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Endocrinology Flashcards

1
Q

Thyroid Antibodies specific for Hashimoto’s Thyroiditis

A

Anti-thyroid peroxidase Ab

Anti-Thyroglobulin Ab

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2
Q

Thyroid Antibodies specific for Grave’s Disease?

A

Thyroid Stimulating Ab

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3
Q

Best thyroid function screening test?

A

TSH

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4
Q

Ordered when TSH is abnormal to determine hyper or hypo thyroid function

A

Free T4

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5
Q

Low TSH (<0.1) with High FT4

Tx:

A

Primary Hyperthyroidism (Thyrotoxicosis)

Methimazole or Propylthiouracil PTU (Pregnant)

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6
Q

High TSH (>5mU) with Low FT4

Tx:

A

Primary Hypothyroidism

Levothyroxine

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7
Q

Radio Active Iodine Test decreased uptake?

A

Thyroiditis (Hashimoto’s De Quervian)

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8
Q

Radio Active Iodine Test diffuse uptake?

A

Grave’s Disease or adenoma

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9
Q

Radio Active Iodine Test hot nodule

A

Toxic Adenoma

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10
Q

Radio Active Iodine Test multiple nodules

A

Multinodular Goiter

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11
Q

Radio Active Iodine Test cold nodule

A

Rule Out malignancy

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12
Q

Clinical Manifestations of Hyperthyroidism X5

A
  • Heat intolerance
  • weight loss
  • skin: warm/moist/ fine hair
  • anxiety
  • Hyperglycemia
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13
Q

Clinical Manifestations of Hypothyroidism X5

A
  • Cold Intolerance
  • Weight gain
  • Skin: dry/thick/ hair loss
  • depression and fatigue
  • hypoglycemia
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14
Q

Congenital hypothyroidism–> Macroglossia, hoarse cry, mental development abnormalities: Tx:

A

Cretinism Tx: Levothyroxine

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15
Q

Hypermetabolic state: palpitations, tachycardia, A-fib, high fever, NV, psychosis, tremors. –> coma and HYTN

Tx:

A

Thyroid Storm (Thyrotoxicosis)

Tx: + BBs +CS (Dex) PTU/Methimazole iodine : Cooling blankets: “in that order”

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16
Q

MC in women and in Cold weather: 2T infection: Bradycardia, hypoglycemia, hyponatremia:

Severe from long standing hypothyroidism Tx:

A

Myxedema crisis

Tx: IV Levothyroxine

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17
Q

Hyperthyroid Disorders?

A
  • Grave’s
  • Pituitary adenoma
  • Multinodular Goiter (Plummer’s)
  • Toxic Adenoma
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18
Q

Hypothyroid disorders?

A
  • Hashimoto’s
  • Lymphocytic
  • postpartum
  • De Quervian’s
  • Acute thyroiditis
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19
Q

Lid-Lag Exophthalmos, proptosis, Pretibial- myxedema: MCC is _______ 90% RAIU= Diffuse

A

Grave’s Disease

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20
Q

Nodular that causes dysphagia, dyspnea, stridor, hoarseness: RAIU Hot nodule

A

Toxic Adenoma

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21
Q

Diffuse enlarged thyroid MC in Elderly: with RAIU=patchy areas multi nodules

A

Multinodular Goiter (Plummer’s Disease)

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22
Q

inappropriate TSH elevation with FT4 elevation: RAIU diffuse uptake: MRI pituitary abnormality

A

Pituitary adenoma

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23
Q

Anti-thyroid Ab/Peroxidase Ab: Painless enlarged thyroid: MCC of hypothyroidism

A

Hashimoto’s

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24
Q

Anti-thyroid Ab/Peroxidase Ab: painless enlarged thyroid : returns to euthyroid state w/I 12-18 months Tx:

A

Silent Lymphocytic Thyroid

Tx: Aspirin

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25
Q

Anti-thyroid Ab/Peroxidase Ab: painless enlarged: occurring after pregnancy

A

Post Partum Thyroiditis

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26
Q

Medications that can induce Thyroiditis or Hypothyroidism

A

Amiodarone or Lithium

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27
Q

Painful fluctuant MC by Staph Aureus: Tx

A

Acute Thyroiditis Tx: Abx

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28
Q

MC post viral: Painful tender thyroid: Increased ESR: usually hyperthyroid acutely: Tx:

A

De Quervian’s Tx: Aspirin

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29
Q

Best initial test to evaluate nodule

A

Fine Needle Aspiration

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30
Q

MC type of thyroid nodule (90% benign)

A

Follicular Adenoma

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31
Q

Suspect malignant nodule when nodule is X3?

