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TAV MDT List > Endocrine MDT > Flashcards

Endocrine MDT Flashcards

1
Q

Blood glucose <70mg/dl

Clinical signs of hypoglycemia (confusion, irritability, fatigue, anxiety, sweating, irregular heart rhythm, perioral paresthesia)

Clinical signs resolve with glucose

A

Whipple’s Triad

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2
Q

Hypoglycemia symptoms begin at plasma glucose levels at ___mg/dl or less

A

60

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3
Q

Hypoglycemia symptoms that impair brain function start at ___mg/dl

A

50

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4
Q

Two types of spontaneous hypoglycemia

A

Fasting

Postprandial

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5
Q

Fasting hypoglycemia is often subacute or chronic and usually presents with ________ as its principal manifestation

A

Neuroglycopenia

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6
Q

Postprandial hypoglycemia is relatively acute and is often heralded by symptoms of:

A

Neurogenic autonomic discharge (sweating, palpitations, anxiety, and temulousness)

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7
Q

Postprandial hypoglycemia may be seen after _______ surgery

A

Gastrointestinal surgery

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8
Q

The clinical manifestations of hypoglycemia are divided into what two broad categories?

A

Neuroglycopenic

Sympathomimetic

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9
Q

Most episodes of symptomatic hypoglycemia include ______ dysfunction

A

Neurological

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10
Q

Hypoglycemia

Sx: Alterations in consciousness, lethargy, confusion, combativeness, agitation, and unresponsiveness, seizures, and focal neurologic deficit

A

Neuroglycopenic

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11
Q

A rapid fall in blood glucose levels or the hypothalamic sensing of neuroglycopenia causes the release of the counter-regulatory hormones, primarily:

A

Catecholamines
-Epinephrine
-Norepinephrine

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12
Q

Hypoglycemia

Sx: Anxiety, nervousness, irritability, nausea, vomiting, palpitations, and tremors

A

Sympathomimetic

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13
Q

Labs if considering hypoglycemia is auto immune in nature

A

Serum antibody testing (GAD-65, anti-islet cell, anti-insulin antibodies)

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14
Q

Labs if considering hypoglycemia is a surreptitious cause

A

C-Peptide

Serial glucose/insulin levels in supervised setting

Serum Sulfonylurea levels

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15
Q

Treatment for hypoglycemia

A

Glucose

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16
Q

Hypoglycemia

Do not give PO glucose to:

A

Patients with altered mental status

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17
Q

Treatment for hypoglycemic patients unable to eat or drink

A

Glucagon 0.5 or 1mg SC/IM

Dextrose 50-100 mL IV Bolus

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18
Q

Hypoglycemia

Once patients are alert and safe to do so they should do what in order to prevent immediate hypoglycemia recurrence?

A

Eat a meal

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19
Q

Complications of Hypoglycemia

A

Coma

Brain Damage

Traumatic Injuries

Death

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20
Q

Essentials of the diagnosis

-Impaired fasting glucose (100-125mg/dl)
-Borderline Hgb-A1C elevation (5.7-6.4%)
-2 Hour post-prandial glucose (140-199mg/dl)

A

Prediabetes

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21
Q

Risk factors for Prediabetes

A

Family history

Obesity

Diet

Physical inactivity

Race

Women who deliver a baby >9 lbs or had gestational diabetes

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22
Q

Symptoms of Prediabetes

A

Usually, no physical exam findings

Early sensory nerve toxicity

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23
Q

Treatment for Prediabetes

A

Weight loss

Metformin may lower risk by 30%

Increase physical activity

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24
Q

Complications of prediabetes

A

Progression to Type 2 Diabetes

Increased cardiovascular / ischemic stroke risk

Peripheral neuropathy

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25
Q

Metabolic disorder or disease that is brought about by either the insufficient production of insulin or inadequate activity of insulin receptors

A

Diabetes mellitus

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26
Q

Three categories of Diabetes

A

Type 1

Type 2

Gestational Diabetes

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27
Q

Symptoms:

-Polyuria / Polydipsia

-Weight loss

-Glucose >126 mg/dl after a fast on more than one occasion

-Ketonemia / Ketonuria

A

Diabetes

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28
Q

Auto immune antibodies

May develop in adults up to age 30

Partial or absolute deficiency of endogenous insulin production and require exogenous insulin for survival

A

Type 1 Diabetes

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29
Q

The presence of polyuria, polydipsia, fatigue, polyphagia, unexplained weight loss, poor wound healing, blurry vision and a high prevalence of infections should lead the IDC to do what test?

