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EOR - Emergency Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

dz of adrenal gland -> insufficient cortisol

A

adrenal insufficiency/primary addison’s

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2
Q

4 causes of addison’s

A

autoimmune - mc
TB
thrombosis/hemorrhagic
malignancy
rifampin/barbs/phenytoin/ketoconazole

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3
Q

seondary addison’s is causd by (2)

A

decreased ACTH:
-exogenous steroids - mc
-hypopituitarism
-pituitary adenoma

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4
Q

dx for addison’s

A
  1. 8 am serum cortisol and plasma ACTH/ACTH stimulation test
  2. CRH stimulation test
  3. adrenal abs
  4. CXR for TB
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5
Q

high ACTH, low cortisol:
low ACTH, low cortisol:

A

primary addison’s
secondary addison’s

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6
Q

with CRH stimulation test ->

high ACTH, low cortisol:
low ACTH, low cortisol:

A

high ACTH, low cortisol: primary addison’s
low ACTH, low cortisol: secondary addison’s

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7
Q

CT of adrenals shows enlarged adrenals with calcification

A

secondary addison’s due to TB

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8
Q

atrophied adrenals on CT

A

autoimmune adrenal insufficiency

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9
Q

CT shows bilateral adrenal hyperplasia

A

genetic enzyme defect

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10
Q

tx for addison’s

A

hydrocortisone + mineralocorticoid

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11
Q

what med is only used for primary addison’s

A

fludrocortisone

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12
Q

5 causes of hyperthyroidism

A

graves dz (autoimmune) - mc
toxic adenoma
thyroiditis
pregnancy
amiodarone

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13
Q

3 PE findings of graves dz

A

diffuse goiter
bruit
pretibial myxedema

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14
Q

3 sx of thyroid storm

A

fever
tachycardia
delirium

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15
Q

dx for hyperthyroidism (3)

A

TSH
T4
RAIU

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16
Q

RAIU findings of graves vs toxic multinodular

A

graves: diffusely high uptake
toxic multinodular: discrete areas of high uptake

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17
Q

abs associated w. graves

A

anti-thyrotropin

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18
Q

tx for hyperthyroidism

A

bb
methimazole vs PTU
radioactive iodine
thyroidectomy

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19
Q

mc complication of thyroidectomy

A

recurrent laryngeal nerve damage

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20
Q

management of hyperthyroidism in pregnancy

A

1st trimester: PTU
after 1st trimester: methimazole

BF’ing: methimazole

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21
Q

complication of prolonged exposure to excess cortisol

A

cushing’s syndrome

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22
Q

ACTH secreting pituitary microadenoma -> excess cortisol

A

cusing dz

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23
Q

sx of hypercortisolism (lots!)

A

obesity
moon facies
supraclavicular pads
HTN
excessive thirst
polyuria
hypokalemia
proximal m weakness
pigmented striae
backache
HA
oligomenorrhea/amenorrhea
ED
emotional ability/psychosis

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24
Q

dx for cushing’s

A
  1. 24 hr urine free cortisol - most reliable vs late night serum cortisol
  2. ACTH level
  3. low dose dexamethasone test
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25
Q

indication for brain MRI in cushing’s work up

A

high ACTH -> look for pituitary adenoma (cushing dz)

ACTH dependent cause

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26
Q

in cushing’s work up, if ACTH is low, you should order

A

adrenal CT

ACTH independent cause

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27
Q

how does the dexamethasone suppression test work

A
  1. give dexamethasone
  2. failure to decrease cortisol = diagnostic
  3. give high dose dexamethasone suppression test
  4. no suppression = cushing syndrome
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28
Q

tx for cushing dz

A

transsphenoidal selective resection of pituitary tumor
+/- xrt

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29
Q

4 causes of hypothyroidism

A

hashimoto’s
thyroidectomy
iodine ablation
congenital

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30
Q

low free T4, elevated TSH

A

primary hypothyroid

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31
Q

low free T4, low/normal TSH

A

secondary hypothyroid

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32
Q

normal T4, elevated TSH

A

subclinical hypothyroid

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33
Q

deficiency of/resistance to vasopressin (ADH) -> decreased ability of kidneys to reabsorb water -> massive polyuria