A
  • rapid growing
  • Fixed in place
  • no movement with swallowing
32
Q

Thyroid Carcinoma Least to most aggressive?

“Name most specific characteristic for each”

A
  • Papillary (Least and MC)
  • Follicular (Distant METS)
  • Medullary (Secretes Calcitonin and no Iodine uptake)
  • Anaplastic (Most aggressive and rapid growing)
33
Q

Incr. serum Ca+2, intact parathyroid, dec. phosphate
Stones, Bones, abdominal groans and psychic moans

Tx:

A

Hyperparathyroidism

Tx: Sx

34
Q

Types of hyperparathyroidism

A

Primary- Inc. PTH from adenoma (MC Type) MEN-1/2

Secondary- Inc. PTH 2T hypocalcemia/ Vit. D deficiency

35
Q

Hypocalcemia causes what ECG finding

A

Prolonged QT interval (Hyper=Short)

36
Q

Types of osteoporosis?

A

Primary: Postmenopause or Senile
Secondary: Chronic disease or Meds

37
Q

Osteoporosis highlights:

A
  • Pathologic Fracture [Compression Fx] (1st sign)
  • Back pain
  • Dexa scan
38
Q

Osteoporosis Drug for postmenopause?

A
  • Raloxifene

- Estrogen

39
Q

Genetic type I mutation collagen: spontaneous fractures in childhood: Blue sclera: presenile deafness

A

Osteogenesis Imperfecta

40
Q

soft bones and demineralization of bones due to vitamin D deficiency; Cortical thinning in adults

rachitic rosary: Delayed fontanelle or growth retardation
Dec. Vit. D, calcium and phosphate:

A

Osteomalacia (Adults) Rickets (children)

41
Q

Adrenal Gland secretes what hormone in what zone and layer?

A

Glomerulosa -Aldosterone
Fasciculata -Cortisol
Reticularis -Estrogen/Androgen

42
Q

Hyperpigmentation 2t melanocyte stimulation, Hyperkalemia, hypoglycemia, HYTN, hyponatremia

Myalgia, fatigue, abdominal pain, anorexia, weigh loss. Adrenal cortisol insufficiency Dx: Tx:

A

Chronic Adrenocortical Insufficiency (Addison’s)
(Pituitary failure= secondary)

Dx: ACTH challenge (@ 30-60 min) Tx: Hydrocortisone

43
Q

refractive hypotension and hypovolemia: Hyperkalemia, Hyponatremia, hypoglycemia: Tx:

A

Adrenal (Addisonian) Crisis (Adrenal corticol insufficiency)

44
Q

MCC of Adrenal (Addisonian) Crisis (Adrenal cortisol insufficiency)?

A

Abrupt withdrawal of glucorticosteroids

45
Q

HTN, weight gain (central trunk), moon facies, buffalo hump, protein catabolism, hirsutism, amenorrhea:

Cortisol Excess: Dx: Tx:

A

Hypercortisolism (Cushing’s Disease)

Dx: LD Dexamethasone Suppression test
24 hour free cortisol (Most reliable)
Tx: Ketoconazole (pituitary Transphenoidal Sx)

46
Q

What is the difference between Cushing’s Syndrome and Cushing’s Disease?

A

Syndrome- S/Sx related to Cortisol excess

Disease- syndrome specifically caused by Pituitary inc. ACTH secretion

47
Q

hypertension, hypokalemia, polyuria: Headaches, hypo magnesium–> decreased DTRs

A

Hyperaldosteronism

48
Q

Types of hyperaldosteronism

A

1ry- Adrenal hyperplasia or Conn’s(Aldesteroneoma)
Renin-independent

2ry- Inc. renin: Renal Artery stenosis MC

49
Q

Anterior Pituitary Hormones

A 
TSH
ACTH
Prolactin
E
FSH/LH
GH
50
Q

Galactorrhea, Amenorrhea, and hypothyroidism: Hypogonadism, infertility, impotence, vaginal dryness

Tx:

A

Hyperprolactinemia

Tx: Cabergoline or Bromocryptine (D. Agonist)

51
Q

Hyperprolactinemia work up?

A
  • Prolactin
  • TSH
  • B-HCG
  • FSH/LH
  • Testicular exam
52
Q

Gynecomastia causing medications top 4

A
  • Spironolactone (Antiandrogenic)
  • Ketoconazole
  • Cimetidine
  • 5 Alpha reductase Inh. (Finasteride dutasteride)
53
Q

Gynecomastia treatment?

