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USMLE Step 2 CK > Endocrinology > Flashcards

Endocrinology Flashcards

Know Endocrinology

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USMLE® Step 1 flashcards
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
Q

Hypothyrodism

Hx / PE

A 
Weakness
Fatigue
Cold intolerance
Constipation
Weight Gain
Depression
Menstrual irregularities
Hoarseness
Bradycarda
Cold skin
Decrease DTR
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26
Q

Hypothyrodism

TX

A

Uncomplicated - Levothyroxine

Myxedema Coma- IV levothyroxine and Hydrocortisone

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27
Q

Thyroiditis

A

Inflammed Thyroid Gland

Subtypes

  • Subacute
  • Radiation-induced
  • Autoimmune
  • Postpartum
  • Drug Induced
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28
Q

Thyroditis

Hx / PE

A
  • Subacute form presents with TENDER thyroid
  • URI

Other forms
- Painless goiter

29
Q

Thyroiditis

DX and Tx

A

Thyroid Dysfunction

Decrease uptake on RAIU

Tx- BB for hyperthyrodism
- Levothyroxine for Hypothyrodism

  • Subacute- NSAIDS and is self limited
30
Q

Thyroid Neoplasms

name them (4)

A
  • Papillary
  • Follicular
  • Medullary
  • Anaplastic
31
Q

Thyroid Neoplasms

Hx / PE

A

Usually Asymptomatic

Hyperfunctioning nodules

+ Family History (especially medullary)

“Cold” nodules on Radionuclide scan

  • Firm and fixed solitary nodules
  • 70 y/o
32
Q

Thyroid Neoplasms

DX

A

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
Q

Thyroid Neoplasms

Tx

A

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
Q

Papillary Carcinoma

A

90% survive 10 years

75-80% of thyroid Cancers

Female-male Radio is 3:1

Slow growing tumor

35
Q

Follicular Carcinoma

A

90% survive 10 years

17% of thyroid cancers

36
Q

Medullary Carcinoma

A

80% survival at 10 years

6-8% of cancers

Found in Calcitonin- producing C cells

37
Q

Anaplastic

A

10 % survival >3 years

<2% of thyroid cancers

Rapid enlarge and metastisizes

38
Q

Multiple Endocrine Neoplasia (MEN)

A 
MEN 1 (wermer's)
MEN 2 (Sipple's)
MEN 3 (Type 2B)

Autosomal-Dominant inheritance

39
Q

MEN I

A

“P” Organs

Pancreas
Pituitary
Parathyroid

MEN Type 1 (Wermer’s)

  • Pancreatic Islet Cell Tumors
  • Parathyroid Hyperplasia
  • Pituitary Adenomas
40
Q

MEN 2

A

Sipple’s

  • Medullary Carcinoma
  • Pheochromocytoma
  • Parathyroid Gland Hyperplasia
41
Q

MEN 3

A

Or Men 2B

  • Medullary Carcinoma
  • Pheochromocytoma
  • Neuromas

Marfanoid Habitus

42
Q

Osteoporosis

A

Common metabolic bone disease

<2.5 bone mass

43
Q

Osteoporosis

Dx

A

DEXA- GOLD Standard
- <2.5 SD below normal

Labs: markers of bone turnover
Xrays: global demineralization

Most common fracture- Vetebral

44
Q

Osteoporosis

Tx

A

Calcium supplementation and Vit D

Weight bearing exercise

Bisphosphates

45
Q

HyperParathyroidism

A

Primary cases- 80% cases due to Single Adenoma

15% parathyroid Hyperplasia

Secondary Cases- Phosphate Retention in kidney disease

46
Q

Hyperparathyrodism

Hx / PE

A

most cases asymptomatic

Mild symptoms- Kidney stones (nephrolithiasis)

  • bones
  • abdominal groans

(Bones, stones and groans)

Psyciatric Overtones

  • Fatigue
  • depression
  • anxiety
  • Sleep issues
47
Q

Hyperparathyroidism

Dx

A

Labs

  • Hypercalcemia
  • HypoPhosphatemia
  • Hypercalciuria
48
Q

Hyperparathyroidism

Tx

A

Parathyroidectomy if Symptomatic

HyperCalceimia - IV FLUIDS
- IV Bisphosphate & Calcitonin

49
Q

Cushing’s Syndrome

A

Cause
- Hypersecretion of ACTH from pituitary adenoma

(HyperCortisolism)

50
Q

Cushing’s Syndrome

Hx / PE

A

Presents with

  • Hypertension
  • Central Obesity
  • Muscle Wasting
  • Thin Skin
  • Purple Striae
  • Hirsutism
  • Moon Facies
  • Buffalo Hump

Exam

  • Oligomenorrhea
  • Growth Retard
  • Depression
51
Q

Cushing’s Dx

A

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
Q

Cushing’s Tx

A

Surgical resection of hypersecretory source

53
Q

HyperProlactinemia

A

Most common pituitary tumor

54
Q

Hyperprolactinemia

Hx / PE

A
  • Hypogonadism is manifested by infertility
  • Oligomenorrhea or Amenorrhea
  • Galactorrhea
  • Gynecomastia
  • Bitemporal Hemianopia

Dx- Serum prolactin >200 mg/mL

55
Q

Hyperprolactinemia

Tx

A

1st line- Dopamine Agonist
(cabergoline or bromocriptine)

Surgery shoudl be considered when medical treatment failed

56
Q

DI

A

Failure to concentrate urine as a result of central or nephrogenci ADH dysfunction

57
Q

DI Subtypes? (2)

A

Central DI

Nephrogenic

58
Q

Central DI

A

Posteriror pituitary fails to secrete ADH

Causes

  • Tumor
  • Ischemia (Sheehan)
  • Traumatic cerebral injury
  • Infection
59
Q

Nephrogenic DI

A

Kidneys fail to respond to ADH

Causes

  • Renal disease
  • Drugs (Lithium, Demeclocycline)
60
Q

DI

Hx / PE

A

Polydipsia
Polyuria
Persistent thirst (dilute urine)

Pt presents with Hypernatremia and Dehydration

61
Q

DI Dx

A

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
Q

DI Tx

A

Treat underlying cause

  • Central DI- give DDAVP IV or oral

Nephrogenic- Salt restriction and water intake

63
Q

SIADH

A

Hyponatremia that results from stimulated ADH release independent of serum osmolality

64
Q

SIADH

Hx / PE

A

Associated with CNS disease (Head injury, tumor)

  • pulmonary disease
  • Ectopic tumor production
  • Drugs
  • Surgery
65
Q

SIADH

Dx

A

Urine osmolality >50-100 mOsm/kg

Urinary sodium >20 mEq/L

66
Q

SIADH

Tx

A
  • Restrict fluid
  • Hyponatremia <110 give hypertonic saline
  • Demeclocycline - normalizes serum Na by antagonizing the action of ADH in collecting duct
67
Q

Adrenal Managment
(Addisons)

4 S’s

A

Salt: 0.9% saline
Steroids: IV 100 mg q 8 h
Support
Search: for underlying conditions

68
Q

Phenochromocytoma

Rule of 10’s

Dx

A 
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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