A

diabetes insipidus

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34
Q

2 types of diabetes insipidus

A

central
nephrogenic

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35
Q

deficiency of ADH from posterior pituitary/hypothalamus

A

central diabetes insipidus

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36
Q

mc type of diabetes insipidus

A

central

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37
Q

6 causes of central diabetes insipidus

A

idiopathic
autoimmune destruction of pituitary
head trauma
brain tumor
infxn
sarcoidosis

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38
Q

diabetes insipidus due to partial/complete insensitivity to ADH

A

nephrogenic diabetes insipidus

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39
Q

4 causes of nephrogenic diabetes insipidus

A

lithium, amphotericin
hypercalcemia
hypokalemia
ATN

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40
Q

serum/urine osmolality findings of diabetes insipidus

A

high serum osmolality
low urine osmolality

water leaks uncontrollably from serum into kidneys

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41
Q

dx for diabetes insipidus

A

water deprivation test
desmopressin stimulation test

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42
Q

what is the water deprivation test

A

most sensitive/reliable for diabetes insipidus:

continued production of dilute urine despite water deprivation

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43
Q

findings of desmopressin stimulation test: central vs nephrogenic diaetes insipidus

A

central: reduction in urine output -> indicates response to ADH

nephrogenic: continued production of dilute urine -> no response to ADH

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44
Q

tx for diabetes insipidus: central vs nephrogenic

A

central: desmopressive/DDAVP
nephrogenic: Na and pro restriction, hctz, indomethacin

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45
Q

mc seen in T2DM
hyperglycemia -> high osmolarity in absence of ketoacidosis

A

nonketotic hyperglycemia

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46
Q

4 sx of nonketotic hyperglycemia

A

over days to weeks
altered consciousness
dehydration/weakness/muscle cramps
vision problems

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47
Q

3 causes of nonketotic hyperglycemia

A

acute infxn
glucocorticoids, diuretics
nonadherence to DM meds

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48
Q

5 complications of nonketotic hyperglycemia

A

sz
DIC
ARF
ARDS
rhabdo

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49
Q

dx for nonketotic hyperglycemia (3)

A

BG > 600
osmolarity > 320
pH > 7.3

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50
Q

tx for nonketotic hyperglycemia (4)

A

IV NS
IV insulin for slow decline in BG
LMWH
K+ replacement

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51
Q

consequence of rapid BG reduction in nonketotic hyperglycemia

A

cerebral edema

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52
Q

target plasma BG in acute tx for nonketotic hyperglycemia

A

250-300

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53
Q

which type of pancreatic cell produces insulin

A

B cells

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54
Q

abs associated w. T1DM

A

insulin
islet cells
glutamic acid decarboxylase

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55
Q

dx for T1DM

A

-BG > 200 + sx
-fasting BG > 126 on more than one occassion
-A1C > 6.5

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56
Q

dx for T2DM

A

-random BG > 200 + sx
-fasting BG > 126 on more than one occassion
-A1C > 6.5
- > 200 on OGTT

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57
Q

gs dx for GDM

A

BG > 200 on OGTT

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58
Q

diagnostic criteria fro preDM

A

-A1C 5.7-6.4
-fasting BG 100-125
-2 hr OGTT 140-199

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59
Q

DM meds

A

metformin
sulfonylureas
thiazolidinediones
alpha-glcosidase inhibitors
meglitinides
GLP-1 agonists
DPP-4 inhibitors
SGLT2 inhibitors
insulin

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60
Q

2 mc s.e of metformin

A

lactic acidosis
GI

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61
Q

metformin is contraindicated for GFR < _ and not recommended w. GFR _

A

contraindicated: GFR < 30
not recommended: GFR 30-45

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62
Q

recs for metformin when using contrast

A

stop 24 hr prior
resume 48 hr after
d/c if Cr > 1.5

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63
Q

what DM med stimulates pancreatic beta cell insulin release (secretagogue)

