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USMLE Step 2 CK > Endocrinology > Flashcards

Endocrinology Flashcards

Know Endocrinology

1
Q

DM Type 1

A

Autoimmune pancreatic B-cell destruction leading to insulin deficiency and abnormal fuel metabolism

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2
Q

DM 1

Hx/ PE

A

Presents with

  • Polyuria (especially nocturia)
  • Polydipsia (drink a lot)
  • Polyphagia (eat a lot)
  • weight loss

Associated with HLA-DR 3
HLA-DR 4

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3
Q

DM 1

DX

A

Fasting (>8 hours) glucose of >126 mg / dl on 2 occasions

Random glucose >200 mm / dL plus symtoms

2 hour post prandial glucose of >200 after glucose tolerance test on 2 occasions

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4
Q

DM 1

Tx

A

Insulin

Self Monitor (Normal range 80-120 mg/dL)

Routine HbA1c Test (children goal <8)

Foot checks, dilated eye exams, kidney check and lipid profiles q 2 - 5 years.

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5
Q

DM 2

A

Dysfunction in glucose metabolism best characterized as varying degrees of insulin resistnace that can lead to B-cell burnout and insulin dependancy

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6
Q

DM 2

Dx / PE

A

Non-ketotic Hyperglycemia

Usually older adults with obesity

Strong Genetic disposition

Onset is insidious

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7
Q

DM 2

Dx

A

Criteria same as DM 1

Follow-up test

  • Test at 45 years
  • Retest every 3 years
  • Impaired fasting glucose (>110 but <126 follow up with frequent retesting
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8
Q

Dm 2 Tx

A

Goal is tight control 80 - 120 mg/dl
HbA1c <130/80 Use ACE/ARBs
- ASA
- Screening CVA, Nephropathy, Retinopathy, Neuropathy

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9
Q

Thyroid

TFT Include:

TSH
RAIU

A

TSH measurement
- Single best test for assessing thyroid function

Radioactive Iodine Uptake (RAIU)
- determines level of iodine uptake. Determines thyrotoxic state

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10
Q

High TSH means?

A

Hypothyroidism

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11
Q

Low TSH means?

A

Thyrotoxicosis

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12
Q

Radioactive Iodine Uptake (RAIU)

A

Determines level of iodine uptake by thyroid.

Differentiates Thyrotoxic States

Limited role in determining malignancy

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13
Q

1 Hyperthyroidism

What way do arrows go?

TSH
T4
T3

A

TSH down
T4 up
T3 up

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14
Q

1 Hyperthyrodism causes (7)

A 
Graves
Toxic Multinodular goiter
Toxic Adenoma
Amiodarone
Molar Pregnancy
Postpartum Thyrotoxicosis
Postviral thyroidits
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15
Q

1 Hypothyrodism

what ways arrows?

TSH
T4
T3

A

TSH up
T4 down
T3 down

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16
Q

1 Hypothyrodism Causes (7)

A

Hasimoto’s
Hypothyroid thyroiditis
Iatrogenci factors (radioactive iodine, Excision with in adequate supplementaions)

External radiation
Iodine deficiency
Infiltrative disease

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17
Q

Total T4 measurement

A

Not adequate screen test

90% T4 bound to TBG

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18
Q

T3 Resin uptake (T3RU)

A

Used with total T4 and T3 to correct for changes in TBG levels

Free thyroxine index = total T4 X T3RU

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19
Q

Free T4 Measurement

A

Preferred screening test for thyroidi hormone levels

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20
Q

Thyroid Storm

A

Acute, life threatening form of thyrotoxicosis

Present with A-fib

  • Fever
  • delirium

Admit to ICU

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21
Q

Hyperthyroidism

A

Refers to causes of Thyrotoxicosis (increase T3 / T4 due to any cause) in which the thyroid overproduces thyroid hormone.

