Endocrinology Flashcards
1
Q
MC cause of acromegaly and gigantism?
A
somatotroph adenoma
2
Q
Who is acromegaly seen in ?
A
adults
3
Q
Who is gigantism seen in?
A
children
4
Q
What other symptoms are seen in acromegaly besides enlargement?
A
glucose intolerance
headache
hypertension
CHF
5
Q
The best screening for acromegaly?
A
insulin like growth factor
6
Q
The best confirmatory test for acromegaly?
A
oral glucose supression test
7
Q
Best imaging for acromegaly or gigantism?
A
MRI
8
Q
Txt of choice for acromegaly?
A
transsphenoidal surgery
9
Q
Medical txt for acromegaly?
A
Octreotide
Bromocriptine
Pegvisomant
10
Q
MC cause of death of those with acromegaly?
A
Dilated cardiomyopathy
11
Q
Is addison disease a secondary or primary disease?
A
primary
12
Q
What is missing in addison disease?
A
cortisol and aldoserone
13
Q
MC cause of Addison disease in the US?
A
Autoimmune
14
Q
MC cause of Addison disease worldwide?
A
infection (TB)
15
Q
What medication can cause Addison disease?
A
Ketocanzole
16
Q
What is the MC cause of secondary addison disease?
A
exogenous glucocorticoid use
17
Q
What sx are seen in Addison disease?
A
salt craving
orthostatic hypotension
hyperpigementation
18
Q
What electrolyte abnormalities are seen in Addison’s?
A
hyponatremia
hyperkalemia
hypoglycemia
19
Q
Dx screening of Addisons?
A
High dose ACTH (cosyntropin) stimulation test
20
Q
Txt for Addison’s dx?
A
Hydrocortisone- 1st line
Fludrocortisone- Addisons only
IV fluids
21
Q
Patient education for Addisons?
A
triple steroids dosing during surgery, stress
carry a medical tag alert as well as injectable
22
Q
Txt for Addison crisis?
A
IV hydrocortisone + IV fluids
23
Q
MC overall cause of cushings syndrome?
A
exogenous steroid therapy
24
Q
What is Cushings disease?
A
pituitary gland ACTH overproduction
25
Sx of Cushing's?
weight gain, moon facies, buffalo hump, fat pads, thin extremities, acanthosis nigricans
26
Most specific screening test?
24hr urinary free cortisol
27
Most specific differentiating test?
Baseline ACTH + High dose dexamethasone test
28
Lab values seen in Cushings?
hyperglycemia, hypokalemia
29
Txt of cushing disease?
transsphenoidal resection
30
Does Cushing's disease supress during dexamethasone test?
Yes
31
MC type of Diabetes Insipidus?
central
32
What convulsant drug can cause DI?
Lithium
33
Sx of DI?
polyuria, polydipsia
34
Electrolyte imbalances in Diabetes insipidus?
hypokalemia, hypernatremia
35
What test establishes the dx of Diabetes insipidus?
fluid deprivation test
36
What test distinguishes central from nephrogenic insipidus?
Desmopressin (ADH) stimulation test
37
1ST Txt for central DI?
Desmopression (DDAVP)
38
2nd Txt for central DI?
carbamazepine
39
Txt for nephrogenic DI?
sodium & protein restriction, Hydrochlorothiazide, Indomethacin
40
A positive nephrogenic ADH test?
continued production of large amounts of dilute urine
41
A positive nephrogenic ADH test?
reduction in urine output
42
MC cause of central DI?
Idiopathic
43
MC cause of nephrogenic DI?
Lithium
44
MC cause of hypercalcemia?
hyperparathyroidism
45
Sx of hypercalcemia?
stones, bones, abdominal groans, psychic moans
46
Txt for hypercalcemia?
