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primary care > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Complications of DM are many. They include:

A
  1. Neuropathy- +/- cranial nerve III palsy
  2. Retinopathy- Nonproliferative microaneurysms are the earliest change, also hard exudates and cotton wool spots
  3. Nephropathy- leads to microalbuminuria (Kidney bx- KIMMELSTIEL-WILSON, nodular glomerulosclerosis)
    - Tx= ACEI, low Na+ diet
  4. Macrovascular- atherosclerosis (CAD, PVD, stroke)
  5. Increased infection risk- b/c of vascular insufficiency and immunosuppression from hyperglycemia
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2
Q

___ is the MC cause of ESRD. ___ is the 2nd MC cause.

A

DM is MC cause!!

HTN is 2nd MC cause

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3
Q

Dx of HYPOglycemia can be made when a random blood sugar is between __ and __.

A

50-60mg/dL- Sx occur at 60

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4
Q

___ is the treatment for mild HYPOglycemia.

A

Fast acting carb- fruit juice or hard candy

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5
Q

___ is the treatment for someone who is severe/unconscious due to HYPOglycemia.

A

IV bolus of D50 or inject glucagon SQ

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6
Q

How to diagnose DM:

A
  1. Fasting blood glucose ≥ 126 (fasting 8 hours on 2 occasions, GOLD STANDARD)
  2. 2hr Glucose Tolerance Test ≥ 200 (3hr GTT is GOLD STANDARD IN GESTATIONAL DM)
  3. Hemoglobin A1c ≥ 6.5%
  4. Random Blood Glucose ≥ 200
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7
Q

DM Screening:

A
  • ADA: all adults > 45y or ANY adult with BMI > 25 and 1 additional RF
  • USPSTF: any 40-70y that is overweight or obese
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8
Q

______ is preferred for glucose control in gestational DM.

A

Insulin

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9
Q

Glucose control goals:

A
  • Hgb A1c < 7% (check Q3 months if not controlled)
  • Pre-prandial glucose goal 80-130
  • Post-prandial glucose goal < 180

*Lipids: LDL < 100; HDL > 40; TG < 150

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10
Q

____ should be prescribed if mircoalbuminuria is present.

A

ACEI

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11
Q

Lactic acidosis, Macrocytic anemia, and GI complaints are common ADRs associated with what diabetes drug?

A

Metformin (Glucophage)

*Should be stopped 24hours before iodine contrast!!

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12
Q

Glipizide, Glyburide, and Glimepiride are in what class of diabetes medications?

A

Sulfonylureas

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13
Q

What are 2 unique ADRs associated with sulfonylureas?

A
  • HYPOGLYCEMIA

- WEIGHT GAIN

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14
Q

Pioglitazone (Actos) and Rosiglitazone (Avandia) are in what class of diabetes medications?

A

Thiazolidinediones

  • Increase risk of bladder cancer with Pioglitazone
  • *Cardiotoxicity with Rosiglitazone
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15
Q

Exenatide and Liraglutide are injectables and are in what class of diabetes medications?

A

GLP-1 Agonists

  • Delay gastric emptying
  • *CI if hx of gastroparesis
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16
Q

Sitagliptin and Linagliptin are in what class of DM medications?

A

DPP-4 inhibitors

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17
Q

Canagliflozin, Empagliflozin, and Dapagliflozin are in what class of DM medications?

A

SGLT-2 Inhibitors

*Increases urinary glucose excretion

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18
Q

What class of DM meds is associated with possible UTIs?

A

SGLT-2 inhibitors

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19
Q

Name 2 rapid insulins:

A

Humalog (Lispro) and Novolog (Aspart)

*Give at same time as meal

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20
Q

Name 2 intermediate insulins:

A

Humulin N and Novolin N (NPH)

*Covers insulin for half day or OVERNIGHT (often given at bedtime)

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21
Q

Name 2 long acting insulins:

A

Levemir (Detemir) and Lantus (Glargine)

  • Covers insulin for 1 full day
  • *Glargine causes FEWER HYPOglycemic episodes :)
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22
Q

Normal glucose until rise in serum glucose between 2-8am is known as:

A

Dawn phenomenon

*Tx= Bedtime injection of NPH

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23
Q

Nocturnal HYPOglycemia followed by rebound HYPERglycemia is known as:

A

Somogyi effect

*Tx= Decreasing nighttime NPH dose or give bedtime snack

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24
Q

DKA and Hyperosmolar Hyperglycemia are direct responses to stressful triggers such as:

A

Infxn, infarction, noncompliance w/ insulin/dosage change, undiagnosed diabetics

*Cortisol is a stress hormone that increases glucose. patients cannot meet the demand of increased insulin requirements in response to hyperglycemia

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25
Q

Hyperglycemia is higher in ____ (DKA/HHS).

A

HHS

26
Q

Younger patients with DM1 are more likely to get ___ (DkA/HHS) and older patients with DM2 are more likely to get ____ (DKA/HHS).

A

Younger- DKA

Older- HHS (Higher mortality!)

27
Q

High anion gap metabolic acidosis and ketonemia is associated with ___ (DKA/HHS).

A

DKA

28
Q

What electrolyte is also depleted in DKA?

A

POTASSIUM

29
Q

MC cause of HHS is ____.

A

Infection (with decreased fluid intake)

30
Q

Plasma glucose in HHS is usually > ____.

A

600

31
Q

Decreasing arterial pH and serum bicarb are associated with what?

A

DKA

32
Q

What is the critical first step in managing DKA/HHS?

A

IV FLUIDS!

