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PANCE REVIEW > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Hallmark findings or pheocromocytoma

A

Palpitations
Diaphoresis
Headache

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2
Q

Cranial nerve palsy found in diabetics

A

Cranial nerve III palsy (the pupil remains normal size)

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3
Q

Types of diabetic retinopathy

A

1) non-proliferative: microaneurysms leading to cotton wool spots , flame hemorrhage
2) proliferating: neovascularization
3) maculopathy: macular edema with central vision loss

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4
Q

Kidney bx finding in diabetic nephropathy

A

Kimmelsteal- Wilson modular glomerulosclerosis!!

Pink hyaline material (protein leakage )

Proteinuria

*ACE inhibitors for management

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5
Q

Who should be screened for diabetes

A
  • ALL adults over 45 q3 years

- any obese adult with 1 additional risk factor

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6
Q

DM diagnosis

A

Fasting glucose >126

Random glucose >200

A1c 6.5%

** on two occasions

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7
Q

Metformin MOA, SE

A
  • decreases hepatic glucose production

* lactic acidosis, GI upset, macrocytic anemia (b12 deficiency)

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8
Q

Sulfonylureas MOA, SE

A

Stimulates pancreatic beta cells to produce insulin no matter the glucose levels

-weight gain and hypoglycemia

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9
Q

Meglitinides MOA, SE

A

Stimulates beta cell insulin production but is glucose dependent

-weight gain and hypoglycemia

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10
Q

Thiazolidinediones MOA, SE

A

Increase insulin sensitivity peripherally at the adipose muscle tissues

  • fluid retention/edema
  • MI (more with rosiglitizone)
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11
Q

GLP-1 agonist MOA, SE

A

Mimic incretin to stimulate insulin secretion and delays gastric emptying

  • pancreatitis
  • CI in someone with gastroporesis
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12
Q

SGLT-2 inhibitor MOA, SE

A

Increases urinary glucose excretion

-thirst, UTI

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13
Q

Rapid acting insulin

A
  • lispro, aspart

* work in 5-15 minutes, give at mealtime

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14
Q

Short acting insulin

A

Regular insulin

-works in 30min-1hr, give before meal

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15
Q

Intermediate acting insulin

A

NPH, lente

  • works about half the day or overnight
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16
Q

Long acting insulin

A

Glargine(Lantus),Detemir

Works 24 hours

*cant be mixed in same syringe as other insulin

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17
Q

Dawn phenomenon Managemeny

A

Early morning hyperglycemia, treat this by giving a bolus of NPH (intermediate) and no snacks before bed

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18
Q

Somogyi effect

A

Nighttime hypoglycemia that is followed by a rebound hyperglycemia

*to treat, prevent the hypoglycemia by encouraging a nighttime snack and not giving as much insulin at night

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19
Q

What is the most common trigger for DKA

A

Infection

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20
Q

What kind of pH change will you see in DKA

A

High anion gap metabolic acidosis (ketonemia)

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21
Q

Kussmaul’s respirations

A

Deep continuous respiration’s in an attempt to blow off CO2 , seen in acidosis

22
Q

1st line treatment in someone just diagnosed with DMT2

A

DIET and exercises.

  • Carbs 50-60%
  • Protein 15-20%
  • Unsaturated fats 10%
23
Q

Best treatment for diabetic neuropathy?

A

Gabapentin

24
Q

Arrythmia associated with thyroid storm

A

a-fib

25
Q

treatment for thyroid storm

A
  1. PTU or mithimozole (prevents conversion)
  2. BB (slow you down)
  3. IV glucocorticoids (prevents concersion)
26
Q

MC cause of adrenal insufficiency

A

abrupt discontinuation of corticosteroids

27
Q

Lab findings in acute adrenal insufficiency

A

hyponatremia, hyperkalemia, hypoglycemia, refractory hypotension

28
Q

pathophis of Graves dz

A

autoimmune process where patient makes TSH receptor antibodies…therefore TSH is “low” resulting in clinical hyperthyroid.
***MC cause of hyperthyroid

