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Master the Boards > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

additional finding in kallman syndrome

A

RENAL AGENESIS in 50%

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2
Q

growth hormone deficiency in adults

A 
RARELY have symptoms,
subtle signs
- central obesity
- increased LDL and CH levels
- reduced lean mass
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3
Q

GH levels low

A

NOT that helpful since GH is pulsatile and maximum at night

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4
Q

confirming low GH

A

no response to arginine infusion

no response to GHRH

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5
Q

prolactin levels low confirmatory Dx

A

no response to TRH

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6
Q

metyrapovnse normally causes…

A

ACTH to rise, since inhibits 11 beta hydroxyls, thus decreasing output of the adrenal gland

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7
Q

before starting thyroxine what should you do,, for panhypopituitarism,,,,

A

CORTISONE before thyroxine

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8
Q

additional info for PC acromegly

A 
carpal tunnel
body odour
colonic polyps
arthralgias 
HTN
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9
Q

what can give a similar picture as acromegaly

A

GH abuse

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10
Q

best initial test for acromegaly

A

IGF-1

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11
Q

when should MRI be done in acromegaly

A

AFTER laboratory identification of acromegaly

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12
Q

what is co-secreted with GH

A

PRL

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13
Q

possible drugs for tx of acromegaly

A

cabergoline: DA agonist, inhibits GH release
octreotide or lanreotide: somatostatin inhibits GH release
PEGVISOMANY

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14
Q

PEGVISOMANT

A

GH receptor antagonist– inhibits IGF release from the liver

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15
Q

physiologic causes of hyperPRL

A
  • pregnancy
  • intense exercise
  • renal insufficiency
  • increased chest wall stimulation
  • cutting pituitary stalk– no dopamine– no inhibition of PRL
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16
Q

drug causes of hyperPRL

A
  • antipsychotic meds
  • methyldopa
  • metoclopramide
  • opiods
  • TCA’s
  • verapamil
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17
Q

ONLY CCB to cause hyperPRL

A

VERAPAMIL

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18
Q

first thing necessary to do if patient has hyperPRL

A

PREGNANCY TEST

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19
Q

work up for hyperPRL

A
  • TFTs
  • Bun/Cr (since kidney insuff elevates PRL)
  • LFTs (since cirrhosis elevates PRL)
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20
Q

which dopamine agonist is preferred for tx of hyperPRL

A

CABERGOLIN

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21
Q

when to tx hypothyroidism

A

High TSH (X2) + normal T4

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22
Q

when to decide on thyroid replacement in hypothyroidism

A

anti-TPO when TSH high, and T4 normal

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23
Q

involuted non palpable thyroid

A

exogenous thyroid hormone use

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24
Q

low TSH and decreased RAIU

A
  • subacute thyroiditis– painful
  • painless “silent” thyroiditis
  • exogenous thyroid hormone use
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25
Q

tx of silent thyroiditis

A

NONE

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26
Q

tx of subacute thyroiditis

A

ASPIRIN

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27
Q

which thiourea drugs is preferred for hypthyeroidism

A

METHIMAZOLE

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28
Q

tx of graves opthalmopathy

A

STEROIDS

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29
Q

what must you do if FNA says follicular adenoma

A

REMOVE SURGICALLY– since can’t tell if benign or malignant from FNA alone

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30
Q

90% of hypercalcemia seen in

A

CANCER PATIENTS

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31
Q

tx of hypercalcemia of malignancy

A

saline
bisphosphonates
—— if not working yet–> CALCITONIN

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32
Q

how to tx hypercalcemia from granulomatous disease/ sarcoidosis

A

PREDNISONE

33
Q

how long does it take for bisphosphonates to work

A

SEVERAL DAYS

34
Q

bone effects imaging for hyperPTH

A

DEXA is greater than bone xr

35
Q

imaging of neck for hyperPTH

A

dont pre-op for planning surgery

36
Q

3 new random causes of hypocalcemia

A
  1. hypoMg: since need magnesium to cause release of PTH
  2. renal failure
  3. low albumin: causes decrease in 0.8 calcium
37
Q

low albumin causing hypocalcemia

A

decrease total calcium

normal free calcium= ASYMPTOMATIC

38
Q

EKG for hypocalcemia

A

PROLONGED QT

39
Q

extra tid bits of info for cushings

A
  • erectile dysfunction in men
  • cognitive disturbance–> psychosis
  • polyuria
40
Q

best initial test for hypercortisolism

A

24-hr urine cortisol– more specific

41
Q

next best test for hypercortisolism

A

1mg overnight DXM

42
Q

FP’s with 1 mg overnight DXM suppression test

A
  • depression
  • alcoholism
  • obesity
43
Q

best initial test for determining the cause/location of hypercortisolism

A

ACTH level

44
Q

ACTH level in cushing disease

45
Q

ACTH level in cushing syndrome

46
Q

ACTH level increased, now what

47
Q

negative MRI brain for cushings, now what

A

inferior petrosal sinus sampling for ACTH, possibly after stimulating with CRH

48
Q

general endocrine rule

A

confirm the lab results first, THEN do imaging

49
Q

cushing disease suppression test

A

YES suppresses

50
Q

cushing syndrome/ cancer

A

NO doesn’t suppress

51
Q

labs in cushings

A 
hyperglycemia
hyperlipidemia
HYPOKalaemia
metabolic alkalosis
LEUKOCYTOSIS
52
Q

why is adrenal crisis from the pituitary less common?

A

because the pituitary makes ACTH, which has a very little role in regulating aldosterone

53
Q

labs in hypoadrenalism

A 
hypoglycemia
hyponatremia
HIGH BUN
HYPERkalaemia
metabolic acidosis
EOSINOPHILIA
54
Q

what type of white cell is elevated in hypoadrenalism

A

EOSINOPHILS

55
Q

dx or tx of adrenal crisis more important

56
Q

which steroid should we give when patient with hypoadrenalism has postural instability

A

fludrocortisone– has sufficient aldosterone-like effect

57
Q

steroid in adrenal crisis

A

hydrocortisone– LIFE SAVING

58
Q

best initial test for phaeo

A

24hr urine metanephreines, VMA

59
Q

after biochemical testing for phaeo

A

CT adrenals

60
Q

location of phaeo outside the adrenals imaging,

A

MIBG scanning

61
Q

dx of DM

A

2 FBG > 125
1 random glucose >200 + symptoms
OGTT– increased glucose
HbA1c> 6.5%

62
Q

goal HbA1c level in DM

A

less than 7%

63
Q

which diabetes drugs cause weight loss

A

incretin mimetics

64
Q

nateglinide, repaglinide

A

stimulators of insulin release, but don’t contain sulfa

65
Q

onset: rapid acting insulin

A

5-15 minutes

66
Q

peak action: rapid acting insulin

67
Q

duration: rapid acting insulin

68
Q

onset: short acting insulin

A

30-60 minutes

69
Q

peak action: short acting insulin

70
Q

duration: short acting insulin

71
Q

onset: intermediate acting insulin

72
Q

peak action: intermediate acting insulin

73
Q

duration: intermediate acting insulin

A

10-20 hours

74
Q

onset: long acting insulin

75
Q

peak action: long acting insulin

76
Q

duration: long acting insulin

77
Q

DKA presentation

A

in BOTH DMT1 and DMT2

78
Q

potassium replacement DKA

A

replace potassium when levels are approaching normal

79
Q

what factor indicates severity of DKA

A

serum bicarb (if very low, risk of death)

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