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Internal Med PAEA > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

MC cause of acromegaly and gigantism?

A

somatotroph adenoma

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2
Q

Who is acromegaly seen in ?

A

adults

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3
Q

Who is gigantism seen in?

A

children

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4
Q

What other symptoms are seen in acromegaly besides enlargement?

A

glucose intolerance
headache
hypertension
CHF

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5
Q

The best screening for acromegaly?

A

insulin like growth factor

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6
Q

The best confirmatory test for acromegaly?

A

oral glucose supression test

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7
Q

Best imaging for acromegaly or gigantism?

A

MRI

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8
Q

Txt of choice for acromegaly?

A

transsphenoidal surgery

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9
Q

Medical txt for acromegaly?

A

Octreotide
Bromocriptine
Pegvisomant

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10
Q

MC cause of death of those with acromegaly?

A

Dilated cardiomyopathy

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11
Q

Is addison disease a secondary or primary disease?

A

primary

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12
Q

What is missing in addison disease?

A

cortisol and aldoserone

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13
Q

MC cause of Addison disease in the US?

A

Autoimmune

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14
Q

MC cause of Addison disease worldwide?

A

infection (TB)

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15
Q

What medication can cause Addison disease?

A

Ketocanzole

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16
Q

What is the MC cause of secondary addison disease?

A

exogenous glucocorticoid use

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17
Q

What sx are seen in Addison disease?

A

salt craving
orthostatic hypotension
hyperpigementation

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18
Q

What electrolyte abnormalities are seen in Addison’s?

A

hyponatremia
hyperkalemia
hypoglycemia

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19
Q

Dx screening of Addisons?

A

High dose ACTH (cosyntropin) stimulation test

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20
Q

Txt for Addison’s dx?

A

Hydrocortisone- 1st line
Fludrocortisone- Addisons only
IV fluids

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21
Q

Patient education for Addisons?

A

triple steroids dosing during surgery, stress

carry a medical tag alert as well as injectable

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22
Q

Txt for Addison crisis?

A

IV hydrocortisone + IV fluids

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23
Q

MC overall cause of cushings syndrome?

A

exogenous steroid therapy

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24
Q

What is Cushings disease?

A

pituitary gland ACTH overproduction

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25
Q

Sx of Cushing’s?

A

weight gain, moon facies, buffalo hump, fat pads, thin extremities, acanthosis nigricans

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26
Q

Most specific screening test?

A

24hr urinary free cortisol

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27
Q

Most specific differentiating test?

A

Baseline ACTH + High dose dexamethasone test

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28
Q

Lab values seen in Cushings?

A

hyperglycemia, hypokalemia

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29
Q

Txt of cushing disease?

A

transsphenoidal resection

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30
Q

Does Cushing’s disease supress during dexamethasone test?

A

Yes

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31
Q

MC type of Diabetes Insipidus?

A

central

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32
Q

What convulsant drug can cause DI?

A

Lithium

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33
Q

Sx of DI?

A

polyuria, polydipsia

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34
Q

Electrolyte imbalances in Diabetes insipidus?

A

hypokalemia, hypernatremia

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35
Q

What test establishes the dx of Diabetes insipidus?

A

fluid deprivation test

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36
Q

What test distinguishes central from nephrogenic insipidus?

A

Desmopressin (ADH) stimulation test

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37
Q

1ST Txt for central DI?

A

Desmopression (DDAVP)

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38
Q

2nd Txt for central DI?

A

carbamazepine

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39
Q

Txt for nephrogenic DI?

A

sodium & protein restriction, Hydrochlorothiazide, Indomethacin

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40
Q

A positive nephrogenic ADH test?

A

continued production of large amounts of dilute urine

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41
Q

A positive nephrogenic ADH test?

A

reduction in urine output

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42
Q

MC cause of central DI?

A

Idiopathic

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43
Q

MC cause of nephrogenic DI?

A

Lithium

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44
Q

MC cause of hypercalcemia?

A

hyperparathyroidism

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45
Q

Sx of hypercalcemia?

A

stones, bones, abdominal groans, psychic moans

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46
Q

Txt for hypercalcemia?

A

IV fluids
Furosemide
Bisphosphonates

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47
Q

MC cause of hypocalcemia?

A

hypoparathyrodism

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48
Q

Sx of hypocalcemia?

A

muscle cramps, Chvostek sign, Trousseau’s sing, dry skin, diarrhea

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49
Q

Dx of hypocalcemia on EKG?

A

prolonged QT interval

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50
Q

Dx of hypercalcemia on EKG?

