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STEP 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Diagnosis of diabetes is made by?

A

One of the following:

  1. Two fasting glucose ≥ 126
  2. One random glucose ≥ 200 with symptoms(polyuria, polydipsia, polyphagia)
  3. Abnormal glucose tolerance test
  4. HgA1c > 6.5%
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2
Q

Best initial treatment for Type 2 diabetes?

A

diet, exercise, weight loss

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3
Q

Best initial medical therapy for type 2 diabetes?

A

metformin (blocks gluconeogenesis)

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4
Q

When is metformin contraindicated?

A

Renal insufficiency

Use of contrast agents

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5
Q

Mechanism of action of sulfonylureas?

A

Increase release of insulin from pancreas

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6
Q

Mechanism of action of thiazolidinediones?

A

Increases peripheral insulin sensitivity

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7
Q

Mechanism of action of alpha-glucosidase inhibitors?

A

block absorption of glucose at the intestinal lining

side effect- diarrhea. abdominal pain, bloating

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8
Q

Mechanism of action of insulin secretagogues?

A

increase release of insulin

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9
Q

What are the long acting insulin agents?

A

Glargine(lantus)
Detemir
NPH

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10
Q

What are the short acting insulin agents?

A

Aspart
Lispro
Glulisine

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11
Q

Best initial test for DKA?

A

Serum bicarb(tells severity)- low bicarb=severe DKA

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12
Q

What to you need to supplement when treating for DKA?

A

K, when giving insulin, the initial high potassium will go into cells and cause hypoK. Need to replace this

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13
Q

What is the initial treatment for DKA?

A

Labs (chemistry, ABG, Acetone)
Fluids (bolus NS)
IV insulin

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14
Q

What is the goal of BP in a diabetic patient?

A

< 130/80

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15
Q

What is the goal of LDL in a diabetic patient?

A

<100

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16
Q

What test should be ordered with regards to the eye with diabetics?

A

Dilated eye exam every year to detect proliferative retinopathy

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17
Q

What needs to be ordered in long standing diabetics with regards to their kidney function?

A

Urine microalbumin, if any albumin is in the urine is present give ACEi

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18
Q

If neuropathy is present in a diabetic what treatment should they be on?

A

gabapentin

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19
Q

How do you treat gastroparesis in a diabetic?

A

metoclopromide or erythromycin

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20
Q

Best initial test for hypothyroid?

A

T4- decreased

TSH- increased (feedback mechanism)

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21
Q

Treatment for Graves disease?

A

PTU (propylthiouracil) or methimazole for acute control
Radioactive iodine
Propranalol for symptomatic treatment

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22
Q

What are the diagnostic findings for subacute thyroiditis?

A

low RAIU
high T4
low TSH
- treat with aspirin

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23
Q

Treatment for thyroid storm?

A

Iodine- blocks uptake of iodine into thyroid
PTU or methimazole- blocks production of thyroxine
dexamethasone- blocks conversion of T4 to T3
propranolol- treats symptoms

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24
Q

What to do for solitary thyroid nodule?

A

FNA

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25
Q

Causes of hypercalcemia?

A 
Primary hyperparathyroid(most common)
malignancy
granulomatous disease
Vit D intoxication
Thiazide diuretics
TB
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26
Q

How does acute sever hypercalcemia present?

A

confusion, constipation, polyuria, polydipsia, short QT, renal insufficiency

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27
Q

Treatment for acute severe hypercalcemia?

A

IV fluids- a shit load- 3-4 L
bisphosphanates-inhibits osteoclasts
furosemide- loops lose calcium- only after hydration
calcitonin- if hydration and furosemide dont work

28
Q

Causes of HYPOcalcemia?

A 
surgical removal
hypomag (Mg needed for release of PTH)
Vit D deficiency
hyperphosphatemia(P binds to calcium)
fat malabsorption
29
Q

Diagnostic findings for HYPOcalcemia?

A 
seizures
neural twitching(Chvosteks, Trousseau's)
arrythmia- prolonged QT
30
Q

Treatment for HYPOcalcemia?

A

Replace calcium

If vitamin D deficient- give Vit D and calcium

31
Q

In a pituitary tumor…

What is the level of the ACTH?

A

High

32
Q

In a pituitary tumor…

What happens when high dose dexamethasone is given?

A

supression of ACTH

33
Q

In a pituitary tumor…

What specific test needs to be ordered?

A

MRI

Petrossal vein sampling

34
Q

In a pituitary tumor…

What is the treatment?

A

removal of tumor

35
Q

With ectopic ACTH production….

