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Internal Medicine > Endocrine High Yield > Flashcards

Endocrine High Yield Flashcards

1
Q

What is Hyperthyroidism and what does it do in your body

A 
High T3/T4 = Increases Metabolism
Increases glucose absorption from GI
Catabolic effect on muscle mass
Increased CO and RR
Increased Catecholamine Levels
Increased Oxygen Consumption
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2
Q

What is the most common cause of Hyperthyroidim

A

Graves

Autoimmune against TSH receptor

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3
Q

What is a common cause of Hyperthyroidism in the elderly

A

Toxic Nodular Goiter

Leads to Thyrotoxicosis (increased T3/T4)

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4
Q

Sx of Hyperthyroidism

A

Anxiety, Emotional Lability, Weight Loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-Reflexia

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5
Q

What is a unique sx seen in Graves

A

Exopthlamos: Proptosis, Lid Lag, Eyes bulging

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6
Q

Dx of Hyperthyroidism

A

Low TSH, High T3/T4

If Graves see thyroid-stimulating Immunoglobulin Antiodies

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7
Q

Tx of Hyperthyroidism

A

Anti-Hormone Therapy: PTU (Propylthiouracil) or Methimazole

Radioactive Iodine destroys gland

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8
Q

Which of the tx for Hyperthyroidism can be used in pregnancy

A

PTU

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9
Q

What drugs can you use to curb sx of Hyperthyroidism

A

Beta Blockers: Propranolol decreases HR and BP

Glucocorticoids prevent conversion of T4 to T3

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10
Q

Dx of TSH Secreting Pituitary Adenoma

A

High TSH, High T3/T4

MRI to look for pituitary adenoma

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11
Q

Tx of TSH secreting Pituitary Adenoma

A

Transphenoidal Surgery to remove pituitary tumor

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12
Q

What is Hyperparathyroidism

A

Overactive Parathyroid Glands that lead to increased Calcium Absorption

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13
Q

What is Primary Hyperparathyroidism and what causes it

A

Excess inappropriate PTH production

Parathyroid Adenoma is most common cause

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14
Q

What is Secondary Hyperparathyroidism and what causes it

A

Increased PTH due to hypocalcemia or Vitamin D Deficiency

Chronic Kidney failure is common cause

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15
Q

Sx of Hyperparathyroidism

A

Bones, Stones, Groans, and Psychic Groans

Bony Pain, Kidney Stones, Abdominal Pain, Constipation, Depression and Confusion

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16
Q

Dx of Hyperparathyroidism

A 
Increased PTH
Hypercalcemia
Decreased Phosphate
Check 24 hour urine calcium excretion
Osteopenia on bone scan
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17
Q

Tx of Hyperparathyroidism

A

Surgery, Parathyroidectomy

Vitamin D/Calcium supplement if secondary

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18
Q

What is Hypoparathyroidism

A

Due to low PTH or Insensitivity to its action

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19
Q

What are the more common causes of Hypoparathyroidism

A

Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland

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20
Q

Sx of hypoparathyroidism

A

Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve causes facial twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist

21
Q

Dx of Parathyroidism

A

Hypocalcemia
Decreased PTH
Increased Phosphate

22
Q

Tx of Parathyroidism

A

Calcium Supplement and Vitamin D
Vitamin D helps absorb Calcium in gut
(Ergocalciferol or Calcitriol)

23
Q

What is Chronic Adrenocortical Insufficiency

A

Disorder where adrenal gland does not produce enough hormones

24
Q

What is Primary Adrenocortical Insufficiency (Addison’s Disease)

A

Adrenal Gland Destruction
Leads to both lack of Cortisol and Aldosterone
High ACTH, Low Cortisol
Normal RAAS system, Low Aldosterone

25
Q

What are causes of Primary Adrenocortical Insufficiency

A

Autoimmune, Infection (TB, Fungal), Vascular

26
Q

What are causes of Secondary Adrenocortical Insufficiency

A

Pituitary failure of ACTH secretion (lack of Cortisol)
You will see Low ACTH and Low Cortisol
Aldosterone is intact because ACTH has nothing to do with Aldosterone, instead RAAS system controls that
Exogenous Steroid Use

