Endocrinology Flashcards
1
Q
dz of adrenal gland -> insufficient cortisol
A
adrenal insufficiency/primary addison’s
2
Q
4 causes of addison’s
A
autoimmune - mc
TB
thrombosis/hemorrhagic
malignancy
rifampin/barbs/phenytoin/ketoconazole
3
Q
seondary addison’s is causd by (2)
A
decreased ACTH:
-exogenous steroids - mc
-hypopituitarism
-pituitary adenoma
4
Q
dx for addison’s
A
- 8 am serum cortisol and plasma ACTH/ACTH stimulation test
- CRH stimulation test
- adrenal abs
- CXR for TB
5
Q
high ACTH, low cortisol:
low ACTH, low cortisol:
A
primary addison’s
secondary addison’s
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
7
Q
CT of adrenals shows enlarged adrenals with calcification
A
secondary addison’s due to TB
8
Q
atrophied adrenals on CT
A
autoimmune adrenal insufficiency
9
Q
CT shows bilateral adrenal hyperplasia
A
genetic enzyme defect
10
Q
tx for addison’s
A
hydrocortisone + mineralocorticoid
11
Q
what med is only used for primary addison’s
A
fludrocortisone
12
Q
5 causes of hyperthyroidism
A
graves dz (autoimmune) - mc
toxic adenoma
thyroiditis
pregnancy
amiodarone
13
Q
3 PE findings of graves dz
A
diffuse goiter
bruit
pretibial myxedema
14
Q
3 sx of thyroid storm
A
fever
tachycardia
delirium
15
Q
dx for hyperthyroidism (3)
A
TSH
T4
RAIU
16
Q
RAIU findings of graves vs toxic multinodular
A
graves: diffusely high uptake
toxic multinodular: discrete areas of high uptake
17
Q
abs associated w. graves
A
anti-thyrotropin
18
Q
tx for hyperthyroidism
A
bb
methimazole vs PTU
radioactive iodine
thyroidectomy
19
Q
mc complication of thyroidectomy
A
recurrent laryngeal nerve damage
20
Q
management of hyperthyroidism in pregnancy
A
1st trimester: PTU
after 1st trimester: methimazole
BF’ing: methimazole
21
Q
complication of prolonged exposure to excess cortisol
A
cushing’s syndrome
22
Q
ACTH secreting pituitary microadenoma -> excess cortisol
A
cusing dz
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
24
Q
dx for cushing’s
A
- 24 hr urine free cortisol - most reliable vs late night serum cortisol
- ACTH level
- low dose dexamethasone test
25
indication for brain MRI in cushing's work up
high ACTH -> look for pituitary adenoma (cushing dz)
*ACTH dependent cause*
26
in cushing's work up, if ACTH is low, you should order
adrenal CT
*ACTH independent cause*
27
how does the dexamethasone suppression test work
1. give dexamethasone
2. failure to decrease cortisol = diagnostic
3. give high dose dexamethasone suppression test
4. no suppression = cushing syndrome
28
tx for cushing dz
**transsphenoidal selective resection of pituitary tumor**
+/- xrt
29
4 causes of hypothyroidism
**hashimoto's**
thyroidectomy
iodine ablation
congenital
30
low free T4, elevated TSH
primary hypothyroid
31
low free T4, low/normal TSH
secondary hypothyroid
32
normal T4, elevated TSH
subclinical hypothyroid
33
deficiency of/resistance to vasopressin (ADH) -> decreased ability of kidneys to reabsorb water -> massive polyuria
diabetes insipidus
34
2 types of diabetes insipidus
central
nephrogenic
35
deficiency of ADH from posterior pituitary/hypothalamus
central diabetes insipidus
36
mc type of diabetes insipidus
central
37
6 causes of central diabetes insipidus
idiopathic
autoimmune destruction of pituitary
head trauma
brain tumor
infxn
sarcoidosis
38
diabetes insipidus due to partial/complete insensitivity to ADH
nephrogenic diabetes insipidus
39
4 causes of nephrogenic diabetes insipidus
lithium, amphotericin
hypercalcemia
hypokalemia
ATN
40
serum/urine osmolality findings of diabetes insipidus
high serum osmolality
low urine osmolality
*water leaks uncontrollably from serum into kidneys*
41
dx for diabetes insipidus
water deprivation test
desmopressin stimulation test
42
