine conditions should be considered with Type II DM?

A
  • Chronic skin infections

- Vulvovaginitis

121
Q

What is the recommended screening for DM (2)?

A
  • ALL patients age 45+ years
    OR
  • Overweight/obese (BMI of 25+) WITH 1+ DM risk factors
122
Q

What are the nine risk factors associated with DM?

A
  • 1st-degree relative with DM
  • High risk ethnicity (AA, Latino, NA, Asian, PI)
  • CVD hx
  • HTN
  • Dyslipidemia
  • PCOS/GDM hx
  • Physical inactivity
  • Severe obesity or acanthosis nigricans
  • Medications (glucocorticoids, HIV meds, antipsychotics)
123
Q

What is a normal fasting blood glucose level?

A

<100

124
Q

What is a DM fasting blood glucose level?

A

126+

125
Q

What is a normal OGTT level?

A

<140

126
Q

What is a DM OGTT level?

A

200+

127
Q

What is a normal HbA1c level?

A

<5.7%

128
Q

What is a DM HbA1c level?

A

6.5+%

129
Q

What are the two diagnostic criteria associated with DM?

A
  • Classic sxs + random glucose of 200+
    OR
  • NO classic sxs + TWO abnormal tests (from same sample or two different tests)
130
Q

Those with pre-DM are at increased risk for what two diseases?

A
  • DM

- CVD

131
Q

What three conditions is pre-DM associated with?

A
  • Obesity
  • HTN
  • Dyslipidemia
132
Q

What medication can be used as DM prophylaxis?

A

Metformin

133
Q

In those with pre-DM, how often should testing for DM be performed?

A

ANNUALLY

134
Q

In what stage of DM can hyperglycemia be reversed?

A

Pre-DM ONLY

135
Q

For macrovascular complications of DM, what are the two types?

A
  • ASCVD

- HF

136
Q

What is an independent risk factor for ASCVD?

A

DM itself

137
Q

For microvascular complications of DM, what are the four types?

A
  • Diabetic Nephropathy
  • Diabetic Retinopathy
  • Diabetic Neuropathy (peripheral)
  • Diabetic Neuropathy (autonomic)
138
Q

What condition involves albuminuria +/- reduced GFR in absence of sxs or other primary causes of kidney dx?

A

Diabetic Nephropathy

139
Q

What is the screening test utilized for Diabetic Nephropathy? When should this begin (2, I vs. II)?

A

UACR
- Type I after 5+ years
OR
- Type II at time of diagnosis

140
Q

What is the screening test utilized for Diabetic Retinopathy? When should this begin (2, I vs. II)?

A

Dilated/comprehensive eye exam
- Type I after 5+ years
OR
- Type II at time of diagnosis

141
Q

What is the recommended treatment for Diabetic Nephropathy?

A

ACE-I or ARBs

142
Q

What is the leading cause of new blindness in DM?

A

Diabetic Retinopathy

143
Q

What are the two subtypes of Diabetic Retinopathy, and what can be seen with each?

A
  • Non-proliferative: hemorrhages, yellow lipid exudates, cotton wool spots
  • Proliferative: neovascularization
144
Q

After initial screening of Diabetic Retinopathy, what is the recommended follow up if NO evidence of retinopathy? What if ANY level of retinopathy present?

A
  • NO evidence for 1+ annual eye exams = every 1-2 years

- ANY level of retinopathy = annually or more frequent

145
Q

What condition involves “stocking-glove” sensory loss (distal symmetric)?

A

Diabetic Neuropathy (peripheral)

146
Q

What condition involves LOPS (loss of protective sensation) → diabetic foot ulcers?

A

Diabetic Neuropathy (peripheral)

147
Q

What condition often involves hypoglycemia unawareness; gastroparesis?

A

Diabetic Neuropathy (autonomic)

148
Q

What is a major cause of morbidity and mortality if DM?

A

Foot ulcers/Amputations

149
Q

How often should a Comprehensive Foot Exam be performed in DM patients? When should this begin (2, I vs. II)?

A

At least annually
- Type I after 5+ years
OR
- Type II at time of diagnosis

150
Q

When evaluating neuro during Comprehensive Foot Exam in DM patients, what two components must be performed?

A
  • Monofilament testing

- Pinprick/temp./vibratory/ankle reflexes

151
Q

What diagnostic test can be used to evaluate vascular function during the Comprehensive Foot Exam in a DM patient?

