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Clincial Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Basal rate of insulin changes throughout the day. When is it highest?

A

Pre-dawn hours

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2
Q

Insulin pumps use which type of insulin?

A

Rapid acting insulin (Lispro)

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3
Q

CSII is recommended by the AACE for patients:

A

treated with insulin for T2DM

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4
Q

The pump reservoir holds how many days worth of insulin? Where is the insulin delivered?

A

2 - 3 days. Subcutaneous tissue.

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5
Q

Where are the infusion set sites?

A

Abdomen, arm, thighs, hip/buttocks

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6
Q

When might a patient need to program an insulin pump to DECREASE basal rate delivery?

A

Before exercise

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7
Q

When might a patient need to program an insulin pump to INCREASE basal rate delivery?

A

During illness, infection, on steroids

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8
Q

What factors are necessary to calculate bolus for an insulin pump? Meal bolus? Correction bolus?

A

Meal bolus: insulin-to-carb ratio, carbs in meal, activity level
Correction: Insulin sensitivity factor, blood glucose target, pre-meal blood glucose, active insulin

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9
Q

CGM device should be worn for how long?

A

3 days at least (in lecture said 7 days is best to get an idea of patient’s behavior/patterns)

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10
Q

For which patients is CGM recommended?

A

Elevated A1c (>6.5-7%) in pts with diabetes on insulin therapy
If better understanding of postprandial and overnight glucose is needed
Pregnancy
A1c levels inconsistent with meter logs

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11
Q

For a patient receiving CSII, what should peak blood glucose values be for postprandial period (3 hours after food intake)?

A

Less than 135 - 180 mg/dL

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12
Q

What can the MiniMed Paradigm device do for a patient?

A

It is an insulin pump plus CGM that can alert patient when thresholds for blood glucose are reached

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13
Q

With combined CGM and CSII, finger sticks are needed for?

A

Therapy modification

Calibration

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14
Q

BMI =

A

weight (kg)/height (m)2

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15
Q

Above which BMI does the risk for comorbidities begin to rise?

A

Above 25

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16
Q

Waist to hip ratio for men and women?

A

Women > 0.9, men > 1.0

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17
Q

Hormone that is an important regulator of appetite, energy expenditure, and neuroendocrine fx in the hypothalamus?

A

Leptin

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18
Q

GLP-1 is produced in the gut and has what effect?

A

Decreased food intake

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19
Q

What is the stratification of energy expenditure?

A

Basal rate uses about 70%

Physical activity uses 5 - 10%

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20
Q

Genetic syndromes related to some cases of obesity:

A 
Decreased leptin production
Increased leptin resistance
Cushing's syndrome
Hypothyroidism
Insulinoma >> overeating
Craniopharyngioma and other hypothalamic disorders
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21
Q

How does obesity affect the reproductive axis for males?

A

Hypogonadism, increased adipose tissue with pattern of distribution more commonly seen in women

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22
Q

How does obesity affect the reproductive axis in females?

A

Menstrual abnormalities, esp with upper body obesity

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23
Q

What are the molecular markers of increased risk for cancer in obesity?

A

Increased insulin, Leptin, adiponectin, and IGF-1

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24
Q

Obesity class for patient with BMI of 30.0 - 34.9

A

Class I: high risk of disease

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25
Q

Obesity class for patient with BMI of 35.0 - 39.9

A

Class II: very high risk of disease

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26
Q

Obesity class for patient with BMI > or = to 40

A

Class III: extremely high risk of disease

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27
Q

A patient with a BMI of 25.0 - 29.9 is

A

overweight

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28
Q

A patient with a BMI

A

Underweight

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29
Q

How many calories in a very low calorie diet?

A
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30
Q

How much exercise is recommended?

A

150min/wk moderate intensity

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31
Q

What obese patients are candidates for pharmacotherapy?

A

BMI > 30

BMI > 27 with morbid conditions

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32
Q

Obesity drug that stimulates norepinephrine release or blocks its uptake:

A

Phentermine

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33
Q

Obesity drug that functions as a serotonin and norepinephrine reuptake inhibitor that is not on market anymore:

A

Sibutramine (Meridia)

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34
Q

Obesity drug that is an NE reuptake inhibitor and opioid receptor antagonist.
Has dopamine effect, decreases pleasure derivation from food.

A

Contrave (buproprion; naltrexone)

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35
Q

Obesity drug that is a 5-HT2C receptor agonist

A

Lorasecin

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36
Q

Qsymia is a combination of which two drugs?

A

Phentermine and topiramate

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37
Q

Obesity drug that is a GLP-1 analogue, given byy injection.

-Weight loss, decreased oral intake, decreased gastric emptying. Nausea.

A

Saxenda (Liraglutide)

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38
Q

When is surgery indicated for an obese patient?