what is the water deprivation test
most sensitive/reliable for diabetes insipidus:
continued production of dilute urine despite water deprivation
43
findings of desmopressin stimulation test: central vs nephrogenic diaetes insipidus
central: reduction in urine output -> indicates response to ADH
nephrogenic: continued production of dilute urine -> no response to ADH
44
tx for diabetes insipidus: central vs nephrogenic
central: desmopressive/DDAVP
nephrogenic: Na and pro restriction, hctz, indomethacin
45
mc seen in T2DM
hyperglycemia -> high osmolarity in absence of ketoacidosis
nonketotic hyperglycemia
46
4 sx of nonketotic hyperglycemia
over days to weeks
altered consciousness
dehydration/weakness/muscle cramps
vision problems
47
3 causes of nonketotic hyperglycemia
acute infxn
glucocorticoids, diuretics
nonadherence to DM meds
48
5 complications of nonketotic hyperglycemia
sz
DIC
ARF
ARDS
rhabdo
49
dx for nonketotic hyperglycemia (3)
BG > 600
osmolarity > 320
pH > 7.3
50
tx for nonketotic hyperglycemia (4)
IV NS
IV insulin for slow decline in BG
LMWH
K+ replacement
51
consequence of rapid BG reduction in nonketotic hyperglycemia
cerebral edema
52
target plasma BG in acute tx for nonketotic hyperglycemia
250-300
53
which type of pancreatic cell produces insulin
B cells
54
abs associated w. T1DM
insulin
islet cells
glutamic acid decarboxylase
55
dx for T1DM
-BG > 200 + sx
-fasting BG > 126 on more than one occassion
-A1C > 6.5
56
dx for T2DM
-random BG > 200 + sx
-fasting BG > 126 on more than one occassion
-A1C > 6.5
- > 200 on OGTT
57
gs dx for GDM
BG > 200 on OGTT
58
diagnostic criteria fro preDM
-A1C 5.7-6.4
-fasting BG 100-125
-2 hr OGTT 140-199
59
DM meds
metformin
sulfonylureas
thiazolidinediones
alpha-glcosidase inhibitors
meglitinides
GLP-1 agonists
DPP-4 inhibitors
SGLT2 inhibitors
insulin
60
2 mc s.e of metformin
lactic acidosis
GI
61
metformin is contraindicated for GFR < _ and not recommended w. GFR _
contraindicated: GFR < 30
not recommended: GFR 30-45
62
recs for metformin when using contrast
stop 24 hr prior
resume 48 hr after
d/c if Cr > 1.5
63
what DM med stimulates pancreatic beta cell insulin release (secretagogue)
**sulfonylureas:**
glyburide, glipizide, glimepiride
64
major s.e of sulfonylureas
hypoglycemia
65
what DM med increases insulin sensitivity in peripheral receptor site adipose/muscle
has no effect on pancreatic cells
**thiazolidinediones**:
proglitazone, rosiglitazone
66
major contraindication for thiazolidinediones
**CHF**
also liver dz, weight gain
67
what DM med works by delaying intestinal gluose absorption
**alpha-glucosidase inhibitors**
acarbose, miglitol
68
s.e of alpha glucosidase inhibitors
GI
69
how do meglitinides work (repaglinide, nateglinide)
stimulate insulin release
70
s.e of meglitinides
hypoglycemia
71
what DM med works by lowering BG by mimicking incretin and increasing insuling secretion/decreasing glucagon/slowing gastric emptying
**GLP-1 agonists:**
exanatide, dulaglutide, semaglutide, liraglutide
72
s.e of glp-1's
GI
73
which DM med works by increasing circulating amt of GLP1
**DPP-4 inhibitors**
sitagliptin, saxagliptin
74
risk of dpp-4 inhibitors
increased risk of HF
75
which DM med lowers renal glucose threshold and increases urinary gluose excretion
**SGLT2 inhibitors:**
canafliflozin
76
s.e of SGLT2 inhibitors
vaginal candidiasis
UTI
bone fx
lower limb amputations
AKI
DKA
77
2 added benefits of sglt2 inhibitors
wt loss
reduced CVD mortality
78
indication to start insulin
A1C > 9
79
progression of DKA
insulin deficiency -> hyperglycemia -> dehydration -> ketonemia -> metabolic acidosis -> hypokalemia
80
PE findings of DKA
tachycardia/tachypnea
hypotn
decreased skin turgor
fruity breath
kussmaul respirations
81
