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ABFM First Aid > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Diagnostic criteria for DM

A
  1. Random plasma glucose of > 200 with symptoms
  2. Glucose >126 after 8 hr fasting
  3. Glucose > 200, 2 hrs after 75 g GGT
  4. A1C > 6.5%
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2
Q

USPSTF recommends screening —– for T2DM.

A

Overweight or obese individuals age 40-70 or those who are symptomatic

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3
Q

C/I to metformin

A

GFR <30

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4
Q

C/I to Rosiglitazone or pioglitazone

A

NYHA class 3-4, bladder cancer or osteoporosis

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5
Q

C/I to exenatide, liraglutide, albiglutide

A

gastroparesis(causes delayed gastric emptying), CrCl <30, hx of Medullary thyroid cancer

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6
Q

C/I to SGLT-2 inhibitors(-flozins)

A

renal or liver failure

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7
Q

Most chronic complications of DM start — years after disease onset.

A

5

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8
Q

Most common functional pituitary adenoma?

A

prolactinomas

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9
Q

You find a pituitary mass incidentally on MRI. What should you do next?

A

Check: Prolactin, IGF-1, 24 hr urine cortisol, ACTH, TSH, LH, FSH & Testosterone. If all normal just monitor. If + then treat condition

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10
Q

Pituitary adenoma compressing the optic chiasm will result in ——(pattern of vision loss)

A

bitemporal hemianopia

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11
Q

Diabetes Insipidus is caused by low —-.

A

ADH = inability to concentrate urine.

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12
Q

Central Diabetes Insipidus vs Nephrogenic DI

A 
Central = decrease ADH release from pituitary 2/2 trauma, genetic or idiopathic
Nephrogenic = resistance to ADH most often due to Lithium or another med
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13
Q

In Diabetes Insipidus urine osmolality will be —, serum osmolality will be —, Na will be — & ADH will be —.

A

Low urine osm, high serum osm, high Na, Low ADH

**per truleson you dnt need a high Na for DI, just someone whos drinking gallons and gallons of water a day.

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14
Q

Treatment for central vs nephrogenic DI

A 
Central = desmopressin(DDAVP)
Nephrogenic = stop rx
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15
Q

Causes of SIADH

A

CNS(tumors, hemorrhage, stroke, infarct), Pulm( pneumonia, cystic fibrosis, Asthma), Tumors(small cell carcinoma of the lungs is the most common), Drugs(commonly: carbamazepine, SSRIs, vincristine, haloperidol, amitriptyline, amiodarone)

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16
Q

SIADH is a —volemic —osmolar —natremia.

A

euvolemic hypoosmolar hyponatremia

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17
Q

First line treatment for GH excess

A

transphenoidal resection – carries 80% risk of hypopituitarism or DI

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18
Q

First line treatment for prolactinoma

A

bromocriptine or cabergoline or stop offending rx.

**if cannot be controlled with rx may be transsphenoidal resection

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19
Q

Dopamines effect on prolactin?

A

inhibits

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20
Q

Tumors associated with MEN1

A

Pancreatic(insulinoma, gastrinoma), Parathyroid, Pituitary tumors

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21
Q

Tumors associated with MEN2A

A

Mendullary thyroid cancer(calcitonin secreting), pheochromocytoma, parathyroid hyperplasia

22
Q

Tumors associated with MEN2B

A

Medullary thyroid cancer, mucosal neuromas, pheochromocytoma

23
Q

You check a TSH and its elevated so you check a T3/T4 & its also elevated. Whats the next step?

A

RAI - could be parathyroid secreting TSH adenoma

24
Q

Causes of increased RAI uptake?

A

Graves(diffuse), active nodule(single focus)

25
Q

Causes of decreased RAI uptake?

A

exogenous thyroid hormone, thyroiditis

26
Q

Which vitamin suppliment can cause false +/- readings for TSH?

A

Biotin

27
Q

Which labs need to be monitored for a patient on methimazole or PTU? why?

A

CBC looking for agranulocytosis

28
Q

Most common type of thyroid cancer? Prognosis? whats it produce?

A

Papillary - excellent prognosis, secrete Thyroglobulin

29
Q

What are the two most aggressive thyroid cancers? Which one is worse?

A

anaplastic > follicular

30
Q

which thyroid cancer is most likely to mets to bone, lungs & brain?

A

Follicular

**often retains ability to make TH = “functioning thyroid cancer”

31
Q

Which thyroid cancer secrets calcitonin?

A

medullary = associated with MEN2B

32
Q

Nodule on thyroid US with low TSH. Next steps?

A

RAI uptake - FNA all cold nodules as these are more likely cancer!
DO NOT FNA hot nodule

33
Q

Hypocalcemia due to hypoparathyroidism will have what P & PTH levels?

A

elevated P, Low PTH

34
Q

Hypocalcemia due to CKD will have what P & PTH levels?

A

elevated P, elevated PTH

35
Q

Hypocalcemia due to Vit D deficiency will have what P & PTH levels?

A

low P, elevated PTH

36
Q

Hypocalcemia due to low Mag will have what P & PTH levels?

A

low P, low PTH

37
Q

Paget Disease labs + imaging

A
  • *elevated alk phos, normal GGT & other liver enzymes, Ca & P often normal.
  • *XR shows increase bone denisty, Bone scintigraphy showed increase uptake due to increased bone osteoclast activity
38
Q

X

A

X

39
Q

Most common cause of adrenal insufficiency in the US

A

Addisons disease

40
Q

Which type of anemia would falsely elevate A1c?

A

Iron deficiency anemia -smaller red blood cells stay around longer

  • a1c will also be increased with hypertriglyceridemia, splenectomy, renal failure, aplastic anemia
41
Q

Pioglitazone improves outcomes of those with…

A

CVA and non fatal MI

42
Q

3 medications Approved for use and diabetes in children

A

MetForman, liraglutide and insulin

  • Other medications are used they’re just not officially approved
43
Q

Which ethnicity do you see the highest rate of diabetes?

A

Native Americans

44
Q

Pt with DKA. When do u switch to 1/2 NS + dextrose w/K?

A

Glucose around 250

45
Q

Best indicator for successful healing of diabetic foot ulcer?

A

Distal pulses

46
Q

Things that effect thyroid supplimentation…

A

Desiccated thyroid(poor quality), T3 alone(poor quality studies), iron, sulcrafate, anticonvulsant, grapefruit, amiodarone, lithium, SSRI, retinoids

47
Q

Things that ca effect T4 to T3 conversion

A

OCPs, steroids, chemotherapy, lithium, SSRIs, Fenelton, IV contrast, theophylline, beta blockers, Florida, opioids, estrogen, Stress, Asian, alcohol use, fasting, radiation, some vegetables in excess, low ferritin, soy, pesticides, hemachromatosis, smoking and kidney disease

48
Q

Patient finds a thyroid nodule. What’s the first test u run?

A

TSH then US

49
Q

Goal TSH in pregnancy?

A

<3

50
Q

When should you check TSH after postpartum thyroiditis & why?

A

Check TSH two months after toxic phase to look for hypothyroidism. If hypothyroid go ahead and treat with Synthroid however this medication can Often be weaned off after 6 to 12 months

ABFM First Aid (22 decks)

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