A

sulfonylureas:
glyburide, glipizide, glimepiride

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64
Q

major s.e of sulfonylureas

A

hypoglycemia

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65
Q

what DM med increases insulin sensitivity in peripheral receptor site adipose/muscle

has no effect on pancreatic cells

A

thiazolidinediones:
proglitazone, rosiglitazone

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66
Q

major contraindication for thiazolidinediones

A

CHF

also liver dz, weight gain

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67
Q

what DM med works by delaying intestinal gluose absorption

A

alpha-glucosidase inhibitors
acarbose, miglitol

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68
Q

s.e of alpha glucosidase inhibitors

A

GI

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69
Q

how do meglitinides work (repaglinide, nateglinide)

A

stimulate insulin release

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70
Q

s.e of meglitinides

A

hypoglycemia

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71
Q

what DM med works by lowering BG by mimicking incretin and increasing insuling secretion/decreasing glucagon/slowing gastric emptying

A

GLP-1 agonists:
exanatide, dulaglutide, semaglutide, liraglutide

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72
Q

s.e of glp-1’s

A

GI

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73
Q

which DM med works by increasing circulating amt of GLP1

A

DPP-4 inhibitors
sitagliptin, saxagliptin

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74
Q

risk of dpp-4 inhibitors

A

increased risk of HF

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75
Q

which DM med lowers renal glucose threshold and increases urinary gluose excretion

A

SGLT2 inhibitors:
canafliflozin

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76
Q

s.e of SGLT2 inhibitors

A

vaginal candidiasis
UTI
bone fx
lower limb amputations
AKI
DKA

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77
Q

2 added benefits of sglt2 inhibitors

A

wt loss
reduced CVD mortality

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78
Q

indication to start insulin

A

A1C > 9

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79
Q

progression of DKA

A

insulin deficiency -> hyperglycemia -> dehydration -> ketonemia -> metabolic acidosis -> hypokalemia

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80
Q

PE findings of DKA

A

tachycardia/tachypnea
hypotn
decreased skin turgor
fruity breath
kussmaul respirations

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81
Q

what are kussmaul respirations

A

consistent rapid, deep breathing

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82
Q

labs indicative of DKA

A

BG > 250
pH < 7.3
bicarb < 18
plasma ketones
+/- hyperkalemia

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83
Q

tx for DKA

A

IVF
regular insulin
K+
severe: bicarb

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84
Q

5 types of thyroiditis

A

hashimoto
postpartum
subacute (quervain’s)
drug induced
infectious

85
Q

difference btw hashimoto and suabacute thyroiditis

A

neck tenderness + recent viral infxn = subacute

86
Q

PE finding of hashimoto thyroiditis

A

goiter

87
Q

lab finding of hashimoto thyroiditis

A

anti-TPO abs

88
Q

tx for hashimoto thyroiditis

A

euthyroid: no tx

preexisting hypothyroid: lifelong T4 replacement

89
Q

postpartum thyroiditis must be w.in _ after giving birth

A

2-12 mo

90
Q

mc cause of thyroid pain

A

quervain’s thyroiditis (subacute)

91
Q

inflamed, painful thyroid, fever, muscle aches

A

subacute/quervain’s thyroiditis

92
Q

hx clues for subacute thyroiditis

A

recent viral infxn w. fever, myalgia, pharyngitis

93
Q

lab findings of subacute thyroiditis

A

early: hyperthyroid
late: hypothyroid
increased ESR

94
Q

drugs associated w. thyroiditis

A

methiamazole/PTU
lithium
amiodarone
interferon alpha
tyrosine kinase inhibitors (sunitinib)
checkpoint inhibitors (nivolumab/pembrolizumab)

95
Q

management of drug induced thyroiditis

A

T4 asap
check TSH q 6-12 hr

96
Q

2 pathogens mc associated w. infectious thyroiditis

A

staph
strep

97
Q

thyroiditis + fever/heat/pain/swelling PLUS elevated WBC

A

infectious thyroiditis

98
Q

causes of painful thyroiditis

A

subacute (quervain’s)
infectious
radiation
trauma

99
Q

4 causes of non painful thyroiditis

A

postpartum (2-12 weeks)
drug-induced
hashimoto
fibrous

100
Q

3 lab findings of thyroiditis

A

elevated ESR -> subacute
elevated WBC -> infectious
eleated anti TPO abs -> hashimoto