A

Blood glucose level

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30
Q

Lab findings in a Type 1 diabetic

A

Glucosuria

Ketonemia, ketonuria, or both

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31
Q

The average renal threshold for glucose is approximately

A

150-180 mg/dl

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32
Q

Testing used if the fasting plasma glucose level is <126 mg/dL in suspected cases, most commonly used to screen for gestational diabetes

A

Oral Glucose Tolerance Test (GTT)

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33
Q

Form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over time

Provides an estimate of glucose control for the preceding 2-3 months

A

Glycosylated Hemoglobin (HbA1c)

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34
Q

What lab tests are diagnostic for diabetes if confirmed by repeat testing?

A

Plasma glucose >126 mg/dL or HbA1c of >6.5%

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35
Q

Only medication that is effective in lowering blood glucose levels in type 1 diabetics

A

Insulin

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36
Q

Insulin supplied in AMMAL

A

10 mL bottles containing 100 un/ml, short-acting

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37
Q

Immediate short-term goal of Type 1 Diabetes

A

Control hyperglycemia

Maintain serum electrolytes and hydration

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38
Q

Therapeutic goal for long term therapy treatment of Type 1 Diabetes

A

Maintain normal glucose levels WITHOUT causing hypoglycemia

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39
Q

Type 1 Diabetes

Physician monitor blood glucose and HbA1c every __ months until at goal, then every __ months indefinitely

A

3 months

6 months

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40
Q

Helps control blood sugar and weight

A

Regular exercise

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41
Q

Drug of choice for diabetes with hypertension because of their renal protection action

A

ACE inhibitors

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42
Q

Goal for HTN in diabetic patients

A

<130/80

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43
Q

Dramatically reduces the risk of developing both the microvascular and macrovascular complications of diabetes

A

Keeping glucose levels at or near normal (Normal A1c = 4.0-6.0)

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44
Q

Type 1 diabetes requires _______ for continued military service

A

Medical Board

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45
Q

Patients determined to have new onset diabetes should be referred to:

A

Internal Medicine or Endocrinology

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46
Q

Insulin overdose treatment

A

Check blood glucose level

-Drink 1/2 cup of regular soda or fruit juice
-Eat a hard candy
-Glucose paste, tablets, or gel

Recheck blood sugar after 15-20 minutes

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47
Q

Insulin overdose

Patient is still symptomatic after first treatment

A

Provide 15-20 grams of sugar

Once safe to do so patient should eat a meal

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48
Q

Uncontrolled glucose often leads to damage of:

A

Small arteries and nerves

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49
Q

Most common diabetic complication, affecting 50% of older patients with Type 2

A

Neuropathies

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50
Q

Diabetic nephropathy is initially manifested by:

A

Proteinuria

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51
Q

Diabetic nephropathy

As kidney function declines, what will accumulate in blood?

A

Metabolic acids and waste products
-Creatinine
-Urea

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52
Q

Hypertension from diabetes is most likely from?

A

Progressive kidney involvement

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53
Q

MI is ____ times more common in DM patients

A

3-5x

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54
Q

Leading cause of death in Type 2 DM patients

A

Heart disease (coronary atherosclerosis)

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55
Q

Correlate with both the duration of diabetes and the severity of chronic hyperglycemia

A

Diabetic cataracts

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56
Q

Diabetic retinopathy after 10-15 years

A

25-50%

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57
Q

Diabetic Retinopathy after 15 years

A

75-95%

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58
Q

Diabetic Retinopathy after 30 years

A

100%

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59
Q

Glaucoma occurs in __% of diabetics

A

6%

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60
Q

Insulin resistance due to inadequate activity of insulin receptors

Most patients are over 40 y/o and obese

A

Type 2 Diabetes

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61
Q

Random glucose 200 mg/dL or higher

Hemoglobin A1c >6.5%

HTN, Dyslipidemia, and Atherosclerosis associated

Polyuria / Polydipsia

Candida vaginitis in women

Glucose >126 on more than one occasion

A

Type 2 Diabetes

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62
Q

DM 2

Resistance to the action of insulin at the ______ level

A

Receptor

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63
Q

Accounts for 90% of patients with DM

A

Type 2

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64
Q

Cause of death in over 70% of Type 2 diabetics

A

Vascular Disease

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65
Q

Symptoms:

-Polyuria / Polydipsia
-Fatigue
-Weight loss
-Poor wound healing
-Blurred vision
-Infections
-NO KETONES IN BLOOD

A

DM 2

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66
Q

Urine dipstick is sensitive to as little as __% glucose

A

0.1%

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67
Q

Normal Glucose Tolerance

Fasting plasma glucose ______

Two hours after glucose load _____

HbA1c _____

A

<100

<140

<5.7

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68
Q

Impaired Glucose Tolerance

Fasting plasma glucose ______

Two hours after glucose load _____

HbA1c _____

A

100-125

> 140-199

5.7-6.4 (Prediabetes)

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69
Q

Diabetes Mellitus

Fasting plasma glucose ______

Two hours after glucose load _____

HbA1c _____

A

> 126

> 200

> 6.5 (diabetes)

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70
Q

Stage 1 Glycemic Control in Type 2 patients

A

Diet (record food eaten)

Exercise

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71
Q

Stage 2 Glycemic Control in Type 2 patients

A

Oral Antidiabetic medications
-FIRST LINE: Biguanides (Metformin/Glucophage)

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72
Q

Stage 3 Glycemic Control in Type 2 patients

A

Insulin

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73
Q

Most important modifiable risk factor

A

Obesity

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74
Q

Leading cause of diabetic-related deaths

A

Heart Disease (40% in men; 32% in women)

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75
Q

Leading cause of new cases of blindness in patients aged 25-74 in the United States

A

Diabetic retinopathy

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76
Q

Patients with diabetic retinopathy are __ times more likely to become blind than those without retinopathy

A

29 times

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77
Q

__% of new cases of renal failure each year are due to diabetic nephropathy

A

43%

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78
Q

Diabetes

Typical entry on feet is from:

A

Broken skin secondary to tinea pedis

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79
Q

Diabetes related foot and lower extremity ulcers

Account for __% of diabetes related admissions

___% if all lower extremity amputations

A

20%

60%

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80
Q

Diabetes

A comprehensive foot examination should be conducted by a clinical provider ______

A

Annually

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81
Q

Mothers who have untreated gestational diabetes may give birth to babies with:

A

Macrosomia (high birth weight)

Congenital heart & nervous system anomalies

Respiratory distress syndrome

Malformations of skeletal muscles

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82
Q

Hyperglycemia >250 mg/dL

Acidosis with blood pH <7.3

Serum bicarbonate < 15 mEq/L

Serum positive for ketones

A

Diabetic Ketoacidosis

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83
Q

May be the initial manifestation of both type 1 or type 2 diabetes

A

Diabetic Ketoacidosis

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84
Q

Commonly occurs with poor compliance in Type 1 diabetes

During Infection, trauma, myocardial infarction, or surgery

May develop in type 2 diabetics under severe stress

A

DKA

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85
Q

Common serious complication of insulin pump therapy

A

DKA

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86
Q

Symptoms:

-Dehydration

-Rapid deep breathing with “fruity” bread odor

-Hypotension with tachycardia

-Mild Hypothermia

-Abdominal pain and tenderness in the absence of abdominal disease

A

DKA

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87
Q

Treatment for DKA

A

Fluids & Insulin

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88
Q

Initial management priority for DKA

A

Fluids (LR fluid of choice)

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89
Q

DKA fluid treatment

When blood glucose falls to 250 mg/dL or less, use 5% glucose solutions to maintain blood glucose _____ mg/dL while continuing insulin to clear serum ketones

A

200-300 mg/dL

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90
Q

DKA

Intravenous fluids may be reduced to maintenance levels when:

A

Vital signs improve

Hyperglycemia is 250 mg/dL or less

Adequate urine output of 30-50 mL/h

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91
Q

The cornerstone therapy for acute hyperglycemia is restoration of ________ and reperfusion of vital organs, especially the kidneys

A

Intravascular volume

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92
Q

DKA Fluid Treatment

Excessive fluid replacement may contribute to acute respiratory distress syndrome or cerebral edema