What is the level of the ACTH?

A

high

36
Q

With ectopic ACTH production….

What happens when high dose dexamethasone is given?

A

no supression

37
Q

With ectopic ACTH production….

What specific test needs to be ordered?

A

scan chest and abdomen

38
Q

With ectopic ACTH production….

What is the treatment?

A

removal of site of ectopic production

39
Q

In an adrenal adenoma….

What is the level of ACTH?

A

low

40
Q

In an adrenal adenoma….

What happens when high dose dexamethasone is given?

A

no supression

41
Q

In an adrenal adenoma….

What specific test needs to be ordered?

A

scan adrenal glands

42
Q

In an adrenal adenoma….

What is the treatment?

A

removal

43
Q

Best initial test for Cushing’s syndrome?

A

1 mg overnight dexamethasone supression test
- normal person will suppress the morning level of cortisol if given dexamethasone at 11pm the night before
24-hour urine cortisol (BEST INITIAL TEST)
- get this if overnight supression test is positive
- more accurate than overnight test

44
Q

Where is the origin if ACTH levels are low in Cushing’s disease?

A

adrenal gland, scan gland, and remove

45
Q

Where is the origin if ACTH levels are high in Cushing’s disease?

A

pituitary gland or ectopic production of ACTH

46
Q

What is the most accurate diagnostic tests for Adrenal insufficiency (Addison’s Disease)?

A

Cosyntropin (synthetic ACTH) stimulation test
- measure level of cortisol before and after administration of cosyntropin, if there is adrenal insufficiency, there will be no rise in cortisol
CT scan of adrenals

47
Q

What is the treatment for Addison’s disease?

A

steroid replacement- acute episodes
prednisone- for stable patients
fludricortisone- use if patient still hypotensive after replacement of prednisone

48
Q

How does hyperaldosteronism present?

A

HTN, hypokalemia, metabolic alkalosis

aldosterone reabsorbs Na, excretes K, increases water reabsorption

49
Q

What are the diagnostic findings with hyperaldosteronism?

A

Low renin
HTN
Elevated aldosterone

50
Q

What is the treatment of hyperaldosteronism

A

Solitary adenoma- surgical resection

Hyperplastic adrenals- spirinolactone

51
Q

Best initial test for pheochromocytoma?

A

high plasma and urinary catecholamine levels

plasma free metanephrine and VMA levels

52
Q

Most accurate test for pheochromocytoma?

A

CT or MRI adrenals

53
Q

Treatment for Pheochromocytoma?

A

phenoxybenzamine (1st to control BP)
Propranalol after alpha blockade
Surgical resection

54
Q

What are the characteristics of Congenital Adrenal Hyperplasia?

A

Elevated ACTH

Low aldosterone and cortisol

55
Q

What are the different forms of CAH?

A
  • 21-OH deficiency(most common)- associated HYPOtension; diagnose with increased 17 hydroxyprogesterone
  • 11 hydroxylase deficiency- associated HYPERtension
  • 17 hydroxylase deficiency- low adrenal androgen levels
56
Q

How does prolactinoma present?

A

Men- impotence, decreased libido, gynecomastia, headache, visual disturbance
Women- amenorrhea, galactorrhea (in absence of pregnancy)

57
Q

What is the diagnostic test for prolactinoma?

A

MRI brain

58
Q

Best initial treatment for prolactinoma?

A 
dopamine agonist (bromocriptine, cabergoline)
- surgery (removal) for those who's medical therapy does not work
59
Q

Best initial test for acromegaly?

A

IGF level (confirmatory)

60
Q

Most accurate test for acromegaly?

A

supression of GH by giving glucose will EXCLUDE acromegaly

61
Q

Treatment for acromegaly?

A

resection (cures 70%)

  • octreotide
  • cabergoline
62
Q

What are the causes of primary amenorrhea?

A 
Turner's (XO karyotype)
Testicular feminization (genetically male, acts like female)
63
Q

What are the causes of secondary amenorrhea?

A

Pregnancy, exercise, weight loss, hyperprolactimemia, PCOS

64
Q

What are the characteristics of Klinefelter’s syndrome?

A
  • Tall men, insensitivity to FSH and LH on their testicles
  • XXY karyotype
  • FSH, LH levels high, but no testosterone produced
65
Q

What is the treatment for Klinefelter’s?

A

testosterone

66
Q

What are the characteristics of Kallman’s syndrome?

A

Anosmia(can’t smell) with hypogonadism

- low GnRH, FSH, LH

STEP 3 (8 decks)

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