A

ABI

152
Q

What are three examples of RAPID-acting insulin?

A
  • Insulin glulisine
  • Insulin lispro
  • Insulin aspart
153
Q

Insulin glulisine, Insulin lispro, Insulin aspart are examples of what type of insulin?

A

RAPID-acting insulin

154
Q

If dyslipidemia + DM + ASCVD present, what is the recommended treatment? If only 40+ with DM, what is the recommended treatment

A
  • HIGH-intensity statin if DM + ASCVD

- MODERATE-intensity statin if 40+ with DM

155
Q

What are three examples of SHORT-acting insulin?

A

Insulin regular

  • Humulin R
  • Novolin R
156
Q

What are three examples of INTERMEDIATE-acting insulin?

A

Insulin NPH

  • Humulin N
  • Novolin N
157
Q

Insulin regular (Humulin R and Novolin R) are examples of what type of insulin?

A

SHORT-acting insulin

158
Q

Insulin NPH (Humulin N and Novolin N) are examples of what type of insulin?

A

INTERMEDIATE-acting insulin

159
Q

Insulin glargine, Insulin determir, Insulin degludec are examples of what type of insulin?

A

LONG-acting insulin

160
Q

What are three examples of LONG-acting insulin?

A
  • Insulin glargine
  • Insulin determir
  • Insulin degludec
161
Q

What type of insulin is considered “mealtime” or “correction”?

A

RAPID-acting insulin

162
Q

What type of insulin is considered “background”?

A

LONG-acting insulin

163
Q

What type of Insulin is used in insulin pumps?

A

RAPID-acting insulin

164
Q

What type of insulin is good for patients stable on insulin with relatively same diet?

A

Insulin Premixed

165
Q

What is the risk associated with Insulin Premixed?

A

HYPOGLYCEMIA

166
Q

What two types of Insulin are basal?

A
  • INTERMEDIATE-acting insulin

- LONG-acting insulin

167
Q

What two types of Insulin are bolus?

A
  • SHORT-acting insulin

- RAPID-acting insulin

168
Q

When treating with insulin, what two types of insulin are recommended to start with?

How do you decide dose (2)?

A

Begin with basal insulin (INTERMEDIATE or LONG) at night
1. Calculate TDD based on weight
OR
2. Start with 10 units then titrate

169
Q

½ of TDD should always be what?

A

BASAL insulin

170
Q

When treating with insulin, if fasting glucose normal but A1c HIGH, what should be considered (2)?

A
  • Need to add mealtime/bolus insulin OR

- Overbasalization (need to add mealtime/bolus insulin)

171
Q

If overbasalization present, what should NOT be done?

A

Do NOT increase basal dosing

172
Q

What are the two treatments for hypoglycemia?

A
  • Glucose (oral vs. IV)

- Glucagon

173
Q

What is the first line treatment for Type II DM?

A

Metformin

174
Q

What DM drug class involves the “-glitazone” name hint?

A

Thiazolidinediones (TZDs)

175
Q

What DM drug class involves the “-gliptin” name hint?

A

DDP-4 Inhibitors

176
Q

What DM drug class involves the “-tide” name hint?

A

GLP-1 Agonists

177
Q

What DM drug class involves the “-gliflozin” name hint?

A

SGLT-2 Inhibitors

178
Q

What is the name hint for Thiazolidinediones (TZDs)?

A

“-glitazone”

179
Q

What is the name hint for DDP-4 Inhibitors?

A

“-gliptin”

180
Q

What is the name hint for GLP-1 Agonists?

A

“-tide”

181
Q

What is the name hint for SGLT-2 Inhibitors?

A

“-gliflozin”

182
Q

What DM medication involves AEs of GI side effects; deplete Vitamin B12 levels?

A

Metformin

183
Q

What DM medication involves AEs of HOLD pre-surgery or with contrast dye for CT

A

Metformin

184
Q

What DM medication involves CIs of CKD, liver disease, HF?

A

Metformin

185
Q

What DM medication involves CI of lactic acidosis?

A

Metformin

186
Q

What DM medication involves CIs of CHF; active bladder CA

A

Thiazolidinediones (TZDs)

187
Q

What DM medication involves MOA of insulin and glucagon back to physiologic levels?