A

> 5L in 8h

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93
Q

Mainstay therapy for DKA

A

Insulin plus fluid and electrolyte replacement

94
Q

DKA insulin treatment dosage

A

0.15 unit/kg as IV Bolus

Follow by:
0.1 unit/kg/h

95
Q

DKA Insulin treatment

If plasma glucose level fails to fall at least __% in the first hour, give repeat loading dose

A

10%

96
Q

DKA complications

Cerebral edema occurs rarely and is prevented by avoiding sudden reversal of marked hyperglycemia

Maintain glycemic levels of _______ mg/dL for the initial 24 h after correction of severe hyperglycemia reduces this risk

A

200-300 mg/dL

97
Q

Abnormal growth of the thyroid gland.

Can be normal, decreased, or increased thyroid production depending on the cause.

A

Goiter

98
Q

Iodine deficiency disorder

Common in regions with low-iodine diets

Most adults with endemic goiter are found to be euthyroid

A

Endemic Goiter

99
Q

Most common cause of endemic goiter is:

A

Iodine deficiency

100
Q

Mild-to-moderate and sometimes severe iodine deficiency exists in ___ countries

A

30

101
Q

Usually, asymptomatic

Can cause tracheal compression, respiratory distress and failure, and dysphagia if large enough

A

Goiter

102
Q

Lab findings for Goiter

A

T4 and TSH are normal

Thyroid Radioactive Iodine Uptake is ELEVATED

103
Q

Treatment for endemic goiter

A

Addition of Potassium iodine to table salt

Surgery for cosmetic reasons or compressive symptoms

104
Q

Weakness, cold intolerance, constipation, depression, menorrhagia, hoarseness, dry skin, bradycardia

Delayed return of deep tendon reflexes

Serum free tetraiodothyronine aka Thyroxin (T4) LOW

TSH hormone elevated in primary disease

A

Hypothyroidism

105
Q

Primary hypothyroidism is due to:

A

Thyroid gland disease

106
Q

Secondary hypothyroidism is due to:

A

Lack of pituitary TSH

107
Q

Maternal hypothyroidism during pregnancy results in cognitive impairment in child.

Generally, increase dose of thyroid replacement hormone by ___%

A

30%

108
Q

Drugs that can cause hypothyroidism

A

Lithium
Amiodarone
Propylthiouracil
Methimazole
Phenylbutazone
Sulfonamides
Interferon

109
Q

Causes of hypothyroidism with goiter

A

Autoimmune (Hashimoto’s, Thyroiditis)

Subacute

Iodine deficiency

Genetic thyroid enzyme defects

Hep C

Drugs

Infiltrating diseases

110
Q

Causes of hypothyroidism without goiter

A

Thyroid Surgery, Irradiation, or Radioiodine treatment

Deficient pituitary TSH

Severe illness

Drugs

111
Q

Sub-clinical hypothyroidism (High TSH and Normal T4 occurs commonly in elderly women ___%

A

10%

112
Q

Early Symptoms:

Fatigue, lethargy, weakness
Arthralgias, myalgias, muscle cramps
Cold Intolerance
Difficulty concentrating
Constipation
Dry Skin
Headache
Weight Gain
Menorrhagia

A

Hypothyroidism

113
Q

Late Symptoms

Slow speech
Peripheral edema
Pallor
Hoarseness
Decreased senses of taste, smell, and hearing
Dyspnea
Absent sweating
Amenorrhea or menorrhagia
Galactorrhea

A

Hypothyroidism

114
Q

Early signs

Thin, brittle nails
Thinning of hair
Pallor
Poor turgor of mucosa
Delayed return of deep tendon reflexes

A

Hypothyroidism

115
Q

Late signs

Goiter
Puffiness of face and eyelids
Thinning of outer eyebrows
Tongue thickening
Hard pitting edema
Pleural, peritoneal, pericardial, and joint effusions

A

Hypothyroidism

116
Q

Hypothyroidism

Serum TSH is Increased in:

A

PRIMARY Hypothyroidism

117
Q

Hypothyroidism

TSH is low or normal in _______ hypothyroidism

A

Secondary

118
Q

Hypothyroidism

Free T4 may be:

A

Low or Low Normal

119
Q

Hypothyroidism

Serum cholesterol, triglycerides, liver enzymes, creatine kinase, prolactin ________

A

INCREASED

120
Q

Lab findings:

-Hyponatremia

-Hypoglycemia

-Anemia (MCV normal or increased)

A

Hypothyroidism

121
Q

Treatment for hypothyroidism

A

Levothyroxine (T4)

25-75 mcg/day

122
Q

Hypothyroidism treatment

Thyroid function tests should be repeated every ___ weeks for medication titration until TSH is at goal

A

4-6 weeks

123
Q

Complications of hypothyroidism

A

Myxedema coma (long term untreated, ‘Hypo’ everything)

Increased susceptibility to infection

Megacolon

Organic psychoses with paranoid delusions

Angina Pectoris, CHF, dysrhythmias

Adrenal crisis

124
Q

Sweating, weight loss, heat intolerance, menstrual irregularity, tachycardia, tremors, eye stare

A

Hyperthyroidism

125
Q

Goiter, often with bruit

Ophthalmopathy

Thyroid stimulating immunoglobulins (active TSH receptor in thyroid
gland)

A

Grave’s disease

126
Q

In primary hyperthyroidism the thyroid is acting:

A

Autonomously (independent from pituitary gland)

127
Q

In primary hyperthyroidism, what would the lab values for T4, T3 and TSH be?

A

Increased Free Thyroxine (T4) and Triiodothyronine (T3)

Low TSH

128
Q

Most common cause of hyperthyroidism

A

Grave’s disease

129
Q

Signs:

-Fever
-Tachycardia
-Diaphoresis
-Tremors
-Disorientation/psychosis
-Goiter
-Exophthalmos
-Hyperreflexia
-Pretibial myxedema

A

Hyperthyroidism

130
Q

Symptoms:

-Weight loss despite INCREASED appetite
-Dysphagia or dyspnea due to goiter
-Rash/pruritis/hyperhidrosis
-Palpations/Chest pain
-Diarrhea
-Myalgias and weakness
-Nervousness/anxiety
-Menstrual irregularities
-Heat Intolerance
-Insomnia and fatigue

A

Hyperthyroidism

131
Q

Eye signs in hyperthyroidism

A

Stare and lid lag

Ophthalmopathy

Diplopia

132
Q

Skin symptoms in hyperthyroidism

A

Moist warm skin

Fine hair

Onycholysis

Dermopathy

133
Q

Heart symptoms in hyperthyroidism

A

Palpitations or angina pectoris

Arrythmias

Thyrotoxic cardiomyopathy due to thyrotoxicosis

Heart failure (Rarely)

134
Q

Extreme form of thyrotoxicosis that may be triggered by stressful illness, thyroid surgery, or radioactive iodine (RAI) administration

Sx: Delirium, severe tachycardia, vomiting, diarrhea, dehydration, very high fever

A

Thyroid Storm

135
Q

Treatment for Graves’ diseease

A

Radioactive Iodine

136
Q

Treatment for hyperthyroid symptoms like tachycardia, tremors, diaphoresis, and anxiety until hyperthyroidism is resolved

A

Propranolol (Beta Blocker)

137
Q

Most widely recommended permanent treatment of hyperthyroidism

A

Radioactive Iodine

138
Q

Longterm treatment options for hyperthyroidism result in the patient developing hypothyroidism and lifelong need for:

A

Levothyroxine (Thyroid hormone replacement)

139
Q

Commonly found during careful thyroid examinations

Small nodule on the thyroid

Usually, asymptomatic/benign

A

Thyroid nodule

140
Q

What tests are mandatory for a thyroid nodule?

