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Step 2 CK > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

autoantibody for type 1 DM?

A

glutamic acid decarboxylase (GAD65)

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2
Q

5 clinical presentations of DM?

A
  1. polyuria, polydipsia, polyphagia
  2. unexplained weight loss
  3. dec wound healing
  4. infections (skin, vulva, urinary tract)
  5. blurred vision
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3
Q

what is the pathologic characteristic of DM type 1?

A

insulitis

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4
Q

what is the underlying pathophysio of type 2 DM?

A

insulin resistance

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5
Q

will anti-GAD antibody positive or neg in type 2 DM?

A

negative

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6
Q

pathologic findings of type 2 DM?

A

fibrosis and hyalinzation (no insulitis)

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7
Q

3 autoimmune endocrine dz associated with Down?

A
  1. hypothyroidism
  2. T1DM
  3. Addison’s dz
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8
Q

what is the diagnosis test for gestational DM?

A

OGTT (oral glucose tolerance test), 2hr > 153 mg/dl

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9
Q

what is another name for metabolic syndrome?

A

insulin resistance syndrome

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10
Q

how do you diagnose metabolis syndrome?

A

need 3 out of 5 below:

  1. inc waist circumference: men > 40 inches, women > 35 inches
  2. high TG > 150 mg/dl
  3. reduced HDL, men 100 mg/dl
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11
Q

Kussmaul respiration is

A

hyperventilation seen in type 1 DM

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12
Q

first step of treatment for type 1 DM ketoacidosis

A

IV fluid resuscitation (3-6 L) + IV insulin

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13
Q

for DKA, keep the IV insulin infusion until

A

the anion gap closes

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14
Q

is urinary ketones useful for diagnosis/management of DKA?

A

no

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15
Q

3 examples of microvascular complications of DM?

A

retinopathy, nephropathy, and neuropathy

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16
Q

3 examples of macrovascular complications of DM?

A

coronary artery dz, peripheral vascular dz, cerebrovascular dz

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17
Q

treatment for non-proliferative retinopathy

A

tighter glucose control

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18
Q

treatment for proliferative retinopathy?

A

laser photocoagulation to prevent visual loss

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19
Q

2 skin manifestations of DM?

A
  1. acanthosis nigricans

2. necrobiosis lipoidica diabeticorum

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20
Q

2 rapid acting insulin?

A

lispro, aspart

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21
Q

time of onset of rapidly acting insulin?

A

5 - 20 min

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22
Q

time of onset for regular insulin?

A

30 - 60 min

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23
Q

time of onset for intermediate NPH?

A

2-4 hrs

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24
Q

duration of action for NPH intermediate?

A

18 - 28 hrs (dosed twice a day)

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25
Q

what are somogyi effect and the dawn phenomenon

A

cause high BG in the morning before breakfast in people with diabetes due to either an over or under treatment of their diabetes

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26
Q

what is Somogyi effect?

A

an early morning hypoglycemia results in a rebound hyperglycemia due to the secretion of growth hormone, cortisol, and catecholamines which are released to overcome the low BG

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27
Q

treatment for Somogyi?

A

dec dose of insulin

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28
Q

treatment for Dawn phenomenon?

A

increase the bedtime insulin dose

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29
Q

what is Dawn phenomenon?

A

counter regulatory hormones (growth hormone, cortisol, and catecholamines) not only induce hepatic gluconeogenesis as part of the normal circadian rhythm, but also act to block the actions of insulin

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30
Q

2 main causes for hyperthyroidism

A
  1. Grave’s (diffuse toxic goiter)

2. Plummer’s dz (multinodular toxic goiter)

31
Q

the name of the antibody in Graves?

A

TSI (thyroid stimulating immunoglobulin), IgG against the TSH receptor

32
Q

name 3 specific signs of Graves dz?

A
  1. proptosis/exophthalmos
  2. pretibial myxedema
  3. thyroid infiltrative dermopathy
33
Q

2 types of thyroid test (other than serum TSH, T3 test)

A
  1. radioactive T3 uptake

2. free thyroxine index

34
Q

what is unique about radioactive T3 uptake test?

A

gives info regarding the status of thyroid binding globulin (TBG)

35
Q

explain the mech of radioactive T3 uptake test

A

radioactive T3 can bind either to TBG or to resin that has been given (binds to resin only if there is no space on TBG, as in hyperthyroidism when T4 is bound to TBG)

Consequently, you measure how much radioactive T3 was taken up by the resin.

36
Q

the importance of radioactive T3 uptake test?

A

helps differentiate btw elevations in thyroid hormones due to inc TBG from true hyperthyroidism (due to an actual inc in free T4)

37
Q

you get an inc radioactive T3 uptake, what is your interpretation?

A

all of the binding sites on TBG will be bound by T4 –> inc uptake of T3, which means that it is “hyperthyroidism” due to thyroid gland producing excess T4.