what are kussmaul respirations
consistent rapid, deep breathing
82
labs indicative of DKA
BG > 250
pH < 7.3
bicarb < 18
plasma ketones
+/- hyperkalemia
83
tx for DKA
**IVF**
regular insulin
K+
severe: bicarb
84
5 types of thyroiditis
hashimoto
postpartum
subacute (quervain's)
drug induced
infectious
85
difference btw hashimoto and suabacute thyroiditis
neck tenderness + recent viral infxn = subacute
86
PE finding of hashimoto thyroiditis
goiter
87
lab finding of hashimoto thyroiditis
anti-TPO abs
88
tx for hashimoto thyroiditis
euthyroid: no tx
preexisting hypothyroid: lifelong T4 replacement
89
postpartum thyroiditis must be w.in _ after giving birth
2-12 mo
90
mc cause of thyroid pain
quervain's thyroiditis (subacute)
91
inflamed, painful thyroid, fever, muscle aches
subacute/quervain's thyroiditis
92
hx clues for subacute thyroiditis
recent viral infxn w. fever, myalgia, pharyngitis
93
lab findings of subacute thyroiditis
early: hyperthyroid
late: hypothyroid
increased ESR
94
drugs associated w. thyroiditis
methiamazole/PTU
lithium
amiodarone
interferon alpha
tyrosine kinase inhibitors (sunitinib)
checkpoint inhibitors (nivolumab/pembrolizumab)
95
management of drug induced thyroiditis
T4 asap
check TSH q 6-12 hr
96
2 pathogens mc associated w. infectious thyroiditis
staph
strep
97
thyroiditis + fever/heat/pain/swelling PLUS elevated WBC
infectious thyroiditis
98
causes of painful thyroiditis
subacute (quervain's)
infectious
radiation
trauma
99
4 causes of non painful thyroiditis
postpartum (2-12 weeks)
drug-induced
hashimoto
fibrous
100
3 lab findings of thyroiditis
elevated ESR -> subacute
elevated WBC -> infectious
eleated anti TPO abs -> hashimoto
101
tx for subacute and postpartum thyroiditis
-usually self resolve
-pain management
-bb
-T4
102
when you see drug induced thyroiditis, think (2)
amiodarone
lithium
103
causes of heat intolerance
**hyperthyroidism**
amphteamines/stimulants
anticholinergics
caffeine
menopause
MS
fibromyalgia
DM
hypothalamic tumors
104
causes of cold intolerance
anemia
anorexia
raynaud
chronic illness
hypothyroidism
hypothalamus pathology
fibromyalgia
105
3 tremors to know
parkinson's
wilson's
essential
physiologic
intention (kinetic)
106
what are the 3 resting tremors
parkinson's
wilson's
severe essential
107
causes of postural/action tremor
stress/fatigue/anxiety
hypoglycemia
thyrotoxicosis
pheochromocytoma
steroids
etoh w.d
caffeine
many meds
108
tremor + peripheral neuropathy
charco-marie-tooth syndrome
109
kinetic tremor is related to _ dysfunction
cerebellar
110
6 causes of intention (kinetic) tremor
MS
trauma
tumor
vascular dz
wilson's
drugs/toxins - mercury
111
postural tremor of hands or head that is worsened by stress - occurs at any age
essential tremor
112
2 types of essential tremors
intention/action
postural
113
shaking occurs w. simple tasks like tying shoelaces, handwriting, shaving, holding hands against gravity
intention/action tremor
114
_ are spared with essential tremors
legs
115
essential tremor is improved with
etoh
116
mc cause of essential tremor
genetic - autosomal dominant
117
tx for essential tremor
**propranolol**
also: primidone, alprazolam, topiramate, gabapentin
118
33 yo F, diffuse pain/fatigue, bones and muscles diffusely hurt, abd pain, trouble focusing
hyperparathyroidism
119
progression of hyperparathyroidism
1. increased PTH -> bone breakdown -> elevated Ca
2. kidneys retain Ca and vit D
3. intestines absorb more Ca -> elevated serum Ca
120
types of hyperparathyroidism
-primary: parathyroid adenoma
-secondary: physiologic response to hypocalcemia, vit D deficiency
121
mc cause of secondary hyperparathyroidism
CKD
122
5 sx of hyperparathyroidism
stones
bones
abd groans
psych moans
fatigue overtones