  • Graves
  • Plummer’s
  • Toxic Adenoma
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22
Q

Hyperthyroidism

Hx / PE

A 
Weight loss
Heat Intolerance
nervousness
palpitations
increase bowel frequency
insomnia
menstrual abnormalities
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23
Q

Hyperthyroidism

Dx and Tx

A

Initial test
- TSH level

then T4 levels

Tx-
1- Radioactive I^131 thyroid ablation
- Antithyroid drugs (methimazole or propylthiouracil) if radioactive iodine is not indicated

  • Give Propanalol for adrenergic symptoms
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24
Q

Hypothyroidism

A

Hashimoto’s Thyroiditis is most common cause
- Anti TPO antibodies are +

-2nd most common cause Iatrogenic

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25
Hypothyrodism Hx / PE
``` Weakness Fatigue Cold intolerance Constipation Weight Gain Depression Menstrual irregularities Hoarseness Bradycarda Cold skin Decrease DTR ```
26
Hypothyrodism TX
Uncomplicated - Levothyroxine Myxedema Coma- IV levothyroxine and Hydrocortisone
27
Thyroiditis
Inflammed Thyroid Gland Subtypes - Subacute - Radiation-induced - Autoimmune - Postpartum - Drug Induced
28
Thyroditis Hx / PE
- Subacute form presents with TENDER thyroid - URI Other forms - Painless goiter
29
Thyroiditis DX and Tx
Thyroid Dysfunction Decrease uptake on RAIU Tx- BB for hyperthyrodism - Levothyroxine for Hypothyrodism - Subacute- NSAIDS and is self limited
30
Thyroid Neoplasms name them (4)
- Papillary - Follicular - Medullary - Anaplastic
31
Thyroid Neoplasms Hx / PE
Usually Asymptomatic Hyperfunctioning nodules + Family History (especially medullary) "Cold" nodules on Radionuclide scan - Firm and fixed solitary nodules - 70 y/o
32
Thyroid Neoplasms DX
1st test- Fine Needle Aspiration (FNA) 2nd- TFT 3rd- Ultrasound (cystic or solid) 4th- Radioactive scan determines if HOT or Cold (Cancer is usually Cold and solid) HOT nodules are NEVER cancer and NOT biopsied
33
Thyroid Neoplasms Tx
Benign FNA - Physical exam / ultrasound - trial of levothyroxine suppresion treatment Malignant FNA - Surgical resection - radioiodine ablation following excision Indeterminate FNA - remove nodules by surgical excision Anaplastic has a poor prognosis
34
Papillary Carcinoma
90% survive 10 years 75-80% of thyroid Cancers Female-male Radio is 3:1 Slow growing tumor
35
Follicular Carcinoma
90% survive 10 years 17% of thyroid cancers
36
Medullary Carcinoma
80% survival at 10 years 6-8% of cancers Found in Calcitonin- producing C cells
37
Anaplastic
10 % survival >3 years <2% of thyroid cancers Rapid enlarge and metastisizes
38
Multiple Endocrine Neoplasia (MEN)
``` MEN 1 (wermer's) MEN 2 (Sipple's) MEN 3 (Type 2B) ``` Autosomal-Dominant inheritance
39
MEN I
"P" Organs Pancreas Pituitary Parathyroid MEN Type 1 (Wermer's) - Pancreatic Islet Cell Tumors - Parathyroid Hyperplasia - Pituitary Adenomas
40
MEN 2
Sipple's - Medullary Carcinoma - Pheochromocytoma - Parathyroid Gland Hyperplasia
41
MEN 3
Or Men 2B - Medullary Carcinoma - Pheochromocytoma - Neuromas Marfanoid Habitus
42
Osteoporosis
Common metabolic bone disease <2.5 bone mass
43
Osteoporosis Dx
DEXA- GOLD Standard - <2.5 SD below normal Labs: markers of bone turnover Xrays: global demineralization Most common fracture- Vetebral
44
Osteoporosis Tx
Calcium supplementation and Vit D Weight bearing exercise Bisphosphates