A

BMI > 40

BMI > 35 with medical comorbidities

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39
Q

Which surgery to correct obesity involves cutting out part of stomach or putting band around stomach to decrease volume?

A

Restrictive:

-Sleeve gastrectomy

40
Q

Which surgery to correct obesity involves removing part of the stomach or placing a band AND a part of the small intestine is removed?

A

Restrictive-malabsorptive:
-Roux-en-Y gastric bypass (RYGB) MC bypass
-Biliopancreatic diversion (BPD)
Biliopancreatic diversion with duodenal switch (BPDDS)

41
Q

Multiple Endocrine Neoplasia syndrome that is:
Autosomal dominant
Occurs in 1 in 30,000
Covers the “3 P’s”

A

MEN 1 or Wermer’s syndrome

42
Q

What are the three P’s of Wermer’s syndrome?

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumor

43
Q

What is the MC feature of MEN 1?

A

Hyperparathyroidism

44
Q

The P of MEN 1 that occurs in 25% of patients, is rarely malignant, and can be functional or nonfunctional:

A

Pituitary adenoma

45
Q

What hormone stimulates calcium reabsorption in the distal tubule and inhibits phosphorus reabsorption in proximal and distal tubules?

A

Parathyroid hormone

46
Q

In MEN 1, parathyroid hyperplasia usually involves how many glands?

A

All four

47
Q

What might distinguish MEN 1 hyperparathyroidism from sporadic hyperPTH?

A

MEN 1 hyper PTH occurs about 2 decades sooner (2nd - 4th decade)

48
Q

What are the different neuroendocrine tumors that could form in the pancreas with MEN1 (5)?

A 
Gastrinoma
Insulinoma
Glucagonoma
VIPoma
Somatostatinoma
49
Q

Of the pancreatic neuroendocrine tumor types, which is the most common? What resultant syndrome is it associated with?

A

Gastrinoma (40 - 60%); associated with Zollinger-Ellison syndrome.

50
Q

How is a gastrinoma diagnosed?

A

Secretin stimulation test: gastrin will be secreted in a gastrinoma in response to secretin but not in normal tissue

51
Q

What is the second MC pancreatic neuroendocrine tumor in MEN1? How often are they malignant?

A

Insulinoma (20%)

Malignancy: 10%

52
Q

How does one test for an insunlinoma?

A

Check serum during 72 hour fast in the hospital; monitor for elevated insulin/c-peptide levels with hypoglycemia

53
Q

What are treatment options for an insulinoma?

A

Surgical resection OR Diazoxide to suppress insulin secretion

54
Q

Of the MEN1 pancreatic tumors, which are more often malignant than not? (2)

A

Glucagonomas and somatostatinomas

55
Q

In which MEN 1 pancreatic tumor does the patient present with Necrolytic Migratory Erythema (NME)?

A

Glucagonoma; affects limbs, lips, lower abdomen, buttocks, perineum, groin

56
Q

How does one diagnose a glucagonoma?

A

Clinical presentation with HYPERglycemia, hyperproteinemia, elevated fasting glucagon

57
Q

Which MEN 1 pancreatic tumor presents with pancreatic cholera syndrome (Watery Diarrhea, Hypokalemia, Achlorydria)?

A

VIPomas

58
Q

What is the clinical presentation of a VIPoma?

A 
High-volume diarrhea, 
muscle weakness, 
lethargy, 
hyperglycemia, 
hypercalcemia, 
cutaneous flushing;
episodic secretion, must measure multiple fasting levels
59
Q

How does a somatostatinoma present?

A

Steatorrhea, diabetes, gallstones

60
Q

How is a somatostatinoma diagnosed?

A

Elevated fasting somatostatin levels

61
Q

How should one approach imaging modalities for neuroendocrine tumors? (Sequence, choice)

A

After biochemical confirmation, start with CT/MRI, then consider octreotide scan if a mass can’t be localized.

62
Q

What is an octreotide scan?

A

Octreotide, a synthetic bioactive peptide similar to somatostatin, that can bind somatostatin receptors (which most neuroendocrine tumors express)

63
Q

Treatment approach to neuroendocrine tumors?

A

Surgical resection, octreotide injection for VIPomas (and off-label use for insulinomas, glucagonomas, gastrinomas)

64
Q 
Multiple endocrine neoplasia syndrome that is:
Autosomal dominant
1-10/100,000
Has an A and B subclassification
Associated with defect in RET
A

MEN 2

65
Q

What are the three parts of Sipple’s syndrome? (3) Which MEN is it associated with?

A

Hyperparathyroidism, pheochromocytoma, medullary thyroid carcinoma.
MEN 2A

66
Q

What are the associated tumors in MEN2B? (4)

A

Pheochromocytoma, medullary thyroid carcinoma, mucosal neuromas, and Marfanoid habitus

67
Q

A catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla, associated with which syndrome?