38
Q

inc endogenous thyroid hormone can be proved by

A

inc thyroglobulin level

39
Q

TSH, FT4 level in hyperthyroidism?

A

low TSH, high FT4

40
Q

dec radioiodine uptake indicates

A

thyroiditis (NOT Hashimoto)

41
Q

normal or elevated radioiodine uptake indicates

A

either toxic nodule or Grave’s dz

42
Q

3 examples for hyperthyroidism

A
  1. Graves (high RAI, radioactive iodine uptake)
  2. toxic adenoma/toxic multinodular goiter (high RAI)
  3. thyroiditis (postpartum, postviral, subacute) –> low RAI
43
Q

treatment for Graves?

A

radioactive iodine (RAI) –> both diagnostic and therapeutic for Graves

44
Q

pharmacological treatment for Graves

A
  1. methimazole
  2. PTU
    - -> block thyroid peroxidase
45
Q

DOC for Graves as maintenance therapy?

A

methimazole (once daily dosing)

46
Q

what is Wolff Chaikoff effect

A

(neg feedback) excess iodine temporarily blocks thyroid peroxidase –> dec iodine organificaiton –> dec T3/T4 production

47
Q

thyroiditis (post partum, postviral, subacute) can be either

A

hyperthyroidism or hypothyroidism

48
Q

clinical diagnosis for thyroid storm?

A

hyperthyroidism + fever + or - mental status changes

49
Q

initial treatment for thyroid storm?

A

IV PTU (inhibition of peripheral T4 –> T3 conversion)

50
Q

what is subclinical hyperthyroidism?

A

hyperthyroidism without any symptoms

51
Q

TSH level in subclinical hyperthyroidism?

A

low TSH

52
Q

two paths associated with subclinical hyperthyroidism?

A

osteoporosis, atrial fibrillation

53
Q

MCC for hypothyroidism?

A

hashimoto

54
Q

what is another name for Hashimoto?

A

chronic lymphocytic thyroiditis

55
Q

4 acquired causes for hypothyroidism

A
  1. post thyroidectomy
  2. post ablative 131I
  3. following head/neck radiation therapy
  4. iodine def
56
Q

4 drugs that can cause hypothyroidism?

A
  1. Li
  2. amiodarone
  3. antithyroid drugs (PTU, methimazole)
  4. bexarotene (vit A derivative)
  5. tyrosine kinase inhibitor
57
Q

5 clinical signs for cretinism

A
  1. severe mental retardation
  2. short stature
  3. coarse facial features
  4. large tongue
  5. protuberant abdomen with umbilical hernia
58
Q

what is myxedema?

A

severe, untreated form of hypothyroidism (not the same as pretibial myxedema

59
Q

3 clinical signs for myxedema?

A
  1. puffy hands, face, eyelids caused by the accumulation of glycosaminoglycans and hyaluronic acid
  2. broadening and coarsening of facial features
  3. lower pitched voice
60
Q

definition of subclinical hypothyroidism?

A

elevated TSH with normal free T4 (affects 15-20% of individuals over 60 yrs old)

61
Q

diagnosis and workup for hypothyroidism?

A
  1. TSH
  2. FT4
  3. antithyroid peroxidase antibody for confirming Hashimoto
62
Q

treatment for myxedema coma?

A

not oral, give IV thyroxine (T4), if no improvement add IV T3

63
Q

what is the name of the sign to detect substernal goiters?

A

pemberton sign

64
Q

what is pemberton sign?

A

within 30 sec after pt simultaneously raises both arms, there is marked facial plethora

65
Q

a positive pemberton sign indicates

A

thoracic inlet obstruction

66
Q

what is the common cause of thoracic inlet obstruction?

A

substernal goiter

67
Q

papillary carcinoma is associated with what GI path?

A

Gardner syndrome (familial adenomatous polyposis coli)

68
Q

how is follicular thyroid carcinoma diff from papillary carcinoma?

A

hematogenous spread with invastion of capsule and vascular system

69
Q

name of the drug that inhibit PTH release?

A

Cinacalcet

70
Q

what are the 6 indications for parathyroidectomy?

A
  1. calcium at least 1 mg/dl > upper limit of normal range
  2. 24 hr urine calcium > 400 mg/day
  3. age under 50
  4. GFR
71
Q

hypomagnesemia can result in

A

functional hypoparathyroidism

72
Q

congenital absence of parathyroid glands

A

DiGeorge syndrome

73
Q

clinical characteristics of pseudohypoparathyroidism?

A
  1. hypocalcemia –> seizures
  2. shortened 4th, 5th digits
  3. short stature
  4. round facies
74
Q

4 lab findings of osteomalacia/rickets (vit D def)

A

high ALP (alkaline phosphatase)
high PTH
low serum Ca2+
low phosphate

Step 2 CK (20 decks)

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