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EOR Family Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Autoimmune destruction of the pancreatic beta cells, which will result in insulin dependence. Pts usually diagnosed in adolescence

A

Type I diabetes

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2
Q

Classically, DKA is seen with Type _ diabetes more often

A

type 1

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3
Q

Characterized by insulin resistance related to obesity. May occur at any age.

A

Type 2

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4
Q

Main distinction between type 1 and type 2 diabetes is that type 2 will not have:

A

Antibodies

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5
Q

Risk Factors for Type 2 Diabetes:

A
  1. > 45 y/o
  2. BMI . 25
  3. Diabetes mellitus in 1st degree relative
  4. Sedentary lifestyle
  5. Gestational DM
  6. Hx of delivery of child > 9 lbs
  7. Dyslipidemia
  8. HTN
  9. PCOS
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6
Q

Signs/Symptoms of diabetes

A

Polyuria, polydipsia, fatigue

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7
Q

More likely to present with a thin pt who is losing weight

A

Type 1 diabetes

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8
Q

More likely to present with obesity and acanthosis nigricans

A

Type 2 diabetes

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9
Q

Screening for diabetes

A

Screening should be done as part of cardiovascular risk assessment in adults aged 40-70 y/o with BMI > 25 years every 3 years

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10
Q

Screening Options for diabetes

A
  1. Two fasting glucose levels > 126
  2. One glucose level > 200 with symptoms
  3. HgA1c > 6.5%
  4. Positive 2 hour oral glucose tolerance test
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11
Q

Diagnosis for type 1 diabetes specifically

A

Positive antibodies

Low c-peptide, low insulin, elevated glucose

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12
Q

Diagnosis for type 2 diabetes specifically

A

No antibodies

Normal to increased c-peptide, normal to increased insulin, elevated glucose

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13
Q

Management of diabetes

A

HgA1c is drawn every 3-6 mo to evaluate management.
Goal HgA1c < 7%
May be drawn every 3 mo if not controlled, every 6 mo if well controlled

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14
Q

Treatment for Type 1 Diabetes

A

Insulin is mainstay. Should receive basal insulin (glargine or detemir) followed by pre-meal insulin

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15
Q

Four types of insulin

A

Rapid Acting
Fast Acting
Intermediate
Long Acting

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16
Q

Treatment for Type 2 Diabetes

A

Counseling on weight loss, exercise, and proper nutrition
First line - metformin
Second line - Sulfonylureas (glipizide, glimepiride)

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17
Q

If a pt has starting HgA1c > 9%

A

Want to start with insulin

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18
Q

Diabetes medications that cause weight gain and hypoglycemia

A

Insulin and sulfonylureas

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19
Q

Other second line options for diabetes (type 2)

A
  1. Pioglitazone
  2. DPP-4 Inhibitors
  3. Meglitinides
  4. GLP-1 agonists
    5- Alpha-glucosidase inhibitors
  5. SGLT2 inhibitors
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20
Q

Diabetic follow up care:

A
  1. Yearly eye exam to screen for retinopathy
  2. Yearly microalbumin screening
  3. Yearly comprehensive foot exam
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21
Q