A

Tamoxifen (Selective Estrogen Modulators)
Letrozole (Aromatase Inhibitors)
Sx:

54
Q

classic symptoms of DM

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight Gain/Loss
55
Q

earliest sign of diabetic nephropathy?

Tx:

A

Microalbuminuria

Tx: ACEi

56
Q

Earliest change in DM retinopathy?

A

Exudates Wool Spots “Micro aneurysms” (Flame shaped hemorrhages)

57
Q

Hypoglycemia Symptoms

A
  • sweating
  • Tremors
  • palpitations
  • tachycardia
  • Nervousness
58
Q

Definition of hypoglycemia mild and severe?

A

Mild <60 Severe <40 Tx: D50 IV/SQ Glucagon

59
Q

Diagnosis of DM lab values

A

Fasting- >/= 126mg/dL (x2 occasions GS)
2 Hours GTT >/= 200 (3h GS in Gest. DM)
A1C >/=6.5 (Average 10-12 wks

60
Q

Anti- hyperglycemic agent that stimulates insulin release: Insulin Secretagogue

Se:?

A

Sulfonylureas ( Glipizide-Gliburide -ide)

SE: Hypoglycemia/Weight Gain (Sulfa allergy)

61
Q

Anti- hyperglycemic agent that stimulates insulin release that is glucose dependent:

SE:

A

Meglitinides (- glinide)

SE: Hypoglycemia

62
Q

Anti- hyperglycemic agent that delays intestinal Anti- hyperglycemic absorption

SE:

A

Alpha Glucoside inhibitors (Acarbose- Miglitol)

SE: Hepatitis (Increases LFTs)

63
Q

Anti- hyperglycemic agent that increases peripheral insulin sensitivity in adipose and muscle cells.

SE:

A

Thiazolidinediones (-azone) Pioglitazone/Rosiglitazone

SE: Fluid retention–> edema

64
Q

Anti- hyperglycemic agent that lowers renal threshold –> increased Urinary Glucose excretion

SE:

A

SGLT-2 Inhibitor (Canagliflozin- Dapagliflozin -ozin)

SE: UTIs, thirst, abd. pain

65
Q

Anti- hyperglycemic agent that mimics incretin –> insulin secretion injectable

SE:

A

GLP-1 (Exanitide-Liraglutide -tide)

SE: Hypoglycemia “CI gastroparesis”

66
Q

Insulin given at the same time of meal: often used with intermediate or long acting

A

Rapid Acting Insulin (Lispro or Aspart)

67
Q

Given 30 min prior to meal often used with intermediate or long acting

A

Short acting Regular insulin:

68
Q

Covers insulin for 12 a day or over night: often combined with short or Rapid acting:

A

NPH or Lente

69
Q

Covers insulin for 1 full day: “Basal insulin”

A

Long acting Detemir or Glargine

70
Q

Nocturnal Hypoglycemia followed by rebound hyperglycemia due to surge in GH

Tx:

A

Somogyi Effect

Tx: Decrease nighttime NPH or bed time snack

71
Q

normal glucose until Hyperglycemia 2 am-8 am due to decreased insulin sensitivity

A

Dawn Phenomenon

Tx: Bed time NPH and no bed time snack

72
Q

Hyperglycemia > 600, Arterial pH >7.30, Urine/Serum ketones= small: MC in DM type II: Potassium deficit

A

Hyperosmolar Hyperglycemic Syndrome

73
Q

Diabetic Ketoacidosis is MC in what patients? What are the diagnosis labs X4

A

MC in DM-I

  • > 250 hyperglycemia (Severe)
  • pH < 7.30 (< 7.0 severe)
  • < 10 Serum Bicarb
  • Positive ketones Serum/urine
74
Q

Diabetic Ketoacidosis Management ?

A 
#1. critical 1st- 0.9 NS 
#2. Regular insulin 0.1 mg/kg
#3. Potassium < 5.5 (20-40 mEq)
75
Q

Multiple Endocrine neoplasm (MEN 1 or Wermer’s) inherited D/O highlights X3

A
  • 3 Ps (Parathyroid 90%, Pancreas 60%, Pituitary 55%
  • hyperparathyroidism
  • Mein gene Genetic testing
76
Q

Multiple Endocrine neoplasm (MEN 2) inherited D/O highlights X3

A
  • MEN 2A 90%
  • Thyroid carcinoma, pheo, hyperparathyroidism
  • Proto-oncogene Genetic testing

PANCE (13 decks)

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