A

Thyroid U/S

Thyroid Function Tests

141
Q

___% of thyroid nodules are benign

A

90%

142
Q

Disposition for a thyroid nodule

A

Referral to endocrinology

143
Q

Causes of solitary thyroid nodule:

A

Benign adenoma

Colloid nodule

Cyst

Primary thyroid malignancy or metastatic neoplasm

144
Q

Thyroid nodule

Higher risk of malignancy if:

A

History of head-neck radiation in childhood

Family history of thyroid cancer

Personal history of another malignancy

145
Q

Toxic multinodular goiter and hyperfunctioning nodules can cause:

A

Hyperthyroidism

146
Q

Thyroid nodules or multinodular goiter can grow and cause:

A

Cosmetic embarrassment, discomfort, hoarseness, or dysphagia

147
Q

Large retrosternal multinodular goiters can cause:

A

Dyspnea due to tracheal compression

148
Q

Thyroid nodules with:

-Hoarseness or vocal cord paralysis

-Nodules in men or young women

-Nodule that is solitary, firm, large, or adherent to trachea or trap muscles

-Vocal cord paralysis

-Enlarged lymph nodes

-Distant metastatic lesions

A

Malignancy

149
Q

History for distant metastatic lesions in regards to thyroid nodules

A

Family History of Goiter

Residence in area of endemic goiter

150
Q

Physical characteristics of distant metastatic lesions of thyroid nodules

A

Older women

Soft Nodule

Multinodular goiter

151
Q

Preferred imaging for thyroid nodules for its accuracy

A

U/S

152
Q

Thyroid

Solid nodules are often:

A

Malignant

153
Q

Thyroid

Cystic nodules are usually:

A

Benign

154
Q

Treatment for thyroid nodules

A

Refer to endocrinology

U/S guided fine-needle aspiration

MEDEVAC

155
Q

Weakness, abdominal pain, fever, confusion, vomiting

Low blood pressure, dehydration

Skin pigmentation may be increased

Insufficient aldosterone will result in elevated serum potassium and low sodium

Insufficient cortisol may result in hypoglycemia

Dehydration and hypotension may result in poor kidney perfusion

A

Adrenal Crisis

156
Q

Primary renal crisis results from:

A

Destruction of dysfunction of the adrenal cortex

157
Q

Secondary renal crisis results from:

A

ACTH hyposecretion

158
Q

May occur during stress in a patient with latent insufficiency or treated adrenal insufficiency with sudden withdrawal of adrenocortical hormones

A

Adrenal Crisis

159
Q

Drugs that if stopped or decreased too quickly will result in the adrenal gland not making cortisol again fast enough to meet the body needs

Resulting in adrenal insufficiency

A

Steroids (glucocorticoids & mineral corticoids)

160
Q

Symptoms:

-Headaches
-Lethargy
-Nausea/Vomiting
-Abdominal pain and diarrhea
-Confusion or coma
-Cyanosis
-Dehydration
-Sparse Axillary hair

A

Adrenal Crisis

161
Q

Signs:

-Skin hyperpigmentation
-Fever
-Hyperkalemia
-Hyponatremia
-Hypotension
-Eosinophilia

A

Adrenal Crisis

162
Q

Lab findings in Adrenal Crisis

A

Eosinophilia

Hyponatremia or hyperkalemia (or both)

Hypoglycemia

Hypercalcemia (due to renal injury)

Blood, sputum, and urine may be positive for bacteria

163
Q

Diagnostic tests for Adrenal Crisis

A

Cosyntropin stimulation test with serum ACTH level

Early morning (0600-0800) serum cortisol

164
Q

What tests helps to determine adrenal insufficiency is primary or secondary?

A

Corsyntopin stimulation with serum ACTH

165
Q

Acute abdomen is neutrophilia

Adrenal Insufficiency is ________ and ________

A

Lymphocytosis & Eosinophilia

166
Q

If symptomatic adrenal insufficiency is suspected, immediately treat with:

A

Hydrocortisone 100-300 mg IV and saline

-Continue 50-100mg IV Q 6h on first day, then Q 8h on second day; taper off

167
Q

Labs for adrenal crisis

A

Electrolytes

Cortisol

ACTH

Screen for infection (PNA, UTI)

168
Q

Patients treated for acute adrenal insufficiency and diagnosed with Addison’s disease require lifelong replacement therapy with both:

A

Glucocorticoids

Mineralocorticoids

169
Q

Weakness, fatigability, anorexia, weight loss; nausea/vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea

Sparse axillary hair; increased skin pigmentation especially of creases, pressure areas, and nipples

Hypotension, small heart

Potassium high, sodium low, blood urea nitrogen high

Plasma cortisol levels are low or fail to rise after administration of corticotropic

