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Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

4 ways to diagnose diabetes?

A
  1. Two fasting glucose >126
  2. One random glucose >200 with symptoms
  3. 2 hour 75g gtt > 140
  4. HgbA1c > 6.4
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2
Q

Metformin mechanism of action?

A

Bigaunide. Inhibits hepatic gluconeogenesis, decreases intestinal glucose absorption, increases insulin sensitivity

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3
Q

2nd line agent for DM2 and what is their mechanism of action?

A

Sulfonylureas (glipizide, glimepiride, glyburide). Act by stimulating pancreatic islet beta-cell insulin release

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4
Q

Adverse side effects of sulfonylureas?

A

Hypoglycemia, SIADH

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5
Q

Dipeptidyl peptidas IV inhibitors. examples and MOA?

A

Sitagliptan and Saxagliptan. Blocks metabolism of incretis (such as glucagon like peptide)

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6
Q

Thiazolidinediones. Examples and MOA?

A

Rosiglitazone, Pioglitazone. Act by increasing peripheral insulin sensitivity

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7
Q

Which diabetes medication should be avoided in chf and why?

A

Thiazolidinediones. Because they can precipitate or worsen CHF.

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8
Q

Alpha-glucosidase inhibitors. Examples and MOA?

A

Acarbose and Miglitol. Block absorption of glucose at intestinal lining.

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9
Q

Side-effects of alpha-glucosidase inhibitors (acarbose)?

A

Since they inhibit glucose uptake at GI lining, will see bloating, distension, flatulance, diarrhea, abdominal pain.

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10
Q

Insulin secretagogues. Examples and MOA?

A

Nateglinide and Repaglinide. act similar to sulfonylureas, stimulate insulin release. Risk of hypoglycemia

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11
Q

Glucagon like peptides. Examples and MOA?

A

Exenatide. Increase insulin and decrease glucagon. They slow gastric emptying and promoted weight loss.

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12
Q

Best initial test when suspecting DKA?

A

Serum bicarbonate

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13
Q

Medical therapy for diabetic retinopathy refractory to laser photocoagulation?

A

VEGF innhibitors: Ranibizumab or Bevacizumab

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14
Q

Treatment for diabetic gastroparesis?

A

Metoclopramide or erythromycin (erythromycin increases the release of “motilin” a promotility GI hormone

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15
Q

Graves disease, radioactive iodine uptake increased or decreased? Treatment?

A

Increased

  • Propylthiouracil (PTU) or methimazole acutely
  • Then radioactive iodine to ablate the gland
  • Propranolol for hyperthyroid symptoms (tremors, palpitations, etc)
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16
Q

Silent thyroiditis clinical and lab/imaging findings?

A

non tender thyroid gland, no other physical exam findings. Normal radioactive iodine uptake, increased T3/T4 with low TSH. Thyroid peroxidase or antithyroglobulin antibodies may be present

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17
Q

Subacute thyroiditis clinical and lab/imaging findings? Treatment?

A

Tender gland. radioactive iodine uptake low. T3/T4 high with low TSH. Can give aspirin for pain.

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18
Q

Hyperthyroidism with elevated TSH. Diagnosis, management and treatment?

A

Pituitary adenoma. Next step get MRI of brain and remove adenoma.

19
Q

Management of thyroid storm?

A

Iodine - blocks uptake of iodine into thyroid gland
PTU or methimazole - blocks production of thyroxine
Dexamethasone - Blocks peripheral conversio of T3 to T4
Propranolol

20
Q

Most common cause of hypercalcemia?

A

Primary hyperparathyroidism

21
Q

Symptoms of hypercalcemia?

A

Kidney stones, osteopenia, ab pain/constipation, confusion

stones, bones, groans, psychiatric overtones

22
Q

Severe hypercalcemia EKG findings?

A

Short QT syndrome

23
Q

Treatment of acute severe hypercalcemia?

A

Fluids mainstay. Add furosemide to help with calcium excretion. Can add bisphosphonates or calcitonin

24
Q

Chvostek’s or Trousseau’s sign indicate?

A

Hypocalcemia

25
Q

3 sources of hypercortisolism causing cushings?

A

Pituitary tumor, Ectopic ACTH production, adrenal adenoma

26
Q

Cushings syndrome and positive dexamethasone suppression test. Diagnosis?

A

Pituitary tumor

27
Q

Workup for cushings syndrome?

A

ACTH level, dexamethasone suppression test and 24 hour urinary cortisol level

28
Q

Diagnostic test to evaluate for adrenal insufficiency (Addison’s Disease)?

A

Cosyntropin (synthetic ACTH) stimulation test

CT of adrenals

29
Q

Example of a glucocorticoid and a mineralocorticoid?

A

Hydrocortisone - Glucorticoid

Fludrocortisone - Mineralocorticoid

30
Q

Difficult to control BP along with headache, palpitations, tremors, flushing. Suspicious for? What test to evaluate?

A

Pheochromocytoma
Order urinary catecholamines, plasma-free metanephrine and VMA levels
Get CT or MRI of adrenals

31
Q

Concern for metastatic pheochromocytoma, what test?

A

MIGB scan

32
Q

Treatment for pheochromocytoma?

A
  1. Phenoxybenzamine (alpha blocker for BP)
  2. Propranolol
  3. Surgery
33
Q

Drugs that can cause elevated prolactin levels?

A

Metoclopramide, phenothiazines, TCAs.

Also always evaluate TSH. hypothyroidism can cause elevated prolactin as well

34
Q

Next diagnostic step after prolactin level found elevated?

A

MRI of brain

35
Q

Treatment of prolactinoma?

A 
Dopamine agonists (Bromocriptine, cabergoline)
Surgery if that doesn't work
36
Q

Best initial test to confirm diagnosis of acromegaly?

A

Insulinlike Growth Factor (IGF)

37
Q

Most accurate test for acromegaly?

A

Glucose induced GH suppression test

38
Q

Treatment for acromegaly?

A
  • Transpheonidal surgical resection cures 70%
  • Octreotide (somatostatin) can prevent GH release
  • Dopamine agonists (Cabergoline, Bromocriptine)
39
Q

Girl presents with primary amenorrhea. Breasts present, but no cervix, tubes, or ovaries. Missing top third of vagina. Diagnosis?

A

Testicular Feminization a.k.a. Androgen insensitivity syndrome

40
Q

Tall man with XXY karyotype, sterile and elevated FSH and LH levels. Diagnosis?

A

Klinefelter’s syndrome

41
Q

55 y/o with recently diagnosed diabetes and ring-shaped red area that blisters, erodes and crusts over, eventually starts clearing from center. Name of rash and underlying diagnosis?

A

Necrolytic migratory erythema. Evaluate for underlying glucagonoma.

42
Q

Asymptomatic adrenal mass noted incidentally on CT scanning. Labs to evaluate?

A

Dexamethasone suppression, ACTH, 24 hour urine cortisol, serum electrolytes, vanillylmandelic acid, plasma metanephrines, 17-ketosteroid

43
Q

Criteria for surgical excision of adrenal mass?

A
  • Functional tumors
  • Malignant appearing on imaging
  • Size greater than 4 cm

Medicine (10 decks)

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