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NPLEX II TIA > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

in what scenario(s) is DHEA tested?

A

hirsutism
adreal function

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2
Q

what is the dexamethasone suppression test?

A

dx for cushings

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3
Q

in what scenario(s) is estradiol tested?

A

amenorrhea

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4
Q

in what scenario(s) is estriol tested?

A

monitor fetal wellbeing

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5
Q

in what scenario(s) is FSH/LH tested?

A

disorders of puberty, subfertility, and pituitary etiologies

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6
Q

gastrin is elevated in what condition(s)

A

zollinger ellison syndrome
pernicious anemia
pyloric stenosis
atrophic gastritis
chronic renal failure

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7
Q

workup for pheochromocytoma

A

24 hour urine catecholamine test with or without VMA (breakdown of catecholamines) testing

inc plasma catecholamines NOT suppressed by clonidine

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8
Q

mechanisms of hormone action:

A

second messengers: insulin, NTs

nuclear reactors: steroids, thyroid, sex hormones, retinoids, vit D

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9
Q

if serum prolactin is high, what are next dx steps?

A

brain MRI

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10
Q

high prolactin but normal brain MRI at this point; what could be causing the exacerbation of the prolactinoma?

A

estrogen dominance
subclinical hypothyroidism

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11
Q

DI presentation

A

ADH def from post pit
inc thirst (wakes at night), urination
water deprivation does NOT cause ADH release; urinate regardless of water intake
kidneys cant concentrate urine

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12
Q

thyroid hormone precursor

A

tyrosine + iodine

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13
Q

herb for hyperthyroid

A

lycopus
melissa

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14
Q

main concern in graves

A

cardio complications; why BB are also in early graves tx with other meds

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15
Q

what medication can often cause hypothyroidism?

A

lithium; screen pts every 6 mo

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16
Q

if you had a pt presenting with what seemed to be a straightforward graves case, but thyroid labs were normal; what ddx would be your next consideration?

A

pheochromocytoma

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17
Q

dequervains subacute granulomatous thyroiditis

A

self limited (8-10 weeks) painful inflammation of thyroid

AI, viral
W>M, 10-40

hyperthyroid > hypothyroid > euthyroid

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18
Q

reidel’s thyroiditis

A

rock hard/woody thyroid
mimics carcinoma
older women
fibrotic thyroid proliferation (may cause hypothyroidism/dyspnea)

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19
Q

causes of goiter

A

simple: iodine def, too many goitrogens (ca/fluorine in water, bassicae, polluted water)

multinodular: cancer, adenomatous dz

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20
Q

workup goiter

A

US and thyroid labs

watch palpation pressure; in secretory/hot nodule can induce thyroid storm with pressing too hard

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21
Q

thyroid adenomas

A

extremely common
most are benign
pressure sx in throat
post meno women

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22
Q

CS AEs

A

adrenal suppression if dose exceeds adrenal output (TAPER)
avascular necrosis of hip from fat emboli
cushings

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23
Q

hydrocortisone:prenisone ratio

A

4:1

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24
Q

pheochromocytoma presentation

A

adrenal medulla tumor of chromaffin cells that secretes catecholamines

triad: palpitations, pounding HA, episodic sweating
HTN, arrythmias, hyperglycemia, hypermetabolism (very similar to graves presentation)

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25
Q

neuroblastoma presentation

A

childhood (<5) tumor of adrenal medulla chromaffin cells

occur sporadically, born with + usually will be present in utero

large abdominal mass, can be fatal

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26
Q

addisons presentation

A

hypoadrenalism (AI, TB, fungal)
adrenal medulla unaffected

weakness, fatigue, wt loss, diarrhea/vomiting, hyperpigmentation from inc ACTH (mimics MSH)
low Na, cl, cortisol
high K

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27
Q

causes of cushings (hyperadrenalism)

A

long term steroids
pituitary adenoma
ectopic ACTH/neoplasm
thyroid carcinoma
adrenal cortex tumor

28
Q

conn’s syndrome presentation

A

solitary aldosterone secreting adenoma in adrenal cortex > hyperaldosteronism

low plasma renin and K
high Na and aldosterone

tachycardic, hypertensive

29
Q

thymic hyperplasia etiology

A

myasthenia gravis
SLE, Graves, RA

30
Q

digeorge syndrome

A

aplasia/hypoplasia of thymus and parathyroid

lack of cell mediated immunity, hypoparathyroidism

dev defects in heart and great vessels

31
Q

zollinger ellison syndrome presentation

A

tumor in pancreas secretes gastrin >

peptic ulcers, gastric hypersecretion, malabsorption, diarrhea

60% are malignant

32
Q

alpha cells of pancrease secrete

A

glucagon (opp insulin)