A

DDP-4 Inhibitors

188
Q

Which DDP-4 Inhibitor can be used in patients with DM and renal disease?

A

Linagliptin

189
Q

Which class of DM medications has been known to reduce MACE?

A

GLP-1 Agonists

190
Q

Which class of DM medications has been known to induce weight loss?

A

SGLT-2 Inhibitors

191
Q

What DM medication involves CI of thyroid CA risk (MTC, or FH of MTC)?

A

GLP-1 Agonists

192
Q

What DM medication involves CI of hypoglycemia?

A

Sulfonylureas (SUs)

193
Q

What DM medication involves CI if GFR <30; DKA risk?

A

SGLT-2 Inhibitors

194
Q

What DM medication involves LE amputation risk?

A

SGLT-2 Inhibitors

195
Q

Which SGLT-2 Inhibitor is associated with LE amputation risk?

A

Canagliflozin

196
Q

What involves morning hyperglycemia due to undetected nocturnal hypoglycemia?

A

Somogyi Effect

197
Q

What involves morning hyperglycemia due to elevated AM hormone levels?

A

Dawn Phenomenon

198
Q

What is Somogyi Effect?

A

Morning hyperglycemia due to undetected nocturnal hypoglycemia

199
Q

What three components are seen with DKA?

A
  • Hyperglycemia
  • Ketonemia
  • Acidemia
200
Q

What condition is precipitated by the 4 S’s and what are they?

A

DKA

  • Sepsis (infection)
  • Skipping insulin dose
  • Sickness
  • Stress (surgery)
201
Q

What condition presents with Kussmaul respirations (rapid breathing)?

A

DKA

202
Q

What test is used to diagnose DKA? What other two lab findings should be seen?

A

ABG diagnoses DKA

  • Hyperglycemia (250+)
  • High ketones
203
Q

What is the recommended treatment for DKA (2)?

A

Hospitalize and…

  • SLOWLY restore volume deficits
  • IV insulin
204
Q

What condition is more common in older Type II DM patients?

A

Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)

205
Q

What often precipitates Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS) (2)?

A
  • Illness

- Infection

206
Q

What condition presents with profound hyperglycemia (600+); NO acidosis, NO/low ketones?

A

Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)

207
Q

What two symptoms present with Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)?

A
  • Dehydration

- AMS

208
Q

What is the recommended treatment for Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS) (2)?

A

Hospitalize and…

  • SLOWLY restore volume deficits
  • IV insulin
209
Q

What is the best initial test of thyroid function? What is the follow up test if abnormal?

A

TSH then Free T4

210
Q

What is the functional study to evaluate low TSH (Hyperthyroidism)?

A

RAIU (Radioactive Iodine Uptake)

211
Q

What is the most common etiology of Hypothyroidism?

A

Hashimoto’s Thyroiditis

212
Q

What condition involves weight gain, fatigue, constipation, cold intolerance, dry skin, hair loss/brittle nails?

A

Hypothyroidism

213
Q

What condition involves slow movement/speech, dry/coarse skin, thinned hair, edema?

A

Hypothyroidism

214
Q

What condition involves bradycardia, weight gain, weakness, delayed DTRs?

A

Hypothyroidism

215
Q

What condition involves high TSH, low T4/T3?

A

Primary Hypothyroidism (Hashimoto’s Thyroiditis)

216
Q

What condition involves high TSH, normal T4/T3?

A

Subclinical Hypothyroidism

217
Q

What condition involves normal or low TSH and T4/T3?

A

Central Hypothyroidism

218
Q

What is the recommended treatment for Hypothyroidism?

A

Levothyroxine (synthetic T4)

219
Q

What four things should be considered with use of Levothyroxine (synthetic T4)?

A
  • Weight-based
  • If older or cardiac concerns, lower initial dose
  • Take on empty stomach 1-hour pre-breakfast
  • Caution with other meds
220
Q

What condition involves +TPO Ab and +TgAb?

A

Hashimoto’s Thyroiditis

221
Q

If Subclinical Hypothyroidism is suspected, what is the recommended follow up testing?

A

Repeat TSH and T4 after 1-3 months

222
Q

What is the severe form of hypothyroidism = life-threatening?

A

Myxedema Coma

223
Q

What condition presents with TOXIC; HIGH TSH, LOW T4/T3?

A

Myxedema Coma

- Severe Hypothyroidism

224
Q

What is the treatment for Myxedema Coma?