*Isotonic NS until hypotension resolves then D51/2NS when glucose levels reach 250 (to prevent hypoglycemia from insulin therapy)

33
Q

What are the treatments used for DKA/HHS after IV fluids?

A
  1. Insulin (regular)
  2. Potassium (first verify renal output)
  3. Bicarb- ONLY IN SEVERE ACIDOSIS
    * Tx goals= Closing anion gap in DKA and Normal mental status in HHS
34
Q

Deficiency in all 3 zones of the adrenal cortex is a form of Adrenal Insufficiency known as:

A

Addison’s Disease

  • Etiology:
  • Autoimmune is MC in industrialized nations
  • Infxn is MC worldwide: TB, HIV
  • KETOCONAZOLE is also a culprit
35
Q

Pituitary failure of ACTH secretion w/ ALDOSTERONE INTACT due to RAA is seen in what diagnosis?

A

Secondary Adrenal Insufficiency

*Tertiary- Hypothalamic disease: very rare!

36
Q

Lots of symptoms related to lack of cortisol associated w/ adrenal insufficiency such as:

A

see p. 136 of study guide!

*HYPOGLYCEMIA common in Secondary

37
Q

Decreased aldosterone, seen w/ Addison’s, can cause a drop in _____ (what electrolyte?) and rise in ______ (what electrolyte?).

A

Drop in sodium- HYPONATREMIA

Rise in potassium- HYPERKALEMIA

*Also hypogylcemia due to low cortisol levels!

38
Q

Primary/Addison’s has ___ (high/low) ACTH levels and ____ (high/low) cortisol levels.

A

HIGH ACTH

LOW CORTISOL

39
Q

Treatment of Adrenal Insufficiency…

A

Glucocorticoids + Mineralcorticoids (only gluco in secondary)

*HYDROCORTISONE (glucocorticoid) is 1st line!!!

40
Q

Treatment of Adrenal Insufficiency…

A

Glucocorticoids + Mineralcorticoids (only gluco in secondary)

*HYDROCORTISONE (glucocorticoid) is 1st line!!!

41
Q

The MC cause of and Adrenal Crisis is ____.

A

Abrupt withdrawal of glucocorticoids

42
Q

S&S of an Adrenal Crisis are:

A

Shock- HYPOtension and HYPOvolemia

*Dx- Labs- HYPOnatremia, HYPERkalemia, HYPOglycemia, low cortisol levels

43
Q

Treatment for Adrenal Crisis involves:

A
  1. IV Fluids
  2. Glucocorticoids- IV Hydrocortisone or Dexamethasone
  3. Reversal of electrolyte disorders
  4. Fludrocortisone
44
Q

S&S of Cushing’s Syndrome and Disease are:

A

Central obesity, moon face, buffalo hump, wasting of extremities, HTN, weight gain, androgen excess (hirsutism, oily skin, acne, increased libido)

45
Q

___ is the MC cause of Cushing’s Syndrome.

A

Long-term high dose corticosteroid use

46
Q

Low-dose dexamethasone suppression test AND

24hr urinary free cortisol levels (most reliable) are used to screen for what?

A

Cushing’s

*No suppression of cortisol levels in low-dose suppression test if you have Cushing’s

  • *In HIGH-dose suppression test:
  • Suppression= Cushing’s Dz
  • No suppression= adrenal or ectopic ACTH-producing tumor
47
Q

What is the treatment of choice for Cushing’s?

A

Transsphenoidal surgery or radiation

*KETOCONAZOLE can be used in inoperable patients

48
Q

Causes of Cushings…

A

70%= benign pituitary adenoma or hyperplasia

Otherwise Ectopic ACTH secreting tumors or Adrenal tumor

49
Q

____ is the most specific test for Hyperthyroidism.

A

Thyroid-stimulating immunoglobulins (Ab)

also TFT and RAIU- increased diffuse uptake

50
Q

What is the treatment for HYPERthyroidism?

A
  1. Radioactive Iodine
  2. Methimazole or PPU (or BB)
  3. Thyroidectomy
51
Q

Toxic Multinodular Goiters are MC in elderly and treated with:

A

Radioactive Iodine or Surgery

52
Q

_____ is the same as TMG + dyspnea, dysphagia, stridor, hoarseness from laryngeal compression.

A

Toxic Adenoma

*Tx= same as TMG

53
Q

Hyperthyroid symptoms + bilateral hemianopsia is associated with what diagnosis?

A

TSH secreting pituitary adenoma

*Tx- transsphenoidal surgery

54
Q

_____ is the MC cause of HYPOthyroidism.

A

Hashimoto’s

*Tx- Synthroid

55
Q

What 2 medications are associated with medication-induced HYPOthyroidism?

A

Amiodarone and Lithium

56
Q

____ is the MC agent involved in acute thyroiditis.

A

S. Aureus

  • Pt. usually ill and febrile
  • *TFT: euthyroid
57
Q

Riedel’s Thyroiditis…

A

Fibrous thyroid, with firm, “woody” nodule. May be hypothyroid.

58
Q

A painful, tender neck with clinical HYPERthyroidism following a viral infection is associated with _____ thyroiditis.

A

de Quervain’s

*Increased ESR is HALLMARK

59
Q

MC cause of HYPOthyroidism worldwide is ____ deficiency.

A

Iodine deficiency

60
Q

You should monitor TSH levels at ___ weeks when initiating synthroid changes.

A

6

*Slow, small increases in patients >50y and patients with cardiovascular dz due to increased metabolic rate

primary care (12 decks)

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