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Step 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Nelson syndrome

A

rapid enlargement of pituitary adenoma after removal of both adrenal glands for Cushing’s disease; characterized by bitemporal hemianopsia and hyperpigmentation

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2
Q

Dx. nelson’s syndrome

A

MRI - suprasellar extension of pituitary adenoma

labs - very high plasma ACTH levels

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3
Q

tx. nelsons syndrome

A

surgery and/or pituitary radiation

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4
Q

lab findings in non-functioning pituitary adenoma

A
  1. hypogonadism - low levels of FSH and LH

2. serum alpha subunit levels are elevated

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5
Q

preferred therapy for nonfunctioning pituitary adenoma

A

trans-sphenoidal surgery

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6
Q

tx. prolactin-secreting adenomas

A

DA agonists ex. cabergoline

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7
Q

what dyslipidemia is common in HIV pt

A

triglyceridemia

assoc. with elevated LDL and TC & decreased HDL

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8
Q

tx. of hypertriglyceridemia in HIV pt on antiretroviral therapy

A

if TG> 500 -> fibrate medication (gemfibrozil)

if TG < 500, can use a statin

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9
Q

amiodarone effects on thyroid

A

decreased conversion from T4 to T3 = decreased T3 and increased T4 levels
- may also cause hypothyroidism and thyrotoxicosis due to high iodine content

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10
Q

diagnoses of DM

A
  1. two FPG > 126
  2. one random glucose > 200 with symptoms
  3. abnormal OGTT
  4. HbA1c > 6.5%
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11
Q

pt with type 2 DM that is not adequately controlled with metformin - next step?

A

add sulfonylurea

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12
Q

S/E of metformin

A

lactic acidosis

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13
Q

contraindications of metformin

A 
renal insufficiency (Cr > 1.4, CCl < 50)
use of contrast agents --> ARF
alcohol abuse
CHF
liver disease
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14
Q

what should you do in pt on metformin about to have a contrast procedure done?

A
  1. stop metformin 1 d prior

2. if high risk for RF, give NaHCO3 or NS before procedure, adequately hydrate

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15
Q

s/e of sulfonylrureas

A

hypoglycemia

SIADH

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16
Q

DPP-IV inhibitors

A

sitagliptin, saxigliptin

- increase insulin release and block glucagon

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17
Q

C/I to rosiglitazone/pioglitazone

A

CHF

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18
Q

insulin secretagogues

A

nateglinide, repaglinide

  • short acting
  • cause hypoglycemia
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19
Q

GLP analogs

A

exenatide, liraglutide

  • decrease gastric motility (increase feeling of fullness)
  • increase satiety
  • promote weight loss
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20
Q

s/e exenatide or liraglutide

A

NV
dyspepsia
sensation of fullness/bloating

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21
Q

best test to determine severity of DKA

A

serum bicarb

also: ph < 7.3 or anion gap high

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22
Q

effect of glucose on Na levels

A

high glucose artificially drops Na levels

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23
Q

which hyperlipidemia drug is C/I in diabetes

A

niacin - worsens glucose intolerance

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24
Q

Tx. diabetic neuropathy

A

gabapentin

pregabalin

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25
Q

Tx. diabetic gastroparesis

A

erythromycin or metoclopramide

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26
Q

lab findings in TSH secreting adenoma

A

elevated TSH and T3/T4

increased serum alpha subunit levels

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27
Q

TH resistance syndrome

A

elevated TSH and T3/T4

symptoms of hypothyroidism

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28
Q

increased RAIU

A

Graves disease
goiter
tsh secreting adenoma

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29
Q

decreased RAIU

A

subacute/painless thyroiditis

iatrogenic/factitious disorder

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30
Q

Grave’s opthalmopathy

A

Tx. does not affect the ocular findings

if severe, may lead to compression of the optic N. with visual field deficits

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31
Q

what intervention may decrease severity of graves ophthalmopathy

A

smoking - increases severity

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32
Q

Tx. Grave’s disease

A

PTU or MTZ acutely, then RAI to ablate the gland

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33
Q

target TSH levels in treatment of thyroid cancer? if mets?

A

TSH between 0.1 and 0.3 uU/mL. Even lower in distant mets

34
Q

s/e of treatment with suppressive doses of levothyroxine

A

bone loss

A.fib

35
Q

silent thyroiditis

A

autoimmune process with a nontender gland and hypothyroidism; RAIU normal or decreased, + TPO ab

36
Q

Tx. silent thyroiditis

A

none - spontaneously resolves

37
Q

CF: Subacute thyroiditis

A

likely due to viral infection; pt presents with fever, tender thyroid gland and hyperthyroid followed by hypothyroid symptoms

38
Q

Lab findings in subacute thyroiditis

A

TSH low, T4 high

RAIU decreased

39
Q

Tx. subacute thyroiditis

A

Aspirin
propranolol - to decrease sx
Steroids - if symptoms severe and not resolving with NSAIDs

40
Q

only cause of hyperthyroidism with an elevated TSH

A

pituitary adenoma

41
Q

Tx. thyroid storm

A

iodine
PTU or MTZ
dexamethasone
propranolol

42
Q

MCC of Hypercalcemia

A

Primary hyperparathyroidism

43
Q

MCC hypophosphatemia

A

Continuous glucose infusions

44
Q

Clinical presentation of hypophosphatemia

A

Muscle weakness, ESP. Diaphragm giving respiratory weakness

Decreased cardiac contractility

45
Q

When do you treat hyperparathyroidism surgically? (4)