123
lab findings indicative of hyperparathyroidism
elevated Ca
elevated PTH
decreased phos
124
2 UA findings of hyperparathyroidism
hyperphosphaturia
hypercalciuria
125
tx for hyperparathyroidism: primary vs secondary
primary: surgery - removal of 3.5 glands
secondary: vit D/Ca supplementation
very high Ca: IVF, lasix, calcitonin, bisphosphanates
126
2 types of amenorrhea
primary
secondary
127
primary amenorrhea is no menses by _ yo with an absence of secondary sex characteristics
OR
by _ yo w. normal growth of secondary sex characteristis
13
15
128
causes of primary menses
**pregnancy**
imperforate hymen
turner syndrome (dysgenesis)
HPO axis abnl
anorexia
bulimia
wt loss
exercise
129
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
3
6
130
mc cause of amenorrhea
pregnancy
131
ascending infxn that ascends from the cervix or vagina to the endometrium and/or fallopian tubes
PID
132
2 mc pathogens associated w. PID
GC
CT
133
what is chandelier's sign
cervical motion tenderness -> PID
134
3 complications of PID
infertility
ectopic
tubo-ovarian abscess
135
dx for PID
abdominal tenderness, cervical motion tenderness, and adnexal tenderness
PLUS 1 or more:
temp > 38
WBC > 10,000
pelvic abscess
136
tx for PID: inpt vs outpt
outpt: ceftriaxone + doxy +/- metro
inpt: doxy + cefoxitin OR cefotetan x 48 hr, followed by doxy
137
indications for inpt tx w. PID
severely ill/vomiting
dx uncertain
ectopic/appendicitis can't be ruled out
pregnancy
pelvic abscess suspected
HIV
failed outpt tx
138
excessive uterine bleeding w. no organic cause
dysfunctional uterine bleeding
139
types of dysmenorrhea
menorrhagia
metorrhagia
menometrorrhagia
polymenorrhea
oligomenorrhea
140
prolonged/heavy uterine bleeding
regular intervals
menorrhagia
141
variable amt of bleeding
irregular, frequent intervals
metrorrhagia
142
more blood loss during menses
frequent irregular bleeding btw menses
menometrorrhagia
143
menses that occur more frequently (< 21 days)
polymenorrhea
144
menses that occur less frequently (> 35 days)
oligomenorrhea
145
what types of dysfunctional uterine bleeding to uterine lesions cause (2)
menorrhagia
metrorrhagia
146
uterine lesions include (6)
endometrial ca/sarcoma
endometrial hyperplasia
submucosal fibroid
endometrial polyps
endometritis
adenomyosis
147
blood disorders associated w. dysfunctional uterine bleeding (4)
vWD (von willebrand)
prothrombin deficiency
leukemia
severe sepsis
148
which types of dysfunctional uterine bleeding is hypothyroidism associated w. (2)
menorrhagia
metrorrhagia
149
which 2 types of dysfunctional uterine bleeding is hyperthyroidism associated w. (2)
oligomenorrhea
amenorrhea
150
continuous unopposed production of estradiol 17 beta causes
anovulatory dysfunctional uterine bleeding:
continuous proliferation of endometrium w.o corpus luteum -> sloughs off in irregular pattern
151
LH surge is associated w. what type of dysfunctional uterine bleeding
mid cycle spotting
152
gs dx for dysfunctional uterine bleeding
dilation and curettage
*diagnostic and therapeutic*
153
_ can be used acutely if pt presents w. hemorrhage due to DUB
IV estrogen
154
_ reduce menstrual blood loss
NSAIDs
155
dysmenorrhea prior to menses, not relieved by NSAIDs or OCPs
dyspareunia
endometriosis
156
2 types of dysmenorrhea
primary
secondary
157
primary menorrhea begins w.in _ to _ mos of menarche
6-12
158
dysmenorrhea is due to excess _ production (2)
PG
leukotriene
-> increased uterine contraction
159
describe pain w. dysmenorrhea
begins w. start of menses
lasts 2-3 days
worst on day 1
160
3 sx associated w. dysmenorrhea
ha
nausea
diarrhea
161
painful menstruation caused by clinical identifiable cause
secondary amenorrhea
162
causes of secondary amenorrhea (lots!)
