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Internal Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

[diagnosis]

50/F overweight, polyuria, nocturia, weakness, acanthosis nigricans

FBS 140 HBA1C 6

A

Dx: TDM
Next step: repeat FBS
Initial tx: MNT
Initial medical tx: metformin

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2
Q

recommended age to start screening for DM

A

Age 45 years old
every 3 years

screen earlier if patient BMI >25 + one additional risk factors for DM

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3
Q

What is the most common pattern of dyslipidemia in DM

A

Hypertriglyceridemia

Reduced HDL

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4
Q

[Diagnosis of DM]

HbA1c

A

> = 6.5%

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5
Q

[Diagnosis of DM]

FBS

A

> =126

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6
Q

[Diagnosis of DM]

2hour plasma 75g OGTT

A

> = 200

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7
Q

[Diagnosis of DM]

RBS

A

> = 200 with 3 Ps

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8
Q

What are the contraindications of metformin monotherapy?

A
  1. Renal insufficiency
  2. Any form of acidosis
  3. Unstable CHF
  4. Liver disease
  5. Severe hypoxemia
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9
Q

[DM Treatment]

First line monotherapy drug

A

Metformin

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10
Q

[DM Treatment]

When will you start dual combination therapy in DM?

A

A1C >= 9%

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11
Q

[DM Treatment]

When will you start combination injectable therapy in DM?

A

A1C >= 10%

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12
Q

Metformin is considered for the prevention of T2DM in ____

A

Prediabetics

  1. BMI >35
  2. Age <60
  3. Prior GDM
  4. Rising HbA1c
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13
Q

Promotes weight gain

A

Sulfonylureas
TZD
Insulin

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14
Q

Promotes weight loss

A

Metformin
SGLT2 inhibitor
GLP1 receptor agonist

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15
Q

Weight neutral

A

DPP4 inhibitor

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16
Q

What are the effects of incretins affect __ insulin and ___ glucagon

A

Increase insulin

Decrease glucagon

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17
Q

What are the effects of GLP affect __ glucose, ___ FFA, glucagon

A

GLP increases glucose
GLP increases FFA
GLP decreases glucagon

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18
Q

What are examples of sulfonylureas?

A

Gliclazide
Glibenclamide
Glimepiride
Glipizide

Secretagogues

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19
Q

What are examples of non-sulfonylureas?

A

Repaglinide
Nateglinide

Secretagogues

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20
Q

What are examples of biguanides?

A

Metformin

insulin sensitizers

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21
Q

What are examples of TZD?

A

Pioglitazone

insulin sensitizers

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22
Q

What are examples of alpha-glucosidse inhibitors?

A

Acarbose
Miglitol

inhibit intestinal absorption of sugar

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23
Q

What are examples of DPP-IV inhibitors?

A

Sitagliptin
Saxagliptin
Linagliptin
Vildagliptin

Incretin-related drugs; prolongs endogenous action of GLP-1

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24
Q

What are examples of GLP-1 agonist?

A

Exenatide
Liraglutide

Incretin-related drugs; prolongs endogenous action of GLP-1

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25
Q

What are examples of SGLT2 inhibitors?

A

Dapagliflzin
Canagliflozin
Empagliflozin

increase urinary glucose excretion

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26
Q

What are examples of rapid acting insulin?

A

Lispro
Aspart
Glulisine

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27
Q

What are examples of short acting insulin?

A

Human regular

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28
Q

What are examples of intermediate-acting insulin?

A

isophane/Human NPH

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29
Q

What are examples of basal insulin analogs?

A

Glargine
Detemir
Degludec

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30
Q

What is the first defense of the body against hypoglycemia?

A

decrease insulin secretion

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31
Q

What is the second defense of the body against hypoglycemia?

A

glucagon

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32
Q

What is the third defense of the body against hypoglycemia?

A

epinephrine

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33
Q

[Goals for treatment]

HbA1c

A

<7

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34
Q

[Goals for treatment]

preprandial capillary plasma glucose

A

80-130

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35
Q

[Goals for treatment]

postprandial capillary plasma glucose

A

<180

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36
Q

[Goals for treatment]

BP goal in patients with DM

A

<140/90

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37
Q

[Goals for treatment]

frequency of eye exam

A

annual

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38
Q

[Goals for treatment]

frequency of foot exam

A

every visit

which is 2-3 months

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39
Q

[Goals for treatment]

frequency of follow-up

A

every 2-3 months

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40
Q

Whipple Triad of hypoglycemia

A
  1. Symptoms of hypoglycemoa
  2. Low plasma glucose
  3. relief of symptoms after plasma glucose is raised
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41
Q

What is the action of ACEi in the efferent arteriole?