101
Q

tx for subacute and postpartum thyroiditis

A

-usually self resolve
-pain management
-bb
-T4

102
Q

when you see drug induced thyroiditis, think (2)

A

amiodarone
lithium

103
Q

causes of heat intolerance

A

hyperthyroidism
amphteamines/stimulants
anticholinergics
caffeine
menopause
MS
fibromyalgia
DM
hypothalamic tumors

104
Q

causes of cold intolerance

A

anemia
anorexia
raynaud
chronic illness
hypothyroidism
hypothalamus pathology
fibromyalgia

105
Q

3 tremors to know

A

parkinson’s
wilson’s
essential
physiologic
intention (kinetic)

106
Q

what are the 3 resting tremors

A

parkinson’s
wilson’s
severe essential

107
Q

causes of postural/action tremor

A

stress/fatigue/anxiety
hypoglycemia
thyrotoxicosis
pheochromocytoma
steroids
etoh w.d
caffeine
many meds

108
Q

tremor + peripheral neuropathy

A

charco-marie-tooth syndrome

109
Q

kinetic tremor is related to _ dysfunction

A

cerebellar

110
Q

6 causes of intention (kinetic) tremor

A

MS
trauma
tumor
vascular dz
wilson’s
drugs/toxins - mercury

111
Q

postural tremor of hands or head that is worsened by stress - occurs at any age

A

essential tremor

112
Q

2 types of essential tremors

A

intention/action
postural

113
Q

shaking occurs w. simple tasks like tying shoelaces, handwriting, shaving, holding hands against gravity

A

intention/action tremor

114
Q

_ are spared with essential tremors

A

legs

115
Q

essential tremor is improved with

A

etoh

116
Q

mc cause of essential tremor

A

genetic - autosomal dominant

117
Q

tx for essential tremor

A

propranolol

also: primidone, alprazolam, topiramate, gabapentin

118
Q

33 yo F, diffuse pain/fatigue, bones and muscles diffusely hurt, abd pain, trouble focusing

A

hyperparathyroidism

119
Q

progression of hyperparathyroidism

A
  1. increased PTH -> bone breakdown -> elevated Ca
  2. kidneys retain Ca and vit D
  3. intestines absorb more Ca -> elevated serum Ca
120
Q

types of hyperparathyroidism

A

-primary: parathyroid adenoma
-secondary: physiologic response to hypocalcemia, vit D deficiency

121
Q

mc cause of secondary hyperparathyroidism

A

CKD

122
Q

5 sx of hyperparathyroidism

A

stones
bones
abd groans
psych moans
fatigue overtones

123
Q

lab findings indicative of hyperparathyroidism

A

elevated Ca
elevated PTH
decreased phos

124
Q

2 UA findings of hyperparathyroidism

A

hyperphosphaturia
hypercalciuria

125
Q

tx for hyperparathyroidism: primary vs secondary

A

primary: surgery - removal of 3.5 glands
secondary: vit D/Ca supplementation
very high Ca: IVF, lasix, calcitonin, bisphosphanates

126
Q

2 types of amenorrhea

A

primary
secondary

127
Q

primary amenorrhea is no menses by _ yo with an absence of secondary sex characteristics
OR
by _ yo w. normal growth of secondary sex characteristis

A

13
15

128
Q

causes of primary menses

A

pregnancy
imperforate hymen
turner syndrome (dysgenesis)
HPO axis abnl
anorexia
bulimia
wt loss
exercise

129
Q

secondary amenorrhea is absence of menses for _ mo in women w. previously normal menstruation,
OR
_ mo in a woman w. a hx of irregular cyles

A

3
6

130
Q

mc cause of amenorrhea

A

pregnancy

131
Q

ascending infxn that ascends from the cervix or vagina to the endometrium and/or fallopian tubes

