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MTBs Step 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

dx diabetes

A

need 1 of the following:

  1. fasting glucose of >126 of two seperate occations
  2. one random glucose of >200 with symptoms(polydip/uria/phagia)
  3. abnormal glucose tolerance test
  4. A1c >6.5%
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2
Q

strongest indication for screening for DM?

A

HTN

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3
Q

best initial therapy for DM

A

weight loss and exercise

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4
Q

best initial pharm therapy for DM

A

metformin = blocks gluconeogenesis

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5
Q

C/I to Metformin

A

renal insufficiency, use of contrast agents

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6
Q

Sulfonylureas drugs +mechanism+ side fx

A

glyburide, glimepiride, glipizide = increase the release of insulin
- cause hypoglycemia and SIADH

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7
Q

DPP-4 inhibitors drugs + mechanism + side fx

A

sltagliptin, linagliptin, alogliptin, saxagliptin, exenatide
- work by blocking metabolism of GLP = allows GLP to stop glucagon release and stimulate insulin release

-fx: weight loss!!!

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8
Q

Thiazolidinedions drugs + mech + side fx?

A

rosiglitazone, pioglitaone

  • increase peripheral insulin sensitivity by activating PPARy or some shit.
  • obesity, worsen CHF, bone crap
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9
Q

A-glucosidase inhibitors drugs? + mech? + fx?

A

acarbose and miglitol = block absorption of glucose at the intestinal lining.
- diarrhea, ab pain, bloating, flatulence

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10
Q

SGLT inhibitors, mech fx?

A

anything that ends in -gliflozin

- causes UTI

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11
Q

DKA causes what type of pH disturbance? why?

A

metabolic acidosis! = no insulin = body is hungry and cant use glucose so starts making ketones = acid! = body starts to hyperventilate to blow of acid & attempt to absorb bicarb. = anion gap acidosis!

*hyperglycemia and HYPERKALEMIA = kidneys remove H via taking up K but cells are also trying to remove H so they suck H up in exchange for K!

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12
Q

tx of DKA?

A

IV BOLUS saline + insulin IV + K(later)

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13
Q

when do you start giving K in DKA

A

when K levels normalize = start giving K as the body is starting to shift K back into the body in exchange for H.

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14
Q

target BP in DM

A

130/80

*normal targer is 140/90

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15
Q

target LDL in DM?

A

LDL <100

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16
Q

ppl with DM need yearly….

A

eye exam, foot exam, influenza and regular pneumococcal vaccine

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17
Q

sx of hypothyroidism

A

slow, tired, fatigue, weight gain, increased menstration, cold, hair loss, dereased reflexes, coma, constipation, bradycardia

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18
Q

Graves Disease?

sx? RAIU?

A

Stimulating ab to TH-receptor
sx: exophthalmos and proptosis, pretibial myxedema, onycolysis(separation of the nail form the nailbed)
RAIU: elevated

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19
Q

tx of Graves Disease

A
  1. Metimazole or PTU to bring gland under crontrol
  2. Radioactive I ablation
  3. Propranolol to tx sx
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20
Q

Slient Thyroiditis?

tx?

A

AI to thyroid peroxidase or TG-antibodies = nontender gland and hyperthyroidism = thyroid is leaking
- no tx, normal RAIU

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21
Q

Subacute Thyroiditis

sx? tx? RAIU?

A

viral etiology?
sx: tender thyroid, low raiu, T4 elevated, TSH low

tx: ASA

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22
Q

Pituitary Adenoma as the cause of hyperthyroidism

whats different about this form other forms?

A

only one that will have an elevated TSH and T4. the rest just have elevated t4s

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23
Q

tx of thyroid storm

A

PTU, Dexamethasone, Propranolol, I

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24
Q

MCC of Hypercalcemia?

