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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
Hyperglycemia is higher in ____ (DKA/HHS).
HHS
26
Younger patients with DM1 are more likely to get ___ (DkA/HHS) and older patients with DM2 are more likely to get ____ (DKA/HHS).
Younger- DKA Older- HHS (Higher mortality!)
27
High anion gap metabolic acidosis and ketonemia is associated with ___ (DKA/HHS).
DKA
28
What electrolyte is also depleted in DKA?
POTASSIUM
29
MC cause of HHS is ____.
Infection (with decreased fluid intake)
30
Plasma glucose in HHS is usually > ____.
600
31
Decreasing arterial pH and serum bicarb are associated with what?
DKA
32
What is the critical first step in managing DKA/HHS?
IV FLUIDS! *Isotonic NS until hypotension resolves then D51/2NS when glucose levels reach 250 (to prevent hypoglycemia from insulin therapy)
33
What are the treatments used for DKA/HHS after IV fluids?
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
Deficiency in all 3 zones of the adrenal cortex is a form of Adrenal Insufficiency known as:
Addison's Disease * Etiology: - Autoimmune is MC in industrialized nations - Infxn is MC worldwide: TB, HIV - KETOCONAZOLE is also a culprit
35
Pituitary failure of ACTH secretion w/ ALDOSTERONE INTACT due to RAA is seen in what diagnosis?
Secondary Adrenal Insufficiency *Tertiary- Hypothalamic disease: very rare!
36
Lots of symptoms related to lack of cortisol associated w/ adrenal insufficiency such as:
see p. 136 of study guide! *HYPOGLYCEMIA common in Secondary
37
Decreased aldosterone, seen w/ Addison's, can cause a drop in _____ (what electrolyte?) and rise in ______ (what electrolyte?).
Drop in sodium- HYPONATREMIA Rise in potassium- HYPERKALEMIA *Also hypogylcemia due to low cortisol levels!
38
Primary/Addison's has ___ (high/low) ACTH levels and ____ (high/low) cortisol levels.
HIGH ACTH LOW CORTISOL
39
Treatment of Adrenal Insufficiency...
Glucocorticoids + Mineralcorticoids (only gluco in secondary) *HYDROCORTISONE (glucocorticoid) is 1st line!!!
40
Treatment of Adrenal Insufficiency...
Glucocorticoids + Mineralcorticoids (only gluco in secondary) *HYDROCORTISONE (glucocorticoid) is 1st line!!!
41
The MC cause of and Adrenal Crisis is ____.
Abrupt withdrawal of glucocorticoids
42
S&S of an Adrenal Crisis are:
Shock- HYPOtension and HYPOvolemia *Dx- Labs- HYPOnatremia, HYPERkalemia, HYPOglycemia, low cortisol levels
43
Treatment for Adrenal Crisis involves:
1. IV Fluids 2. Glucocorticoids- IV Hydrocortisone or Dexamethasone 3. Reversal of electrolyte disorders 4. Fludrocortisone
44
S&S of Cushing's Syndrome and Disease are:
Central obesity, moon face, buffalo hump, wasting of extremities, HTN, weight gain, androgen excess (hirsutism, oily skin, acne, increased libido)
45
___ is the MC cause of Cushing's Syndrome.
Long-term high dose corticosteroid use
46
Low-dose dexamethasone suppression test AND 24hr urinary free cortisol levels (most reliable) are used to screen for what?
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
What is the treatment of choice for Cushing's?
Transsphenoidal surgery or radiation *KETOCONAZOLE can be used in inoperable patients
48
Causes of Cushings...
70%= benign pituitary adenoma or hyperplasia | Otherwise Ectopic ACTH secreting tumors or Adrenal tumor
49
____ is the most specific test for Hyperthyroidism.
Thyroid-stimulating immunoglobulins (Ab) | also TFT and RAIU- increased diffuse uptake
50
What is the treatment for HYPERthyroidism?
1. Radioactive Iodine 2. Methimazole or PPU (or BB) 3. Thyroidectomy
51
Toxic Multinodular Goiters are MC in elderly and treated with:
Radioactive Iodine or Surgery
52
_____ is the same as TMG + dyspnea, dysphagia, stridor, hoarseness from laryngeal compression.
Toxic Adenoma *Tx= same as TMG
53
Hyperthyroid symptoms + bilateral hemianopsia is associated with what diagnosis?
TSH secreting pituitary adenoma *Tx- transsphenoidal surgery
54
_____ is the MC cause of HYPOthyroidism.
Hashimoto's *Tx- Synthroid
55
What 2 medications are associated with medication-induced HYPOthyroidism?
Amiodarone and Lithium
56
____ is the MC agent involved in acute thyroiditis.
S. Aureus * Pt. usually ill and febrile * *TFT: euthyroid
57
Riedel's Thyroiditis...
Fibrous thyroid, with firm, "woody" nodule. May be hypothyroid.
58
A painful, tender neck with clinical HYPERthyroidism following a viral infection is associated with _____ thyroiditis.
de Quervain's *Increased ESR is HALLMARK
59
MC cause of HYPOthyroidism worldwide is ____ deficiency.
Iodine deficiency
60
You should monitor TSH levels at ___ weeks when initiating synthroid changes.
6 *Slow, small increases in patients >50y and patients with cardiovascular dz due to increased metabolic rate

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