A

Pheochromocytoma, MEN 2

68
Q

A catecholamine-secreting tumor that arises in the sympathetic ganglia outside of the adrenal gland?

A

Paraganglioma

69
Q

What is the classic triad of symptoms with a pheochromocytoma?

A

Episodic hypertension, headaches, diaphoresis

70
Q

Rule of 10’s for pheochromocytoma (6):

A 
10%:
bilateral
malignant
familial
in children
extra-adrenal
not associated with HTN
71
Q

How does one screen for pheochromocytoma? (2 screening recommended)

A

Fractionated plasma metanephrines.

24 hour urine catecholamines + franctionated metanephrines.

72
Q

Pheochromocytoma may be treated with:

A

Surgical resection with preoperative alpha-adrenergic blockade a week leading up to surgery (phenoxybenazmine)

then beta-adrenergic blockade after alpha blockade

73
Q

In treating pheochromocytoma, why must one first administer an adequate alpha-blockade?

A

Unopposed alpha-adrenergic stimulation can lead to severe elevation in blood pressure and possibly a hypertensive crisis

74
Q

A neoplasm of the parafollicular cells of the thyroid:

A

Medullary thyroid carcinoma

75
Q

What does a MTC secrete?

A

Calcitonin

76
Q

Treatment of MTC:

A

First screen for pheo before performing total thyroidectomy.

77
Q 
A polyglandular autoimmune syndrome that is:
Autosomal recessive
Linked to AIRE
Has equal gender distribution
Onset in infancy
A

Type I PGA

78
Q 
A polyglandular autoimmune syndrome that is:
Polygenic
Has some HLA association
Higher prevalence in females
Onset ages 20 - 40
A

Type II PGA

79
Q

PGA where:
+Addison’s disease is seen in 60 - 72% of patients
+HypoPTH is common
+Hashimoto’s is rare
+T1DM is about 14%
+Primary hypogonadism is more common in females
+No hypophysitis reported

A

Type I PGA

80
Q 
PGA where:
\+Addison's disease is see in 70% of patients
\+HypoPTH is rare
\+Hashimoto's is frequent
\+T1D occurs in >50% of patients
Primary hypogonadism is less frequent
Hypophysitis is reported
A

Type II PGA

81
Q

In which PGA type does one see:

Myasthenia gravis, stiff-man syndrome, and Parkinson’s?

A

Type II PGA

82
Q

In which PGA type does one see:

Enamel hypoplasia, nail dystrophy, and tympanic membrane calcification?

A

Type I PGA

83
Q

PGA I is also known as

A

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)

84
Q

Need 2/3 of the following for diagnosis of PGA I:

A

Chronic mucocutaneous candidiasis
Autoimmune hypoPTH
Primary adrenal insufficiency

85
Q

Less commonly occurring autoimmune diseases associated with PGA I:

A 
Primary hypogonadism
autoimmune hepatitis
T1DM
Vitiligo
Autoimmune thyroid disease
Pernicious anemia
86
Q

Chvostek’s sign tests:

A

Hypocalcemia by tapping facial nerve to elicit contraction of facial muscles

87
Q

Trousseau’s sign tests:

A

Hypocalcemia by eliciting carpal spasm with blood pressure cuff at 20mmHg above systolic BP for 3 minutes

88
Q

An autoimmune process directed against melanocytes resulting in skin depigmentation

A

Vitiligo

89
Q

Schmidt’s syndrome, which is more common in women and has no identifiable pattern of inheritance is also known as:

A

PGA II

90
Q

Need 2/3 of the following to make a diagnosis of PGA II:

A

DM1 (GAD)
Addison’s disease
Autoimmune thyroid disease (TPO for hypo, TSI for hyper)

91
Q

Less commonly occurring autoimmune diseases associated with PGA II:

A 
Primary hypogonadism
Myasthenia gravis
Celiac disease
Pernicious anemia
Alopecia
Vitiligo
Hypophysitis
92
Q

What are the three layers of the adrenal cortex and what do they produce?

A

Zona Glomerulosa: Mineralocorticoids
Zona Fasciculata: Glucocorticoids
Zona Reticularis: Adrenal androgens

93
Q

Screening for adrenal insufficiency:

A

8 am cortisol

Normal is >10ng/dL

94
Q

Diagnostic tests once cortisol screening indicates potential for adrenal insufficiency:

A

Rapid cosyntropin stimulation: administered IV or IM and cortisol is checked at 30 and 60 minutes. Normal >18ng/dL

If secondary is suspected:
Insulin-induced hypoglycemia test (dangerous, must be done with physician present)

Matyrapone stimulation test blocks 11 B-hydroxylase lowering cortisol levels and stimulating CRH to increase ACTH

95
Q

Treatment of adrenal insufficiency with:

A

Glucocorticoids, prednisone

Clincial Medicine (10 decks)

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