45
HyperParathyroidism
Primary cases- 80% cases due to Single Adenoma 15% parathyroid Hyperplasia Secondary Cases- Phosphate Retention in kidney disease
46
Hyperparathyrodism Hx / PE
most cases asymptomatic Mild symptoms- Kidney stones (nephrolithiasis) - bones - abdominal groans (Bones, stones and groans) Psyciatric Overtones - Fatigue - depression - anxiety - Sleep issues
47
Hyperparathyroidism Dx
Labs - Hypercalcemia - HypoPhosphatemia - Hypercalciuria
48
Hyperparathyroidism Tx
Parathyroidectomy if Symptomatic HyperCalceimia - IV FLUIDS - IV Bisphosphate & Calcitonin
49
Cushing's Syndrome
Cause - Hypersecretion of ACTH from pituitary adenoma (HyperCortisolism)
50
Cushing's Syndrome Hx / PE
Presents with - Hypertension - Central Obesity - Muscle Wasting - Thin Skin - Purple Striae - Hirsutism - Moon Facies - Buffalo Hump Exam - Oligomenorrhea - Growth Retard - Depression
51
Cushing's Dx
Begin with Screen - 24 hr urine cortisol or - + low dose dexamethasone suppresion test is considered abnormal if A.M. cortisol is persistently elevated following overnight suppression - Distinguish ACTH dependent from ACTH-independent causes
52
Cushing's Tx
Surgical resection of hypersecretory source
53
HyperProlactinemia
Most common pituitary tumor
54
Hyperprolactinemia Hx / PE
- Hypogonadism is manifested by infertility - Oligomenorrhea or Amenorrhea - Galactorrhea - Gynecomastia - Bitemporal Hemianopia Dx- Serum prolactin >200 mg/mL
55
Hyperprolactinemia Tx
1st line- Dopamine Agonist (cabergoline or bromocriptine) Surgery shoudl be considered when medical treatment failed
56
DI
Failure to concentrate urine as a result of central or nephrogenci ADH dysfunction
57
DI Subtypes? (2)
Central DI | Nephrogenic
58
Central DI
Posteriror pituitary fails to secrete ADH Causes - Tumor - Ischemia (Sheehan) - Traumatic cerebral injury - Infection
59
Nephrogenic DI
Kidneys fail to respond to ADH Causes - Renal disease - Drugs (Lithium, Demeclocycline)
60
DI Hx / PE
Polydipsia Polyuria Persistent thirst (dilute urine) Pt presents with Hypernatremia and Dehydration
61
DI Dx
Water deprivation test Pt excrete high volume of dilute urine Desmopression (DDAVP)- analog of ADH can be used to distinguish central from dephrogenic - Central DDAVP will decrease urine outpoot and increase urine osmolarity - Nephrogenic- DDAVP challenge will not significantly decrease urine output
62
DI Tx
Treat underlying cause - Central DI- give DDAVP IV or oral Nephrogenic- Salt restriction and water intake
63
SIADH
Hyponatremia that results from stimulated ADH release independent of serum osmolality
64
SIADH Hx / PE
Associated with CNS disease (Head injury, tumor) - pulmonary disease - Ectopic tumor production - Drugs - Surgery
65
SIADH Dx
Urine osmolality >50-100 mOsm/kg Urinary sodium >20 mEq/L
66
SIADH Tx
- Restrict fluid - Hyponatremia <110 give hypertonic saline - Demeclocycline - normalizes serum Na by antagonizing the action of ADH in collecting duct
67
Adrenal Managment (Addisons) 4 S's
Salt: 0.9% saline Steroids: IV 100 mg q 8 h Support Search: for underlying conditions
68
Phenochromocytoma Rule of 10's Dx
``` 10% Extra-adrenal 10% Bilateral 10% Malignant 10% occur in children 10% familiar ``` Dx- Metanephrines (24 hr) and CT/MRI

USMLE Step 2 CK (5 decks)

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