IV fluids
Furosemide
Bisphosphonates
47
MC cause of hypocalcemia?
hypoparathyrodism
48
Sx of hypocalcemia?
muscle cramps, Chvostek sign, Trousseau's sing, dry skin, diarrhea
49
Dx of hypocalcemia on EKG?
prolonged QT interval
50
Dx of hypercalcemia on EKG?
shortened QT interval
51
Txt of hypocalcemia?
oral calcium + Vitamin D
52
Txt for sever hypocalcemia?
IV calcium gluconate or IV calcium carbonate
53
MC cause of hyperparathyrodism?
parathyroid adenoma
54
Sx of hyperparathyrodism?
stones, bones, abdominal groans, psychic moans
55
Triad of hyperparathyrodism?
hypercalcemia + increased intact PTH + decreased phosphate
56
Definitive management of hyperparathyroidism?
Parathyroidectomy
57
Medical management for hyperparathyrodism?
Cinacalcet
58
2 most common causes of hypoparathyroidism?
post neck surgery
| autoimmune
59
Sx of hypoparathyroidism?
hypomagnesemia
| increased muscle contraction
60
Triad of hypoparathyroidism?
hypocalcemia + decreased intact PTH + increased phosphate
61
What is seen on EKG for hypocalcemia?
prolonged QT interval
62
Txt for hypocalcemia?
calcium supplementation + activated Vitamin D (calcitriol)
63
Txt for acute symptomatic hypocalcemia?
IV calcium gluconate
64
What causes hypernatremia?
increased free water loss
65
Who is prone to hypernatremia?
infants, elderly, debilitated patients
66
What is the common initial symptom of hypernatremia?
thrist
67
What is seen on PE for hypernatremia?
dry mouth, decreased skin turgor
68
Txt for hypernatremia?
oral fluids
69
Rapid correction with fluids can lead to what?
cerebral edema
70
What is considered hyPERnatremia?
>145 mEq/L
71
What is considered hyPOnatremia?
<135mEq/L
72
What causes hyponatremia?
increased free water
73
Sx seen in hyponatremia?
cerebral edema
74
Txt for isovolemic hypotonic hyponatremia?
water restriction
75
Txt for hypovolemic hypotonic hyponatremia?
volume replacement normal saline
76
Txt for hypervolemic hypotonic hyponatremia?
volume removal, diuretics, sodium + water restriction
77
MC cause of hypothyroidism in the US?
Hashimoto thyroiditis
78
Patho of hasimoto thyroiditis?
autoimmune thyroid cell destruction
79
Sx of Hashimoto?
fatigue, hoarseness, dry thickened skin, menorrhagia, weight gain
80
Sx seen on PE for Hashimoto?
PAIN LESS Goiter, bradycardia, loss of outer 1/3 of eyebrows, myxedema
81
Primary hypothyroid pattern?
Increased TSH + decreased T4/T3
82
What antibodies are seen in Hashimoto?
antithyroid peroxidase/ anti-thyroglobulin antibodies
83
Txt for Hashimotos?
Levothyroxine therapy
84
MC cause of hyperthyrodism in the US?
Graves dx
85
Patho of Graves?
TSH- receptor autoantibodies target and stimulate the TSH receptor
86
Sx of Graves?
heat intolerance, tremors, atrial fib
87
Sx specific to Graves?
Proptosis, exophthalmos, lid lag, pretibial myxedema
88
Primary hyperthyroid profile?
decreased TSH + increased T4/3
89
What antibodies are seen in Graves?
thyroid stimulating immunoglobulins (TSH receptor antibodies)
90
Txt for Graves?
radioactive iodine
91
Txt for Graves in preggo?
PTU
92
Medical txt for Graves?
Methimazole or PTU
93
MOA of PTU?
prevents peripheral conversion of T4 into T3
94
Best initial therapy for ophthalmopathy in Graves?
steriods
95
What txt is contraindicated in pregnant and lactating women for Graves dx?
Radioactive iodine
96
Painful thyroid after a viral infection, presents as hyperthyroid.. euthyroid.. hypo?
Subacute thyroiditis
97
Txt for subacute thyroiditis?
supportive, NSAIDS
98
MC cause of suppurative thyroiditis?