endometriosis
adenomyosis
polyps
fibroids
PID
IUD
tumors
adhesions
cervical stenosis/lesions
psych
163
describe pain w. secondary menorrhea
pain begins mid cycle
increases in severity til the end
164
mc age for secondary dysmenorrhea
20-40
165
top 2 locations for ectopic pregnancy
1. fallopian tubes
2. ampulla of tube
166
3 hallmark findings of ectopic
abd pain
bleeding
adnexal mass
167
mc cause of ectopic
occlusion of tube 2/2 adhesions
168
6 rf for ectopic
previous ectopic
previous salpingitis
previous abd/tubal surgery
IUD
assisted reproduction
smoking
169
5 sx of ruptured ectopic
severe abd pain or shoulder pain
peritonitis
tachycardia
syncope
orthostatic hypotn
170
dx for ectopic
b hcg > 1,500 w. no fetus in utero on US
171
when bHCG > _ there should be evidence of developing intrauterine gestation on US
1,500
172
hallmark US finding of ectopic
**ring of fire (ring of vascularity)**
*hypervascular lesion w. peripheral vascularity*
173
what is this showing
ring of fire -> ectopic
174
indications for MTX for ectopic
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
contraindications for MTX for ectopic (3)
bf'ing
active pulm dz
immunodeficiency
176
moa for MTX
folic acid antagonist -> inhibits DNA replication
177
indications for emergent laparoscopy salpingostomy for ectopic
rupture
MTX contraindicated
178
premature separation of all/sections of otherwise normally implanted placenta from uterine wall after 20 weeks gestation
placental abruption
179
mc cause of third trimester bleeding
placental abruption
180
5 rf for placental abruption
trauma
smoking
HTN
preeclampsia
cocaine
181
painful 3rd trimester bleeding is always _ until proven otherwise
placental abruption
182
dx for placental abruption
clinical...always
183
US findings of placental abruption
retroplacental blood collection
184
PE finding of placental abruption
blood stained amniotic fluid in vagina
185
_ indicate fetal hypoxia/bradycardia
decelerations
186
tx for placental abruption (5)
**delivery**
type and match
coag studies
large bore IV
steroids
187
management of small placental abruptions
expectant management
188
endometriosis is mc found in the (2)
ovary
peritoneum
189
t/f: the severity of endometriosis sx does not equate to severity of dz
t!
190
endometriosis is most likely caused by
retrograde menstruation: endometrium floats back out of fallopian tubes into ovary
191
rf for endometriosis
early menarche
short cycles
heavy/prolonged cycles
mullerian anomalies
fam hx
autoimmune dz
192
3 factors that decrease risk for endometriosis
multiparity
longer lactation
regular exercise
193
3 d's of endometriosis
dyspareunia
dyschezia
dysmenorrhea
194
PE finding of endometriosis
**uterus is fixed and retroflexed**
tender nodularity of cul de sac/uterine ligaments
195
gs dx for endometriosis
pelvic laparoscopy and bx
196
laparascopy findings of endometriosis
chocolate cysts
197
tx for endometriosis (5)
endometrial resection
NSAIDs
progestins/OCPs
danazol
GnRH agonist
198
max duration of tx w. danazol
6 mos
*risk for bone loss after*
199
increasing intake of _ can decrease risk of endometriosis
omega 3
200
placental lies very low in the uterus -> covers all or part of the cervix
placenta previa
201
painless third trimester bleeding is always _ until proven otherwise
placenta previa
202
5 types of placenta previa
complete
partial
marginal
low-lying
vasa previa
203
6 fetal complications associated w. placenta previa
preterm delivery
PPROM
intrauterine growth restrition
malpresentation
vasa previa
congenital abnl
204
4 rf for placenta previa
prior c section
multiple gestations
multiple induced abortions
advanced maternal age
205
dx for placenta previa
transvaginal US
206
what PE test is contraindicated in placenta previa
pelvic exam
207
management of placenta previa (4)
strict pelvic rest
+/- transfusion
c section
rhogam
208
preferred delivery for placenta previa
c section
209
3 types of fetal monitoring
non stress
contraction stress test
APGAR