A

dilate the efferent arteriole

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42
Q

What is the most common form of diabetic neuropathy is

A

distal symmetric polyneuropathy

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43
Q

One of the earliest sign of diabetic neuropathy

A
  1. erectile dysfunction

2. retrograde ejaculation

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44
Q

what is the most common skin manifestation of DM

A
  1. Xerosis

2. Pruritus

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45
Q

[diagnosis]

22/M T1Dm, poorly compliant with insulin.

Nausea, vomiting, abdominal pain. PE: pale, diaphoretic, fruity breath

100/70 110bpm

Glucose 450 HAGMA, postivie ketones

A

Dx: DKA

Next step: IV hydration, insulin administration

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46
Q

[Management of DKA]

How will you hydrate the patient

A
  1. 2-3L of 0.9% pNSS over the first 3 hours (10-20 mL/kg/hour)
  2. Add D5 containing once the blood glucose reaches 250mg/dL
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47
Q

[Management of DKA]

How will you give the insulin?

A

Regular insulin IV (0.1 units/kg) bolus then continous infusion

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48
Q

[DKA vs HHNS]

Nausea/vomiting, abdominal pain
Glucose >450
pH < 7.3
fruity breath, dehydration

A

DKA

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49
Q

[DKA vs HHNS]

Glucose >900
Hyperosmolarity >320
pH >7.3

A

HHNS

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50
Q

What are the components of metabolic syndrome?

A
  1. Waist M >=40; F >= 35 inches
  2. Glucose 100mg/dL
  3. Hypertriglyceridemia >=150
  4. Hypertension >= 130/85
  5. HDL <40 or <50

3H WG

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51
Q

Recite the Hypothalamic-Pituitary-Thyroid Axis

A

TRH&raquo_space;> TSH&raquo_space;> Thyroid gland&raquo_space;> T4 and T3

Peripherally, T4&raquo_space;> T3

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52
Q

T4 an T3 has negative feedback to the ___

A

pituitary gland and the hypothalamus

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53
Q

T4 an T3 has negative feedback to the ___

A

pituitary gland and the hypothalamus

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54
Q

Hyperthyroidism due to excessive intake of exogenous iodine

A

Jod-Basedow phenomenon

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55
Q

What are the different grading for the ophthalmologic findings in Graaves?

A 
1=No signs 
2=Only signs (lid lag)
3= Soft tissue involvement (periorbital)
4 = EOM (diplopia)
5 = corneal involvement
6 = sight
56
Q

Iodine-deprived thyroid is exposed suddenly to an iodine-rich diet

A

Jod-Basedow phenomenon

57
Q

T4 an T3 has negative feedback to the ___

A

pituitary gland and the hypothalamus

58
Q

Iodine-deprived thyroid is exposed suddenly to an iodine-rich diet

A

Jod-Basedow phenomenon

59
Q

what is the most common cardiovascular manifestation of graves disease?

A

sinus tachycardia

60
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound, high

A

Primary thyrotoxicosis

61
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound normal
T3 high

A

T3 toxicosis

62
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound normal
T3 normal

A

subclinical hyperthyroidism

63
Q

[Diagnose: thyrotoxicosis]

TSH normal
T4 unbound high

A
  1. TSH-secreting primary adenoma

2. Thyroid hormone resistance syndrome

64
Q

What is the most serious manifestation of Grave’s ophthalmopathy?

A

optic nerve compression

65
Q

Damage to parathyroid glands can lead to what electrolyte imbalances?

A
  1. HypoCa

2. HyperPhos

66
Q

What is the drug of choice for thyroid storm?

A

PTU

67
Q

What is the DOC to reduce adrenergic manifestation of graves and decrease peripheral conversion of T4 to T3?

A

Propranolol

68
Q

What treatment blocks thyroid hormone synthesis via Wolff-Chaikoff effect?

A

Stable iodide

69
Q

Cite the Burch-Wartofsky score

A 
10 Temp: 37.8 to 38.2
10 Mild Agitatation
10 Diarrhea
10 tachycardia 110-119
10 moderate CHF
10 present AFib
10 with precipitant history
70
Q

what is the most common cardiovascular manifestation of graves disease?

A

sinus tachycardia

71
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound, high

A

Primary thyrotoxicosis

72
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound normal
T3 high

A

T3 toxicosis

73
Q

[Diagnose: thyrotoxicosis]

TSH low
T4 unbound normal
T3 normal

A

subclinical hyperthyroidism

74
Q

[Diagnose: thyrotoxicosis]

TSH normal
T4 unbound high

A
  1. TSH-secreting primary adenoma

2. Thyroid hormone resistance syndrome

75
Q

What is the most serious manifestation of Grave’s ophthalmopathy?