A

PID

132
Q

2 mc pathogens associated w. PID

A

GC
CT

133
Q

what is chandelier’s sign

A

cervical motion tenderness -> PID

134
Q

3 complications of PID

A

infertility
ectopic
tubo-ovarian abscess

135
Q

dx for PID

A

abdominal tenderness, cervical motion tenderness, and adnexal tenderness

PLUS 1 or more:
temp > 38
WBC > 10,000
pelvic abscess

136
Q

tx for PID: inpt vs outpt

A

outpt: ceftriaxone + doxy +/- metro

inpt: doxy + cefoxitin OR cefotetan x 48 hr, followed by doxy

137
Q

indications for inpt tx w. PID

A

severely ill/vomiting
dx uncertain
ectopic/appendicitis can’t be ruled out
pregnancy
pelvic abscess suspected
HIV
failed outpt tx

138
Q

excessive uterine bleeding w. no organic cause

A

dysfunctional uterine bleeding

139
Q

types of dysmenorrhea

A

menorrhagia
metorrhagia
menometrorrhagia
polymenorrhea
oligomenorrhea

140
Q

prolonged/heavy uterine bleeding
regular intervals

A

menorrhagia

141
Q

variable amt of bleeding
irregular, frequent intervals

A

metrorrhagia

142
Q

more blood loss during menses
frequent irregular bleeding btw menses

A

menometrorrhagia

143
Q

menses that occur more frequently (< 21 days)

A

polymenorrhea

144
Q

menses that occur less frequently (> 35 days)

A

oligomenorrhea

145
Q

what types of dysfunctional uterine bleeding to uterine lesions cause (2)

A

menorrhagia
metrorrhagia

146
Q

uterine lesions include (6)

A

endometrial ca/sarcoma
endometrial hyperplasia
submucosal fibroid
endometrial polyps
endometritis
adenomyosis

147
Q

blood disorders associated w. dysfunctional uterine bleeding (4)

A

vWD (von willebrand)
prothrombin deficiency
leukemia
severe sepsis

148
Q

which types of dysfunctional uterine bleeding is hypothyroidism associated w. (2)

A

menorrhagia
metrorrhagia

149
Q

which 2 types of dysfunctional uterine bleeding is hyperthyroidism associated w. (2)

A

oligomenorrhea
amenorrhea

150
Q

continuous unopposed production of estradiol 17 beta causes

A

anovulatory dysfunctional uterine bleeding:

continuous proliferation of endometrium w.o corpus luteum -> sloughs off in irregular pattern

151
Q

LH surge is associated w. what type of dysfunctional uterine bleeding

A

mid cycle spotting

152
Q

gs dx for dysfunctional uterine bleeding

A

dilation and curettage

diagnostic and therapeutic

153
Q

_ can be used acutely if pt presents w. hemorrhage due to DUB

A

IV estrogen

154
Q

_ reduce menstrual blood loss

A

NSAIDs

155
Q

dysmenorrhea prior to menses, not relieved by NSAIDs or OCPs
dyspareunia

A

endometriosis

156
Q

2 types of dysmenorrhea

A

primary
secondary

157
Q

primary menorrhea begins w.in _ to _ mos of menarche

A

6-12

158
Q

dysmenorrhea is due to excess _ production (2)

A

PG
leukotriene

-> increased uterine contraction

159
Q

describe pain w. dysmenorrhea

A

begins w. start of menses
lasts 2-3 days
worst on day 1

160
Q

3 sx associated w. dysmenorrhea

A

ha
nausea
diarrhea

161
Q

painful menstruation caused by clinical identifiable cause

A

secondary amenorrhea

162
Q

causes of secondary amenorrhea (lots!)

A

endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis/lesions
psych

163
Q

describe pain w. secondary menorrhea

A

pain begins mid cycle
increases in severity til the end

164
Q

mc age for secondary dysmenorrhea

A

20-40

165
Q

top 2 locations for ectopic pregnancy

A
  1. fallopian tubes
  2. ampulla of tube
166
Q

3 hallmark findings of ectopic

A

abd pain
bleeding
adnexal mass

167
Q

mc cause of ectopic

A

occlusion of tube 2/2 adhesions

168
Q

6 rf for ectopic

A

previous ectopic
previous salpingitis
previous abd/tubal surgery
IUD
assisted reproduction
smoking