A

IV T4 +/- T3

225
Q

What are three etiologies of Hyperthyroidism?

A
  • Graves’ Disease
  • Toxic Adenoma
  • Toxic Multinodular Goiter (MNG
226
Q

What condition presents with weight loss with high appetite, heat intolerance, diaphoresis, tremor, tachycardia/palpitations, anxiety, hyperdefecation?

A

Hyperthyroidism

227
Q

What condition presents with hyperactivity, rapid speech, warm/moist skin, stare and lid lag, exophthalmos, proptosis?

A

Hyperthyroidism

228
Q

What condition presents with hyperactive BS, tachycardia, muscle wasting, tremors, hyperreflexia?

A

Hyperthyroidism

229
Q

What condition involves low TSH, high T4/T3?

A

Graves’ Disease

230
Q

What condition involves low TSH, normal T4/T3?

A

Subclinical Hyperthyroidism

231
Q

What condition involves low TSH, high T3, normal T4?

A

T3 Toxicosis (early Graves’)

232
Q

Diffuse elevated uptake on RAIU indicates?

A

Graves’ Disease

233
Q

Diffuse decreased/absent uptake on RAIU indicates?

A

Thyroiditis/exogenous hormone

234
Q

Focal irregular uptake on RAIU indicates (2)?

A

Toxic Adenoma vs. MNG

235
Q

If focal elevated uptake on RAIU, what does this indicate?

A

Hyperfunctioning “hot” nodules = likely benign

236
Q

If focal decreased uptake on RAIU, what does this indicate?

A

Hypofunctioning “cold” nodules = likely malignant

237
Q

What is the first line treatment for Hyperthyroidism (2)?

A
  • BB (sxs control)

- Thionamides (Methimazole or PTU if pregnant)

238
Q

What is the first line DEFINITIVE treatment for Hyperthyroidism?

A

Radioiodine ablation (I-131)

239
Q

What is the MOST common cause of Hyperthyroidism?

A

Graves’ Disease

240
Q

When should a thyroidectomy be considered for Hyperthyroidism?

A

Obstructive sxs present

241
Q

What condition involves +TRAb?

A

Graves’ Disease

242
Q

How can you differentiate Toxic Adenoma from Toxic MNG?

A
  • Toxic Adenoma = focal hyperplasia of follicular cells

- Toxic MNG = thyroid nodules

243
Q

What condition is a severe form of thyrotoxicosis = life-threatening?

A

Thyroid Storm

244
Q

What condition presents with TOXIC; LOW TSH, HIGH T4/T3?

A

Thyroid Storm

245
Q

What is the treatment for Thyroid Storm (2)?

A

ICU admission

  • BB
  • Thionamide (Methimazole or PTU
246
Q

What condition involves painful OR painless thyroid inflammation → dysfunction?

A

Thyroiditis (subacute)

247
Q

With Thyroiditis (subacute), what is the progression seen (4 steps)?

A
  1. Hyperthyroid
  2. Euthyroid
  3. Hypothyroid
  4. Euthyroid
248
Q

What is the diagnosis and treatment of Thyroiditis (subacute)?

A
  • Dx: clinical

- Tx: ASA/NSAIDs for pain, monitor TSH

249
Q

What two questions should be asked when working up Thyroid Nodules?

A
  • Cancer?

- Causing dysfunction?

250
Q

What are the two primary tests used to evaluate Thyroid Nodules?

A
  • TSH

- Thyroid US

251
Q

What five findings are indicative of a MALIGNANT Thyroid Nodule?

A
  • Hypoechoic (darker)
  • Larger (1+ cm)
  • Taller (more than wide)
  • Irregular
  • Extrathyroid extension + associated cervical nodes
252
Q

What three findings are indicative of a BENIGN Thyroid Nodule?

A
  • Colloid
  • Cystic
  • Smaller (<1 cm)
253
Q

If a MALIGNANT Thyroid Nodule is suspected, what is the next test?

A

FNA

254
Q

What is the most common type of Thyroid CA?

A

Papillary

255
Q

What is the most aggressive type of Thyroid CA? What population is this most often seen?

A

Anaplastic

- Elderly

256
Q

What is the definitive test for Thyroid CA?

A

Fine-Needle Aspiration (FNA) biopsy

257
Q

What is the treatment for Thyroid CA? What two other treatments may be included, as well?