A

primary hyperparathyroidism

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25
other causes of hypercalcemia besides primary hyperparathyroidism
malignancy(MM), granulomatous disease(sarcoid), vitaD intoxication, Thiazide diuretics, TB, Histoplasmosis, Berylliosis
26
sx of hyperparathyroidism
kidney stones, osteoporosis/osteomalacia/fractures, confusion, stupor, lethargy, constipation, abdominal pain, polyuria, polydipsia, renal insufficiency, ATN, short QT syndrome
27
Person with hypercalcemia due to primary hyperparathyroidism should be suspected/worked up for...
MEN 1 and MEN2 MEN1: pituitary, PTH, Pancreas MEN2: PTH, Pheo, Medually Thryoid
28
Tx of hypercalcemia
1. hydration 2. bisphosphonates 3. furosemide 4. steroids
29
sx of hypocalcemia
twitchy, hyperexcitable, seizures, arrhythmia, prolonged QT, Chvostek & Trousseau sign
30
causes of hypocalcemia
surgical removal of PT glands, hypomagnesmia, vit D deficiency, acute hyperphosphatemia, fat malabsoption, PTH resistance
31
Cushing Syndrome vs Cushing Disorder
syndrome: ACTH excess from ectopic sources dz: ACTH excess from overproduction by pituitary
32
sx of cushing
moon face, buffalo hump, thin arms and legs, easy bruising and striae(loss of collagen due to breakdown to make protein & gluco), HTN due to Na retention(mild mineralo effect of cortisol), Muscle wasting(protein breakdown for gluco), hirsutism(+irregular menstation), insulin resistance = polyuria,polydipsia, leukocytosis
33
what type of PH disorder will you see with cushings? why?
metabolic alkalosis = loss of H via kidney and retention of Na due ot mild mineralocorticoid effect
34
whats the first thing u do when you have high cortisol and wanna find out why?
measure ACTH! if High = pituitary prob or ectopic | if low = adrenal prob and you need to CT adrenals
35
high cort + high ACTH what test do you need to do?
Dexamethasone supression test = if LD still has high ACTH = prob! try HD. if nothing supressed with HD = ectopic if supressed = pituitary = do MRI
36
what do you do if u do a abdominal CT for some reason and happen to find a adrenal mass?
1. metanephrin lvl to r/o pheo 2. renin + aldo to r/o hyperaldo(Conns) 3. LD dexamethasone to r/o cushing *if all are negative your done =)
37
Addisons Disease | sx?
``` adrenal insufficiency(salt, sex, stress) sx: fatigue weakness, weight loss, hypotension, hyperpigmented skin, hyperkalemia with mild metabolic acidosis(inability to excrete H or K), hyponatremia ```
38
tx of addisons
acute addison = hydrocortisone(glutcocorticoid and mineralocorticoid acitivty) and when stable give prednisone
39
Hyperaldosteronism | sx?
aka Conn's syndrome = solitary adenoma of the adrenals causing increased aldo sx: hypertension, Hypokalemia, metabolic alkalosis
40
when should you be thinking about Conn's syndrome?
when BP isnt controlled by 2+antiHTN drugs
41
dx of Conns syndrome?
low renin, HTN, elevated aldo & confirmed with CT
42
tx of Conn syndrome?
spironolactone for hyperplasia and resection for adenoma
43
Pheochromocytoma | sx?
HA, palpation, tremors, axiety, flushing = episodic
44
dx of pheochromocytoma
high plasma and urinary catecholamines, elevated urine metanephrin or plasma metanephrine
45
tx of pheochromocytoma
phenoxybenzamine then propanolol *if not reflex tachy
46
21 OH deficiency sx
*salt comes before sex | low salt, high sex
47
11 OH deficiency sx
mild elevation in salt, high sex
48
17 OH def sx
high salt, low sex
49
Prolactin may be elevated due to....
prolactinoma, pregnancy, cosecreted with GH in acromegaly, hypothyroid(elevated TRH triggers prolactin and TSH), antipsychotics
50
sx of prolactinoma in men & women
men: ED, decreased libido, gynecomastic(late), HA, visual disturbances women: amenorrhea & galactorrhea in absence of prego > same sx as men
51
tx of prolactinoma?
bromocriptine or cabergoline
52
Acromegaly | sx?
pit tumor secreting GH: - enlargement of soft tissue: Feet, jaw(gap in teeth), fingers(carpel tunnel), head, nose, sweat glands(increased sweatig), obstructive sleep apnea, seep void, large tongue, colon polyps(increased risk of colon cancer), HTN & cardiomegaly(arteriol enlargment), joint abnormalites(50yoa = wheelchair due to pain), Diabetes(GH = anti-insulin) & Hyperlipiedemia
53
best dx test for acromegaly
IGF level then Glucose supression test
54
tx of acromegaly
Surgery > Cabergoline > Pegvisomant >Octreotide
55
Turner Syndrome | sx?
XO karyotype, short, webbed neck, wide spaced nippes, scant pubic and axillary hair = streak ovaries, primary ammorhea
56
Androgen Insensitivity
46XY but looks female bc androgen receptors do not respond to testosterone = looks female bc estrogen receptors are fine
57
Mullerian Agenesis
46XX but mullerian ducts fail to fuse = normal female with out a uterus
58
PCOS | how do you dx?
need 2 of the following: 1. elevated Test/DHEA or Hirsutism 2. U/S showing PCOS 3. Irreg. menstration
59
PCOS sx?
gradula onset hirsutism, obesity, acne, irregular bleeding and infertility, elevated LH>>FSH + insulin resistance
60
PCOS tx
OCP, Spironolactone(anti-androgen), Metformin(for DM), Clomiphene if trying to get prego
61
Klinefelters syndrome | sx? tx?
XXY karyotype - insensitive FSH and LH recepters on testicles = VERY high FSH and LH but no testosterone = feminization tx: give testosterone
62
Kallman Syndrome
anosmia with hypogonadism *low GnRH, FSH and LH + Anosmia = dx!
63
Central DI | causes?
stroke, tumor, trauma, hypoxia, infiltration(sarcodosis, hemochromatosis), infection
64
Central DI | tx?
caused by decreased ADH = tx with desmopressin!
65
Nephrogenic DI | causes?
chronic pyelo, amyloidosis, meyloma, SSD, lithium use, elevated Ca & low P
66
Nephrogenic DI | tx?
caused by ADH insensitivty in kidney --> tx w/HCTZ, NSAIDs, Amiloride *not gonna fix kidneys just memorize this
67
whats Demeclocyclin used for?
abx and induces DI = can be used to tx SIADH

MTBs Step 3 (30 decks)

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