29
Q

Physical exam findings specific to Graves dz

A
  1. thyroid bruits
  2. Opthalmopathy (lid lag, proptosis, exophthalmos)
  3. Pretibial Myxedema (nonpitting, edematous pink/brown plaques)

**diffuse radioactive iodine uptake

30
Q

Treatment of Grave’s dz

A
  1. radioactive iodine to destroy thyroid (then give thyroid replacement)
  2. PTU, methimazole
  3. BB
31
Q

What is silent thyroiditis

A

autoimmune process where thyroid first enlarges causing thyroidtoxicosis, THEN changes to hypothyroid state over a year.

***treat with ASA , most return to normal on their own.

32
Q

Medications that can precipitate hypothyroidism

A

amiodorone
lithium
alpha interferon

33
Q

Are hot or cold thyroid nodules highly suspicious for malignancy?

A

cold

34
Q

What level of thyroid hormone do most people with thyroid cancer present in

A

euthyroid

35
Q

What is the most common type of thyroid cancer?

A

Papillary (80%) , least aggressive with best prognosis, young females , DISTANT METS UNCOMMON

36
Q

What are the 4 types of thyroid concer

A
  1. papillary, only local mets, good prog.
  2. follicular, distant mets, good prog
  3. medulary,MEN2 association, secrete calcitonin
  4. anaplastic , older men, rapid growth to invade trachea, most die in 1 yr and need tracheostomy
37
Q

MEN2 syndrome is made up of what diagnoses

A
  1. hyperparathyroid
  2. medullary thyroid cancer
  3. pheochromocytoma
38
Q

MEN1 syndrome is made up of what diagnoses

A
  1. hyperparathyroid
  2. pituitary tumur
  3. Pancreatic tumor
39
Q

2 MC causes of hypoparathyroidism

A

post surgical removal, autoimmune destruction

40
Q

Treatment of symptomatic hypercalcemia

A

IV fluids and lasix (loop diuretics increase renal calcium excretion)

41
Q

Addisions dz.. what is it and what causes it?

A

adrenal gland destruction leading to low cortisol and aldosterone levels. some causes are :

  1. autoimmune
  2. infection (TB, HIV)
  3. metastatic cancer
42
Q

clinical manifestations of primary addisons disease

A

hyperpigmentation, hypotension, hyperkalemia, hyponatremiametabolic acidosis , loss of sex hormones

43
Q

What is the screening test for adrenal insufficiency

A

ACTH stimulation test… no rise in cortisol after injection

44
Q

What is the best test to differentiate primary vs secondary adrenal insufficiency

A

CRH stimulation test

  • if test causes a list in ACTH then you know it is PRIMARY
  • if the test doesn’t cause a rise in ACTH then you know it is SECONDARY (there is a problem with the pituitary itsself )
45
Q

Treatment of adrenal insufficiency

A

if primary (addison’s) then give glucocorticoid and mineralocorticoid

if secondary adrenal insufficiency then only give glucocorticoid

46
Q

What is the most common cause of cushing syndrome

A

long term steroid use

47
Q

What is cushion’s dz?

A

cushing syndrome caused by a PITUITARY adenoma secreting ACTH

48
Q

What is a pheochromocytoma?

A

catacholamine secreting adrenal tumor

*diagnosed by 24 hr urine catecholamines with elevated metanephrine and vanillylmandelic acid

49
Q

Pheocromocytoma treatment

A

Adrenalectomy

**need alpha blockade with PHEnoxybenzamine or PHEntolamine x2 weeks pre-surgery

BB post surgery

50
Q

What is the cause of acromegaly and how do you test for it?

A

It is caused by a pituitary adenoma secreting growth hormone (somatotropinoma)

*diagnosed by a high level of IGF (insulin like growth factor)

51
Q

what is de Quervain’s thyroiditis

A

MC post viral inflammatory reaction resulting in painfully tender thyroid with clinical hyperthyroid

  • Elevated ESR , no thyroid antibodies
  • Treat with ASA

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