33
Q

beta cells of pancrease secrete

A

insulin

34
Q

delta cells of pancrease secrete

A

somatostain

35
Q

PP cells of pancrease secrete

A

pancreatic polypeptide

36
Q

insulinoma presentation

A

beta islet cell tumor of pancreas > hypoglycemia (confusion, LOC, stupor), temp relieved by eating

insulin will be high fasting and non fasting, inc c peptide

need pancreas/abdominal imaging CT/US

MEN1 syndrome

37
Q

DM1

A

AI to beta islet cells > dec function
insulin dependent

wt loss, wasting, hypotension, hypothermia

38
Q

HbA1c levels

A

5.7-6.5 prediabetic/impaired glucose metabolism

> 6.5 diabetes

<7 DM management

39
Q

5.7 HbA1c is about an avg blood glucose of

A

126

40
Q

what do incretins do?

A

inc insulin secretion

41
Q

what insulin is long acting?

A

glargine

42
Q

what insulin is short acting?

A

lispro

43
Q

DKA presentation

A

ONLY DM1
lack of insulin > acidosis > burns fat > bodywide dump of ketones

lack of tx
MI, CHF
infxn or emotional disturbance (cortisol release)

digestive complaints > acetone breath odor, low BP, high HR > urinary ketone!!!

44
Q

DKA tx

A

test for ketones/sugar

ER!! can not do anything outpatient, they will die.

45
Q

reactive dysglycemia/hypoglycemia

A

excess insulin tx in T1DM, sulfonylurea, T2DM excessive insulin

hypoglycemic 1-5 hours after eating

46
Q

calcitonin production and functions

A

produced in parafollicular cells of thyroid
lowers blood Ca (via kidney), preserves bone Ca

in bone: inhibit resorption, inc Ca resorption by osteoclasts

in kidney/cortex: inc ca/na/k excretion, dec mg excretion

47
Q

PTH purpose

A

raise low blood calcium (dec ca excretion via vit D)

48
Q

PTH vs calcitonin

A

calcitonin: blood ca DEC, bone ca INC (via kidney)

PTH: blood ca INC, bone ca DEC (via kidney via vit D)

49
Q

lysis (loss) of bone triggered by

A

thyroid function, gravity, bone stress, hypocalcemia > stim osteoclasts

osteoclasts leave behind alk phos

50
Q

blastic (building) of bone is triggered by

A

alk phos triggers osteoblasts

51
Q

abnormal serum ca

what are your next steps

A

ionized calcium > if abnormal: 24 hr urinary ca&raquo_space; if abnormal work up parathyroid, vit d metabolites, consider lytic bone lesions

52
Q

high PTH = x calcium

A

high

53
Q

bisphosphonates MOA, uses, SEs

A

inhibit osteoclast activity (osteoporosis prev AND tx)

-ronates (alendronate)
orally/by injection

SE: esophagitis, osteonecrosis of jaw

54
Q

what SERM is used in osteoporosis prev/tx more commonly

SEs

A

raloxifene

SE: faux menopause

55
Q

MEN I

A

kidnety stones, stomach ulcers, sx of hyperparathyroidism and insulinoma

56
Q

MEN II

A

medullary thyroid cancer (secretes calcitonin), hyperparathyroidism, pheochromocytoma (pounidng Ha, palpitations, sweats, inc BP)

57
Q

panhypopituitarism workup

A

triple bolus test (rapid IV infusion insulin, GnRH, TRH)

58
Q

how to differentiate between central and nephrogenic DI?

A

exogenous ACH (desmopressin)

in central, will inc water reabsorption in kidneys

59
Q

tx nephrogenic DI

A

HCTZ

60
Q

tx SiADH

A

furosemide

61
Q

gigantism/acromegaly tx

A

bromocriptine

62
Q

tx cushing

A

radiation

63
Q

primary hyperthyroidism / graves tx

A

propylthiouracil
BB for sx

64
Q

hyperparathyroidism presentation

A

hypercalcemia > bones, stones, groans, psychiatric overtones

65
Q

causes of acute adrenal insufficiency

A

abrupt steroid withdrawwl
waterhouse friderichsen syndrome (septicemia from neisseria>hemorrhage), anticoags

66
Q

addison disease tx

A

corticoid replacement therapy

67
Q
A

NPLEX II TIA (21 decks)

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