A

Thyroid lobectomy OR Total thyroidectomy

  • Iodine ablation
  • T4 hormone replacement (to avoid hypothyroidism)
258
Q

High PTH means what for calcium?

A

HIGH calcium

259
Q

Low PTH means what for calcium?

A

LOW calcium

260
Q

What is the most common etiology of Hypoparathyroidism?

A

Acquired via post-thyroidectomy

261
Q

What condition presents with irritability, depression; prolonged QT interval?

A

Hypoparathyroidism

262
Q

What condition presents with +Chvostek sign; +Trousseau sign?

A

Hypoparathyroidism

263
Q

What condition presents with LOW PTH, LOW calcium, HIGH phosphate?

A

Hypoparathyroidism

264
Q

For treatment of Hypoparathyroidism, what is recommended if mild case (2)? Severe case?

A
  • Mild: Vitamin D (Calcitriol) + oral calcium carbonate

- Severe: IV calcium gluconate

265
Q

If hyperphosphatemia is present with Hypoparathyroidism, what is the recommended treatment?

A

Phosphate binders

266
Q

What is the etiology of Primary Hyperparathyroidism?

A

Parathyroid adenoma

267
Q

What is the etiology of Secondary Hyperparathyroidism (2)?

A

CKD or Vitamin D deficiency

- High calcium or high phosphate → high PTH

268
Q

What condition involves “bones, moans, stones, groans”?

A

Hyperparathyroidism

269
Q

What condition involves fragile bones/bone pain, kidney stones, abdominal pain, psychosis, depression, delirium?

A

Hyperparathyroidism

270
Q

What condition involves HIGH PTH, HIGH calcium, LOW phosphate?

A

Primary Hyperparathyroidism

271
Q

What condition involves HIGH PTH, LOW calcium, HIGH phosphate?

A

Secondary Hyperparathyroidism

272
Q

What is the definitive treatment for Hyperparathyroidism? What other two treatments can be considered?

A

Parathyroidectomy

- Also restrict Ca intake and bisphosphates

273
Q

What radiographic imaging should be obtained for Primary Hyperparathyroidism?

A

DEXA Scan

274
Q

What thyroid test monitors for thyroid CA recurrence?

A

Thyroglobulin (TG)

275
Q

What is responsible for iodine oxidation in thyroid hormone synthesis?

A

TPO Ab

276
Q

What activates TSH receptor → thyroid synthesis/secretion and thyroid gland growth = goiter?

A

TSI

277
Q

What does a Sestimibi Scan test for, and what is a + finding?

A

Primary Hyperparathyroidism

    • if localization
  • Can support diagnosis and help with preoperative mapping
278
Q

When evaluating adrenal gland, a 24-hour UFC can provide false + in these four patient groups, and should therefore be avoided…

A
  • DM
  • Obesity
  • Depression
  • Alcoholism
279
Q

What is a + finding on Dexamethasone Suppression Test?

A

High OR normal serum cortisol/ACTH

- Normal is low cortisol/ACTH

280
Q

What is a + finding on Clonidine Suppression Test?

A

Elevation of normetanephrine after 3 hours AND <40% decrease from baseline

281
Q

In DM patients, what lab should be checked at EVERY visit?

A

HbA1c

282
Q

If a patient has DM + ASCVD, what three medications should be considered?

A
  • Metformin
  • SGLT-2 Inhibitors
  • GLP-1 Agonists
283
Q

If a patient has DM + CHF, what medication should be considered?

A

SGLT-2 Inhibitors

284
Q

If a patient has DM + CKD, what two medications should be considered?

A
  • SGLT-2 Inhibitors

- GLP-1 Agonists

285
Q

In what two DM populations should Metformin be avoided?

A
  • CHF

- CKD

286
Q

If HbA1c 10+%, what medication can be added for Type II DM (type and dose)?

A

Insulin (basal)

- 10 units at bedtime

287
Q

What are four IMMEDIATE benefits of exercise?

A

IMMEDIATE:

  • Decrease anxiety/BP
  • Improve sleep
  • Improve cognitive function/brain health
  • Improve insulin sensitivity
288
Q

What are four LONG-TERM benefits of exercise?

A

LONG-TERM:

  • Cardiorespiratory fitness
  • Muscle strength
  • Decreased depression
  • Sustained reduction in BP

Clin Med II Disease Key Notes (4 decks)

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