Diabetic with LDL > 100

A

Statin first line

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22
Q

Diabetic with BP > 140/90

A

ACE/ARB first line

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23
Q

Adrenal insufficiency secondary to autoimmune destruction

A

Addison’s disease

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24
Q

Fatigue, weakness, anorexia, nausea, weight loss, hyperpigmentation

A

Addison’s disease

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25
Cause of hyperpigmentation in addison's disease
Long-standing elevated ACTH levels
26
Other symptoms of addison's disease
``` Hypotension Hyponatremia Hypoglycemia Hyperkalemia Metabolic acidosis ```
27
1st step in diagnosis of adrenal insufficiency
Low cortisol levels (< 3) - measure early morning (normally highest in the AM)
28
Most specific test for adrenal insufficiency
ACTH stimulation test | Give pt ACTH, if cortisol levels do not rise, adrenal insufficiency is confirmed
29
Increased levels of ACTH in adrenal insufficiency
``` Adrenal problem (primary) CT of adrenal gland ```
30
Decreased levels of ACTH in adrenal insufficiency
Pituitary problem (secondary) OR hypothalamus problem (tertiary) MRI of the brain
31
Treatment of primary adrenal insufficiency dz
Hydrocortisone and fludrocortisone
32
Treatment of secondary adrenal insufficiency dz
hydrocortisone
33
Occurs under major stress, infection, trauma, pituitary apoplexy or acute withdrawal of chronic steroids
Adrenal crisis
34
Treatment for adrenal crisis
Volume repletion | High dose IV glucocorticoid
35
Pathophysiology behind cushing's disease
Pituitary increased ACTH secretion causing high levels of cortisol release
36
Signs/Symptoms of cushing's disease
1. Redistribution of fat 2. Catabolism (breakdown of protein) 3. Hypertension, acanthosis nigricans 4. mental 5. Androgen excess
37
Redistribution of fat in cushing's disease
Central (trunk) obesity, moon facies, buffalo hump, supraclavicular fat pads
38
Catabolism (breakdown of protein) in cushing's disease
Wasting of extremities (thin extremities, proximal muscle weakness), skin atrophy (easy bruising, striae), increased infections, hyperpigmentation
39
Mental symptoms of cushing's disease
Depression, mania, psychosis
40
Androgen excess in cushing's disease
Hirsutism, oily skin, acneiform rash, increased libido, virilization, amenorrhea
41
Most common cause of cushing's disease
Exogenous - long-term high dose corticosteroid therapy
42
Diagnosis of cushing's disease
1. Low-dose dexamethasone suppression test 2. 24 hour urinary free cortisol levels 3. salivary cortisol levels
43
Low-dose dexamethasone suppression test for cushing's disease
Normal response is cortisol suppression | No cortisol suppression = Cushing's syndrome
44
24 hour urinary free cortisol level test for cushing's disease
Most reliable index of cortisol secretion | Increased urinary cortisol = cushing's syndrome
45
Salivary cortisol level test for cushing's disease
Increased cortisol is Cushing's syndrome | Usually performed at night
46
Management for cushing's disease
Transsphenoidal surgery (pituitary)
47
Management for iatrogenic cushing's disease
Gradual steroid taper (to prevent Addisonian crisis)
48
Most common cause of hyperthyroidism
Grave's disease - autoimmune disease that leads to TSH receptor antibodies
49
Signs/Symptoms of hyperthyroidism
``` Heat intolerance Menstrual irregularities Weight loss Palpitations Hyperdefecation Anxiety Tachycardia ```
50
Grave's disease specific symptoms
``` Eye proptosis, chemosis, lid retraction Skin abnormalities (pretibial myxedema) ```
51
Diagnostic Testing for Hyperthyroidism
1. R/o pregnancy first if menstrual irregularities are present 2. Suppressed TSH, high T4 3. Radioactive iodine will show decreased uptake (except Graves)
52
Treatment of thyroid storm
PTU or methimazole, beta blockers, high dose corticosteroids
53
Treatment of Grave's disease
``` Beta blockers PTU or Methimazole Definitive: radioactive ablation Steroids for ophthalmopathy PTU for first trimester ```
54
S/E of PTU
Hepatotoxicity
55
Most common etiology of hypothyroidism
Hashimoto's Thyroiditis (autoimmune disease)
56
Most common etiology worldwide of hypothyroidism
Iodine deficiency
57
Signs/Symptoms of hypothyroidism
``` Constipation Weight gain Fatigue Decreased reflexes (on the relaxation phase) Cold intolerance Menstrual irregularities Hair loss ```
58
Diagnosis of hypothyroidism
High TSH and low T4
59
Diagnosis of hypothyroidism specifically hashimoto's'
Thyroid peroxidase antibodies
60
Treatment for hypothyroidism
Levothyroxine
61
Instructions for levothyroxine
Take fasting, wait 4 hours before taking iron or calcium supplements

EOR Family Medicine (14 decks)

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