Elevated ACTH level

A

Chronic Adrenal Insufficiency

170
Q

Uncommon disorder caused by destruction or dysfunction of the adrenal cortices

A

Addison Disease

171
Q

Chronic deficiency of cortisol, aldosterone, and adrenal androgens and causes skin pigmentation that can be subtle or strikingly dark

A

Chronic Adrenal Insufficiency

172
Q

Chronic Adrenal Insufficiency

Skin pigmentary changes are not encountered when:

A

ACTH is not elevated

173
Q

Most common cause of Addison disease in the US

A

Autoimmune destruction of the adrenals

174
Q

Leading cause of Addison disease

A

Tuberculosis

175
Q

Symptoms:

-Weakness and Fatigability
-Weight loss
-Myalgias
-Arthralgia’s
-Anorexia
-Nausea/Vomiting
-Anxiety
-Mental irritability

A

Chronic Adrenal Insufficiency

176
Q

Signs:

-Hyperpigmentation skin changes
-Hypopigmented skin (Vitiligo 10%)
-Hypoglycemia
-Hypotensive blood pressure
-Nail beds (longitudinal pigmented bands)
-Small Heart
-Scant axillary and pubic hair

A

Chronic Adrenal Insufficiency

177
Q

Lab Findings:

-Moderate neutropenia, lymphocytosis, eosinophilia

-Low Na+, High K+

Hypoglycemic

Low Cortisol

High ACTH

A

Chronic Adrenal Insufficiency

178
Q

Chronic Adrenal Insufficiency

Chest X-ray, look for:

A

TB

Fungal infection

Cancer

Edema

179
Q

Chronic Adrenal Insufficiency

Abdominal CT, Look for:

A

Small noncalcified adrenal in autoimmune Addison disease

Adrenals are enlarged (85%)

Calcification is noted in 50% of TB cases

180
Q

Drug of choice for Chronic Adrenal Insufficiency

A

Hydrocortisone

181
Q

Most Addison patients are well maintained on:

A

15-30mg of hydrocortisone orally daily in two divided doses

182
Q

Common endocrine disorder of unknown pathophysiology affecting up to 10% of women of reproductive age

A

Polycystic Ovarian Syndrome

183
Q

Menstrual disorders

Infertility

Hirsutism

Obesity

Acne

Insulin resistance, DM2, metabolic syndrome

Dyslipidemia

Perinatal complications if able to become pregnant

A

Polycystic Ovarian Syndrome

184
Q

Labs for Polycystic Ovarian Syndrome

A

LH / FSH (Ratio is 2:1 or 3:1; normal is 1:1)

TSH

Hgb A1c and Fasting Glucose

Prolactin

Free testosterone

185
Q

Lab test for Polycystic Ovarian Syndrome if clinical evidence of Cushing Syndrome

A

Midnight salivary cortisol or dexamethasone suppression test

186
Q

Treatment for Polycystic Ovarian Syndrome

A

Weight loss and exercise

Metformin

Contraceptives

187
Q

Polycystic Ovarian Syndrome drug of choice that will increase FSH and will increase chances of ovulation

A

Clomiphene

188
Q

Deficient testosterone secretion by the testes or sperm production

A

Hypogonadism

189
Q

Hypogonadism

Insufficient gonadotropin by the pituitary

A

Hypogonadotropic

190
Q

Hypogonadism

Pathology in the testes themselves

A

Hypergonadotropic

191
Q

Fatigue

Decreased strength

Poor libido

Hot flushes

Erectile dysfunction

Gynecomastia

Infertility

Small testes

A

Hypogonadism

192
Q

Total testosterone

General rule is low

A

<200ng/dl

193
Q

Total testosterone that is normal

A

> 350ng/dl

194
Q

For values of free testosterone between 200-350ng/dl measures it with:

A

Albumin to calculate Bioavailable testosterone

195
Q

Hypogonadism

If testosterone is low, obtain what labs?