27
Q

Sx of Primary Adrenocortical Insufficiency

A

No Cortisol, No Aldosterone, No Sex hormones from Adrenal Gland
Hyperpigentation due to increased ACTH
Orthostatic Hypotension, Severe Hyponatremia, Hyperkalemia and non-anion gap Metabolis Acidosis, Hypoglycemia
Reduced sex hormones in women leads to loss of libido, amenorrhea, loss of axillary and pubic hair

28
Q

Dx of Adrenocortical Insufficiency

A
  1. Get baseline ACTH, Cortisol, and Renin
  2. High dose ACTH Stimulation Test. Normal response is a rise in blood/urine cortisol levels. If no rise in cortisol = Adrenal Insufficiency
  3. CRH Stimulation Tests will differentiate the cause. Primary will produce high levels of ACTH but low Cortisol. Secondary will produce low ACTH and low Cortisol
29
Q

Tx of Adrenocortical Insufficiency

A

Primary: Glucocorticoids + Mineralocorticoids
Secondary: Glucocorticoids only
Glucocorticoids: Hydrocortisone 1st line, Presdnisone, Dexamethasone
Mineralocorticoids: Fludrocortisone

30
Q

What does the Anterior Pituitary Secrete

A

Prolactin, Somatotropin (GH), ACTH, TSH, FSH/LH

31
Q

Sx seen with Prolactinomas

A

Oligomenorrhea, galactorrhea, amenorrhea, infertility

32
Q

What inhibits prolactin

A

Dopamine

33
Q

Sx of Somatotropinoma

A

In adults: Acromegaly
In Children: Gigantism
DM and glucose intoelrance

34
Q

Dx of Acromegaly

A

Insulin-like growth factor screening test

Confirmatory test: Oral Glucose suppression. If increased GH levels you have Acromegaly

35
Q

Sx of Adrenocorticotropinomas

A

They secrete ACTH

Cushing’s Disease and Hyperpigmentation

36
Q

Sx of TSH secreting Adenomas

A

Secrete TSH
Thyrotoxicosis
Increased T3/T4

37
Q

Dx of Anterior Pituitary tumors

A

MRI

Endocrine Studies

38
Q

Tx for Anterior Pituitary Adenomas

A

Transsphenoidal Surgery

39
Q

Tx for Acromegaly

A

TSS + Bromocriptine

Octeotride

40
Q

Tx for Prolactinoma

A

Cabergoline or Bromocriptine (Dopamine agonist that inhibits prolactin)

41
Q

What is DM Type I

A

Insulin Deficiency
Inability to produce insulin and insulin resistance
Autoimmune destruction of pancreatic beta cells

42
Q

What is DM type II

A

Insulin Resistance and Relative Impairment to insulin secretion
Likely genetic and environmental, especially weight gain and decreased physical activity

43
Q

Dx of DM

A

Fasting blood sugar >126
Random blood glucose >200
Blood Sugar after oral glucose tolerance test >200
HgA1C >6.5%

44
Q

Sx of DM

A

Polyuria, Polydipsia, Polyphagia, Weight Loss

DKA

45
Q

Complications of DM

A

Parastehsias, Abnormal Gait, Decreased Proprioception, Pain, Decreased DTR
Orthostatic Hypotension, Gastroparesis Constipation
Retinopathy: Painless deterioration of small retinal vessels, may lead to permanent vision loss/blindness

46
Q

Sx of Nephropathy and Tx

A

Progressive kidney function deterioration leading to microalbuminuria
Tx: Ace-I

47
Q

How does a Sulfonylureas Work

A

Stimulates pancreas to release more insulin
Can cause hypoglycemia
Glipizide

48
Q

How do Biguanides work

A 
Suppress Hepatic Gluconeogenesis
No Hypoglycemia
Can cause lactic acidosis
GI side effects are common
Metformin
49
Q

How do Thiazolidenediones work

A

Increase sensitivity to insulin
Affect fat metabolism
Side effects are hepatitis and edema, Acites

Internal Medicine (16 decks)

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