A

shortened QT interval

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51
Q

Txt of hypocalcemia?

A

oral calcium + Vitamin D

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52
Q

Txt for sever hypocalcemia?

A

IV calcium gluconate or IV calcium carbonate

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53
Q

MC cause of hyperparathyrodism?

A

parathyroid adenoma

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54
Q

Sx of hyperparathyrodism?

A

stones, bones, abdominal groans, psychic moans

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55
Q

Triad of hyperparathyrodism?

A

hypercalcemia + increased intact PTH + decreased phosphate

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56
Q

Definitive management of hyperparathyroidism?

A

Parathyroidectomy

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57
Q

Medical management for hyperparathyrodism?

A

Cinacalcet

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58
Q

2 most common causes of hypoparathyroidism?

A

post neck surgery

autoimmune

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59
Q

Sx of hypoparathyroidism?

A

hypomagnesemia

increased muscle contraction

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60
Q

Triad of hypoparathyroidism?

A

hypocalcemia + decreased intact PTH + increased phosphate

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61
Q

What is seen on EKG for hypocalcemia?

A

prolonged QT interval

62
Q

Txt for hypocalcemia?

A

calcium supplementation + activated Vitamin D (calcitriol)

63
Q

Txt for acute symptomatic hypocalcemia?

A

IV calcium gluconate

64
Q

What causes hypernatremia?

A

increased free water loss

65
Q

Who is prone to hypernatremia?

A

infants, elderly, debilitated patients

66
Q

What is the common initial symptom of hypernatremia?

A

thrist

67
Q

What is seen on PE for hypernatremia?

A

dry mouth, decreased skin turgor

68
Q

Txt for hypernatremia?

A

oral fluids

69
Q

Rapid correction with fluids can lead to what?

A

cerebral edema

70
Q

What is considered hyPERnatremia?

A

> 145 mEq/L

71
Q

What is considered hyPOnatremia?

A

<135mEq/L

72
Q

What causes hyponatremia?

A

increased free water

73
Q

Sx seen in hyponatremia?

A

cerebral edema

74
Q

Txt for isovolemic hypotonic hyponatremia?

A

water restriction

75
Q

Txt for hypovolemic hypotonic hyponatremia?

A

volume replacement normal saline

76
Q

Txt for hypervolemic hypotonic hyponatremia?

A

volume removal, diuretics, sodium + water restriction

77
Q

MC cause of hypothyroidism in the US?

A

Hashimoto thyroiditis

78
Q

Patho of hasimoto thyroiditis?

A

autoimmune thyroid cell destruction

79
Q

Sx of Hashimoto?

A

fatigue, hoarseness, dry thickened skin, menorrhagia, weight gain

80
Q

Sx seen on PE for Hashimoto?

A

PAIN LESS Goiter, bradycardia, loss of outer 1/3 of eyebrows, myxedema

81
Q

Primary hypothyroid pattern?

A

Increased TSH + decreased T4/T3

82
Q

What antibodies are seen in Hashimoto?

A

antithyroid peroxidase/ anti-thyroglobulin antibodies

83
Q

Txt for Hashimotos?

A

Levothyroxine therapy

84
Q

MC cause of hyperthyrodism in the US?

A

Graves dx

85
Q

Patho of Graves?

A

TSH- receptor autoantibodies target and stimulate the TSH receptor

86
Q

Sx of Graves?

A

heat intolerance, tremors, atrial fib

87
Q

Sx specific to Graves?

A

Proptosis, exophthalmos, lid lag, pretibial myxedema

88
Q

Primary hyperthyroid profile?

A

decreased TSH + increased T4/3

89
Q

What antibodies are seen in Graves?

A

thyroid stimulating immunoglobulins (TSH receptor antibodies)

90
Q

Txt for Graves?

A

radioactive iodine

91
Q

Txt for Graves in preggo?

A

PTU

92
Q

Medical txt for Graves?

A

Methimazole or PTU

93
Q

MOA of PTU?

A

prevents peripheral conversion of T4 into T3

94
Q

Best initial therapy for ophthalmopathy in Graves?

A

steriods

95
Q

What txt is contraindicated in pregnant and lactating women for Graves dx?

A

Radioactive iodine

96
Q

Painful thyroid after a viral infection, presents as hyperthyroid.. euthyroid.. hypo?

A

Subacute thyroiditis

97
Q

Txt for subacute thyroiditis?

A

supportive, NSAIDS

98
Q

MC cause of suppurative thyroiditis?

A

Staph aureus

99
Q

Sx of suppurative thyroiditis?