A

Symptomatic disease
Renal insufficiency
Markedly elevated 24 hr urine calcium
Very elevated serum calcium > 12.5

46
Q

Presentation of acute severe hypercalcemia

A 
Confusion
Constipation
Short QT syndrome
Polyuria, polydipsia from nephrogenic DI
Renal insuff, ATN, kidney stones
47
Q

Management of acute hypercalcemia

A
  1. Hydration: 3-4 L normal saline
  2. Furosemide: only after hydration has been given
    - if those two don’t work, can try calcitonin
  3. Bisphosphonate (pamidronate) - chronic management
48
Q

Clinical findings in severe Hypocalcemia

A

Seizures
Neural twitching
Arrhythmia prolonged QT

49
Q

Diagnosis of Cushing syndrome

A
  1. 1 mg dexamethasone suppression test
    - if this fails to suppress:
  2. 24 hour urine cortisol test
50
Q

You find a pt to have high cortisol, high ACTH level that suppresses to high dose dexamethasone test. You suspect pituitary adenoma but MRI does not show any lesions. What should you do next?

A

Inferior petrosal sinus sampling

51
Q

CF of Addison Disease

A

Fatigue, anorexia, weakness, weight loss, hypotension
Thin pt with hyperpigmented skin
Concomitant autoimmune disorders

52
Q

Lab findings in Addison’s disease

A 
Hyperkalemia with metabolic acidosis
Hyponatremia
Hypoglycemia
Neutropenia
Peripheral eosinophillia
53
Q

Most accurate diagnostic test

A

Cosyntropin (ACTH) stimulation test

- give ACTH , should have increase in cortisol, if no increase then you have adrenal insufficiency

54
Q

Tx. Addison’s disease

A
  1. Acute crisis (ie hypotensive) - give hydrocortisone or dexamethasone (doesn’t interfere with cortisol measurement) and IVF
  2. Chronic - prednisone
  3. If still hypotensive despite steroid replacement, give fludrocortisone
55
Q

CF in hyperaldosteronism

A

Hypertension
Hypokalemia with metabolic alkalosis
Weakness
Nephrogenic DI from Hypokalemia (polyuria and polydipsia)

56
Q

Diagnostic findings in hyperaldosteronism

A

Low renin
Hypertension
Elevated aldosterone level despite salt loading with normal saline

57
Q

Tx. Hyperaldosteronism

A

Solitary adenoma - surgery

Hyperplasia - spironolactone

58
Q

Best initial tests for pheochromocytoma

A

High plasma and urinary catecholamine levels

Plasma free metanephrine and VMA levels

59
Q

Most accurate test for pheochromocytoma

A

CT or MRI of the adrenal glands

60
Q

When do you do a MIBG scan for pheochromocytoma

A

If >5 cm in size and suspicion of extra renal disease

Positive hormone levels but negative imaging

61
Q

Tx. Hypertensive crisis in pheochromocytoma

A

IV nitroprusside
Phentolamine
Nocardipine

62
Q

Tx. Hypotensive crisis in pheo

A

Normal saline bolus

Pressors if no response

63
Q

Tx. Hypoglycemia in pheo

A

IV dextrose infusion

64
Q

Cardiac tachyarrhythmias

A

IV lidocaine or esmolol

65
Q

Medical prep prior to surgery for pheo

A

Phenoxybenzamine for 10-14 days

Propranolol before surgery (1-2d)

66
Q

Features of all types of CAH

A

Low aldosterone and cortisol
High ACTH levels
Tx. Prednisone

67
Q

Most accurate test for prolactinoma

A

MRI of the brain

68
Q

Best initial therapy for prolactinoma

A

DA agonists - bromocriptine, cabergoline

69
Q

Best initial test for acromegaly

A

IGF1 level

70
Q

Most accurate test for acromegaly

A

OGTT
- normally, GH is suppressed by glucose
Suppression of GH by glucose excluded acromegaly

71
Q

Tx. Acromegaly

A

Surgical removal - transsphenoidal resection

Octreotide, cabergoline, bromocriptine - prevent release of GH

72
Q

Pegvisomant

A

GH receptor antagonist

73
Q

Testicular feminization - features

A

Female, who does not menstruate
Breasts present
Exam: vagina ends in blind pouch, no cervix, uterus or ovaries
Genetically, XY

74
Q

CF of Klinefelters

A

Tall men, small testicles
XXY karyotype
Insensitivity to FSH and LH on their testicles (high levels but no testosterone is produced)

75
Q

Tx. Klinefelters

A

Testosterone

76
Q

Kallmans syndrome

A

Anosmia

Hypogonadism - low LH, FSH, GnRH

77
Q

Pituitary apoplexy

A

Sudden hemorrhage into pituitary gland causing obtundation due to a rapid drop in cortisol level and hypotension that fails to respond to IVF

78
Q

Tx. Pituitary apoplexy

A

Stabilized with high dose steroids and IVF. Give fludrocortisone

79
Q

In what situation should you not use Ringers lactate solution

A

Hyperkalemia - it contains K+

80
Q

Insulin dosing prior to surgery

A

Admin of 1/3 usual insulin dose

Step 3 (20 decks)

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