Staph aureus
99
Sx of suppurative thyroiditis?
PAINFUL thyroid, tenderness, fever, chills, pharyngitis
100
Tx for suppurative thyroiditis?
antibiotics, surgical drainage
101
What is Pheocromocytoma?
catecholamine secreting adrenal tumor
102
The most common finding in pheocromocytoma?
hypertension
103
3 symptoms found in pheocromocytoma?
Palpitations
Headache
Excessive sweating
104
Dx of pheochromocytoma?
24hr urinary fractionated catecholamines
105
Txt of pheochromocytoma?
nonselective alpha-blockade "PHEnoxybenzamine" or PHEntolamine
106
Why aren't beta blockers used first for txt of pheochromocytoma?
to prevent unopposed alpha constriction
107
Definitive txt for pheochromocytoma?
complete adrenalectomy (after 1-2wks of medical therapy)
108
What is Paget dx of the bone?
abnormal bone remodeling
109
MC symptoms of Paget dx of the bone?
bone pain
110
What is seen on labs for Paget's?
markedly elevated alkaline phosphatase
111
1st line txt for Paget's?
Bisphosphonates
112
MC type of thyroid carcinoma?
papillary
113
Risk factor for papillary thyroid carcinoma?
radiation exposure
114
Initial test for thyroid cancer?
Thyroid function + ultrasound
115
Txt for papillary thyroid cancer?
thyroidectomy
116
2nd MC type of thyroid cancer?
Follicular
117
Txt for follicular thyroid cancer?
thyroidectomy
118
10% of medullary thyroid cancer is associated with?
MEN IIa or IIb
119
What is seen on labs for medullary thyroid cancer?
increased calcitonin
120
Txt for medullary thyroid cancer?
total thyroidectomy
121
Used to monitor for reoccurrence of medullary thyroid cancer?
calcitonin
122
The most aggressive thyroid cancer?
anaplastic
123
Rock hard thyroid mass?
Anaplastic
124
Txt for anaplastic thyroid cancer?
amenable to surgical resection
125
MC type of pituitary adenoma?
prolactinoma
126
What prohibits prolactin release?
dopamine
127
Sx of a prolactinoma in women?
hypogonadism, amenorrhea
128
Sx of prolactinoma in men?
hypogonadism, decreased libido, infertility, headache
129
Hormone levels seen in prolactinoma?
increased prolactin, decreased FSH and LH
130
DOC for pituitary tumors?
MRI
131
1ST line txt for prolactinoma?
dopamine agonists- Bromocriptine
132
Txt of prolactinoma in a women wishing to become pregnant?
Transsphenoidal surgery
133
Patho of DM I?
insulin deficiency due to pancreatic beta cell destruction
134
Most common presentation of DM I?
polyuria, polydipsia, polyphagia
135
Most common secondary presentation of DM I?
diabetic ketoacidosis
136
Patho of DM II?
insulin insensitivity and impairment of insulin secretion
137
Greatest risk factor for DM II?
obesity
138
Screening of DM II?
all adults > 45 q 3yrs or any adult w/ BMI > 25 & 1 risk factor
139
Fasting plasma glucose dx?
> 126
140
2-hour glucose tolerance test dx?
>200
141
Hemoglobin A1c dx?
>6.5%
142
Random plasma glucose dx?
>200 in a pt w/ classic diabetic symptoms
143
Gold standard dx of DM?
fasting plasma glucose x2
144
Gold standard dx of DM in pregnancy?
3h glucose tolerance test
145
Initial management of DM?
diet, exercise and lifestyle changes
146
Benefits of metformin?
weight loss, decreased triglycerides, decreased cardio risk
147
Adv rxn of metformin?
GI upset, VB12 deficiency, lactic acidosis
148
Sulfonylurea associated with disulfiram reaction?
Chlorpropamide
149
What is the Dawn phenomenon?
rise in serum glucose levels between 2am-8am
150
What is the Somogyi phenomenon?
nocturnal hypoglycemia followed by rebound hyperglycemia