169
Q

5 sx of ruptured ectopic

A

severe abd pain or shoulder pain
peritonitis
tachycardia
syncope
orthostatic hypotn

170
Q

dx for ectopic

A

b hcg > 1,500 w. no fetus in utero on US

171
Q

when bHCG > _ there should be evidence of developing intrauterine gestation on US

A

1,500

172
Q

hallmark US finding of ectopic

A

ring of fire (ring of vascularity)

hypervascular lesion w. peripheral vascularity

173
Q

what is this showing

A

ring of fire -> ectopic

174
Q

indications for MTX for ectopic

A

b HCG < 5,000
ectopic mass < 3.5 cm
no FHR
hemodynamically stable
no blood d.o
no pulm. dz
no peptic ulcer
normal renal fxn
normal hepatic fxn
compliant pt

175
Q

contraindications for MTX for ectopic (3)

A

bf’ing
active pulm dz
immunodeficiency

176
Q

moa for MTX

A

folic acid antagonist -> inhibits DNA replication

177
Q

indications for emergent laparoscopy salpingostomy for ectopic

A

rupture
MTX contraindicated

178
Q

premature separation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks gestation

A

placental abruption

179
Q

mc cause of third trimester bleeding

A

placental abruption

180
Q

5 rf for placental abruption

A

trauma
smoking
HTN
preeclampsia
cocaine

181
Q

painful 3rd trimester bleeding is always _ until proven otherwise

A

placental abruption

182
Q

dx for placental abruption

A

clinical…always

183
Q

US findings of placental abruption

A

retroplacental blood collection

184
Q

PE finding of placental abruption

A

blood stained amniotic fluid in vagina

185
Q

_ indicate fetal hypoxia/bradycardia

A

decelerations

186
Q

tx for placental abruption (5)

A

delivery
type and match
coag studies
large bore IV
steroids

187
Q

management of small placental abruptions

A

expectant management

188
Q

endometriosis is mc found in the (2)

A

ovary
peritoneum

189
Q

t/f: the severity of endometriosis sx does not equate to severity of dz

A

t!

190
Q

endometriosis is most likely caused by

A

retrograde menstruation: endometrium floats back out of fallopian tubes into ovary

191
Q

rf for endometriosis

A

early menarche
short cycles
heavy/prolonged cycles
mullerian anomalies
fam hx
autoimmune dz

192
Q

3 factors that decrease risk for endometriosis

A

multiparity
longer lactation
regular exercise

193
Q

3 d’s of endometriosis

A

dyspareunia
dyschezia
dysmenorrhea

194
Q

PE finding of endometriosis

A

uterus is fixed and retroflexed
tender nodularity of cul de sac/uterine ligaments

195
Q

gs dx for endometriosis

A

pelvic laparoscopy and bx

196
Q

laparascopy findings of endometriosis

A

chocolate cysts

197
Q

tx for endometriosis (5)

A

endometrial resection
NSAIDs
progestins/OCPs
danazol
GnRH agonist

198
Q

max duration of tx w. danazol

A

6 mos

risk for bone loss after

199
Q

increasing intake of _ can decrease risk of endometriosis

A

omega 3

200
Q

placental lies very low in the uterus -> covers all or part of the cervix

A

placenta previa

201
Q

painless third trimester bleeding is always _ until proven otherwise

A

placenta previa

202
Q

5 types of placenta previa

A

complete
partial
marginal
low-lying
vasa previa

203
Q

6 fetal complications associated w. placenta previa

A

preterm delivery
PPROM
intrauterine growth restrition
malpresentation
vasa previa
congenital abnl

204
Q

4 rf for placenta previa

A

prior c section
multiple gestations
multiple induced abortions
advanced maternal age

205
Q

dx for placenta previa

A

transvaginal US

206
Q

what PE test is contraindicated in placenta previa

A

pelvic exam

207
Q

management of placenta previa (4)

A

strict pelvic rest
+/- transfusion
c section
rhogam

208
Q

preferred delivery for placenta previa

A

c section

209
Q

3 types of fetal monitoring

A

non stress
contraction stress test
APGAR

EOR - Emergency Medicine (13 decks)

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