A

PAINFUL thyroid, tenderness, fever, chills, pharyngitis

100
Q

Tx for suppurative thyroiditis?

A

antibiotics, surgical drainage

101
Q

What is Pheocromocytoma?

A

catecholamine secreting adrenal tumor

102
Q

The most common finding in pheocromocytoma?

A

hypertension

103
Q

3 symptoms found in pheocromocytoma?

A

Palpitations
Headache
Excessive sweating

104
Q

Dx of pheochromocytoma?

A

24hr urinary fractionated catecholamines

105
Q

Txt of pheochromocytoma?

A

nonselective alpha-blockade “PHEnoxybenzamine” or PHEntolamine

106
Q

Why aren’t beta blockers used first for txt of pheochromocytoma?

A

to prevent unopposed alpha constriction

107
Q

Definitive txt for pheochromocytoma?

A

complete adrenalectomy (after 1-2wks of medical therapy)

108
Q

What is Paget dx of the bone?

A

abnormal bone remodeling

109
Q

MC symptoms of Paget dx of the bone?

A

bone pain

110
Q

What is seen on labs for Paget’s?

A

markedly elevated alkaline phosphatase

111
Q

1st line txt for Paget’s?

A

Bisphosphonates

112
Q

MC type of thyroid carcinoma?

A

papillary

113
Q

Risk factor for papillary thyroid carcinoma?

A

radiation exposure

114
Q

Initial test for thyroid cancer?

A

Thyroid function + ultrasound

115
Q

Txt for papillary thyroid cancer?

A

thyroidectomy

116
Q

2nd MC type of thyroid cancer?

A

Follicular

117
Q

Txt for follicular thyroid cancer?

A

thyroidectomy

118
Q

10% of medullary thyroid cancer is associated with?

A

MEN IIa or IIb

119
Q

What is seen on labs for medullary thyroid cancer?

A

increased calcitonin

120
Q

Txt for medullary thyroid cancer?

A

total thyroidectomy

121
Q

Used to monitor for reoccurrence of medullary thyroid cancer?

A

calcitonin

122
Q

The most aggressive thyroid cancer?

A

anaplastic

123
Q

Rock hard thyroid mass?

A

Anaplastic

124
Q

Txt for anaplastic thyroid cancer?

A

amenable to surgical resection

125
Q

MC type of pituitary adenoma?

A

prolactinoma

126
Q

What prohibits prolactin release?

A

dopamine

127
Q

Sx of a prolactinoma in women?

A

hypogonadism, amenorrhea

128
Q

Sx of prolactinoma in men?

A

hypogonadism, decreased libido, infertility, headache

129
Q

Hormone levels seen in prolactinoma?

A

increased prolactin, decreased FSH and LH

130
Q

DOC for pituitary tumors?

A

MRI

131
Q

1ST line txt for prolactinoma?

A

dopamine agonists- Bromocriptine

132
Q

Txt of prolactinoma in a women wishing to become pregnant?

A

Transsphenoidal surgery

133
Q

Patho of DM I?

A

insulin deficiency due to pancreatic beta cell destruction

134
Q

Most common presentation of DM I?

A

polyuria, polydipsia, polyphagia

135
Q

Most common secondary presentation of DM I?

A

diabetic ketoacidosis

136
Q

Patho of DM II?

A

insulin insensitivity and impairment of insulin secretion

137
Q

Greatest risk factor for DM II?

A

obesity

138
Q

Screening of DM II?

A

all adults > 45 q 3yrs or any adult w/ BMI > 25 & 1 risk factor

139
Q

Fasting plasma glucose dx?

A

> 126

140
Q

2-hour glucose tolerance test dx?

A

> 200

141
Q

Hemoglobin A1c dx?

A

> 6.5%

142
Q

Random plasma glucose dx?

A

> 200 in a pt w/ classic diabetic symptoms

143
Q

Gold standard dx of DM?

A

fasting plasma glucose x2

144
Q

Gold standard dx of DM in pregnancy?

A

3h glucose tolerance test

145
Q

Initial management of DM?

A

diet, exercise and lifestyle changes

146
Q

Benefits of metformin?

A

weight loss, decreased triglycerides, decreased cardio risk

147
Q

Adv rxn of metformin?

A

GI upset, VB12 deficiency, lactic acidosis

148
Q

Sulfonylurea associated with disulfiram reaction?

A

Chlorpropamide

149
Q

What is the Dawn phenomenon?

A

rise in serum glucose levels between 2am-8am

150
Q

What is the Somogyi phenomenon?

A

nocturnal hypoglycemia followed by rebound hyperglycemia

Internal Med PAEA (9 decks)

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