A

LH, FSH, and Prolactin

196
Q

Hypogonadism

High FSH/LH indicates _______ failure

A

Primary testicular

197
Q

Hypogonadism

High prolactin indicates possible:

A

Prolactinoma

198
Q

Hypogonadism

Low FSH/LH indciates:

A

Secondary hypogonadism

199
Q

Hypogonadism

Low FSH/LH should prompt additional screening for:

A

Hemochromatosis w/ Transferrin, Ferritin, and genotypic for HFE Gene

Pituitary mass with MRI of the Sella

Anabolic steroid or supplement use

200
Q

Treatment for Hypogonadism should only be initiated:

A

With guidance from a medical officer

201
Q

Testosterone replacement is contraindicated in ______ cancer

A

Prostate cancer

202
Q

Testosterone

HCT of ___% or greater is of high risk of developing erythrocytosis

A

55%

203
Q

Treatment for Hypogonadism

A

Transdermal testosterone 25-100mg (PREFERRED)

IM Testosterone 100mg (LONG ACTING)

204
Q

Higher doses >100mg of IM testosterone sometimes spread-out injection intervals to ___ weeks

A

2-4 weeks

205
Q

Normal hypothalamus-pituitary-gonadal (HPG) axis is down regulated by estrogen sensing in the hypothalamus.

This negative feedback mechanism can be blocked by inhibiting the hypothalamic estrogen receptors with:

A

Clomiphene (Clomid)

206
Q

Hypogonadism

Preferable therapy if patient desires fertility

A

Clomiphene (Clomid)

207
Q

Hypogonadism

This modality is used to attempt to restore normal physiology before committing life-long testosterone replacement therapy

A

Clomiphene (Clomid)

208
Q

Regimen of Clomiphene that may be attempted 3 times

A

Daily 25mg for 3 months, followed by 6 weeks off

209
Q

Therapeutic target for testosterone levels

A

800ng/dl

210
Q

Do not titrate testone dose to:

A

Patient-reported symptoms

211
Q

Sub-areolar glandular hyper density which may be unilateral or bilateral, and may be painful or non-painful

Common transient finding in pubertal males which general self-resolves

A

Gynecomastia

212
Q

Any condition resulting in excess estrogen, or testosterone which is metabolically linked to the estrogen via:

A

Aromatase

213
Q

Gynecomastia

Excess estrogen may be from:

A

Normal Physiology (Aging, obesity, puberty)

Endocrine Disease

Systemic Disease

Neoplasms

Drugs

214
Q

Gynecomastia

Physical exam, use what fingers as pincers to examine subareolar tissue as compared to nearby adipose tissue

A

Thumb and index finger

215
Q

Tissue that is diffuse and non-tender

A

Adipose

216
Q

Tissue that is dense and may be tender

A

Breast tissue

217
Q

True Gynecomastia will be localized to ________ region only

A

Subareolar

218
Q

Red flags of Gynecomastia

A

Asymmetry

Density located away from subareolar region

Nipple retraction

Nipple bleeding or discharge

Unusual firmness

219
Q

Gynecomastia

What else should you examine for size and masses?

A

Testicles

220
Q

All masses or presence of HCG warrant:

A

Testicular U/S

221
Q

Labs for Gynecomastia

A

Free testosterone

LH / FSH

Liver function panel

Renal panel (BUN and Creatinine)

Beta HCG (not pregnancy test; specific Tumor Marker)

Estradiol

Thyroid function panel

Prolactin

222
Q

Treatment for Gynecomastia

A

Selective estrogen receptor modulator (SERM)
-Raloxifine
-Tamoxifine

Aromatase inhibitor
-Anastrozole

Testosterone therapy for males with hypogonadism

223
Q

Treatment for Gynecomastia Refractory cses

A

Radiation therapy

Surgery

224
Q

Referral for Gynecomastia

A

Family Practice or Internal Medicine

225
Q

Constellation of 3 or more of the following:

-Abdominal Obesity

-Triglycerides 150mg/dl or higher

-HDL <40mg/dl for men or 50mg/dl for women

-Fasting glucose of 110mg/dl or higher

-HTN

A

Metabolic Syndrome

226
Q

Metabolic Syndrome

Waist measurement if BMI is ____

A

> 25

227
Q

Metabolic Syndrome

Lipid screening every __ years

A

5 years

228
Q

Metabolic Syndrome

Check fasting glucose or A1c every __ years in patients BMI >25 with one or more additional risk factor

A

3 years

229
Q

Metabolic Syndrome

Most important modifiable risk factor

A

Obesity

230
Q

Management for Metabolic Syndrome

A

Weight management and physical activity

Diet modification

Nutrition referral

Metformin

Blood pressure medications

TAV MDT List (12 decks)

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