A

optic nerve compression

76
Q

Damage to parathyroid glands can lead to what electrolyte imbalances?

A
  1. HypoCa

2. HyperPhos

77
Q

What is the drug of choice for thyroid storm?

A

PTU

78
Q

What is the DOC to reduce adrenergic manifestation of graves and decrease peripheral conversion of T4 to T3?

A

Propranolol

79
Q

most common early consequence of estrogen deficiency

A

vertebral fractures

80
Q

Cite the Burch-Wartofsky score

A 
10 Temp: 37.8 to 38.2
10 Mild Agitatation
10 Diarrhea
10 tachycardia 110-119
10 moderate CHF
10 present AFib
10 with precipitant history
81
Q

To inhibit hormone release, KISS is initiated how many hours after PTU administration?

A

1 hour

82
Q

Antithyroid drug class that inhibits organification

A
  1. Iodide

2. Thioamides

83
Q

What is the treatment for subacute thyroiditis?

A
  1. Aspirin

2. Glucocorticoid

84
Q

[diagnosis]

32F fatigue, weakness, weight gain, menstrual abnormality for the past 3 months.

PE: puffy eye lids, dry skin, enlarged thyroid, bradycardia, delayed DTRs

A

Dx: hypothyroidism
best screening test: TSH
Tx: Levothyroxine

85
Q

What is the size of the nodule to be detectable on palpation?

A

> 1cm in diameter

86
Q

After obtaining low TSH, what is the next step in the evaluation of a thyroid nodule

A

Thyroid scan

87
Q

If a thyroid scan was done and the TSH is high, what is the next step?

A

ultrasound-guided FNAB

88
Q

What is the operational definition of osteoporosis?

A

BMD <2.5 SD from normal peak bone mass

T-score less than -2.5

89
Q

What are the target sites of PTH in the body

A
  1. Proximal tubules of kidney
  2. Osteoclasts
  3. Intestine
90
Q

What is the net effect of PTH?

A

To increase Calcium by

  1. Reabsorption in kidneys
  2. Bone resorption
  3. Dietary absorption
91
Q

What are the target sites of calcitonin?

A
  1. Distal convoluted tubules

2. Osteoblast

92
Q

What is the net effect of calcitonin?

A

To decrease serum calcium

  1. Secretion in urine
  2. Bone formation
93
Q

most common early consequence of estrogen deficiency

A

vertebral fractures

94
Q

[Diagnose]

High calcium
low phosphate
high alkaline phosphatase

A

Hyperparathyroidism

95
Q

[diagnose]

normal to low calcium, high alkaline phosphatase

A

osteomalacia

96
Q

[diagnose]

very high alkaline phosphatase

A

paget disease

97
Q

Drug that is a selective-estrogen modulator used in the prevention of osteoporosis and reduction of invasive breast CA

A

Raloxifene

98
Q

[diagnose]

cortisol: HIGH
ACTH: High
High dose DST: No effect
CRH: No response

A

Ectopic Cushing Syndrome

99
Q

What is the best initial diagnostic test if cushing’s syndrome is considered?

A
  1. 1mg overnight Dexamethasone suppresion test

2. 24 hours urine cortisol

100
Q

What is the next best step if the patient has hypercortisolism?

A

Plasma ACTH measurement

101
Q

What is the sequence of trophic hormone failure associated with pituitary compression?

A

GH&raquo_space;> FSH/LH&raquo_space;> TSH&raquo_space;> ACTH

102
Q

in adults, what is the earliest symptom of cushing’s syndrome?

A

hypogonadism

103
Q

[Trace the hormone release]

To produce T3 and T4

A
  1. TRH
  2. TSH
  3. T4 T3
104
Q

[Trace the hormone release]

to produce milk

A
  1. Prolactin-releasing factor
  2. PRL
  3. Mammary gland
105
Q

[Trace the hormone release]

to produce cortisol

A
  1. CRH
  2. ACTH
  3. Adrenals (fasciculata)
106
Q

[Trace the hormone release]

to stimulate the ovary

A
  1. GNRH
  2. LH/FSH
  3. Ovaries
107
Q

What is the drug of choice for pregnant women with cushing syndrome?

A

metyrapone

108
Q

What inhibits GH release?

A

somatostatin

109
Q

An excess cortisol release from ACTH-producing pituitary adenoma is called

A

Cushing’s disease

110
Q

[diagnose]

cortisol: HIGH
ACTH: decreased
High dose DST: no effect
CRH: no response

A

Adrenal cushing syndrome

111
Q

[diagnose]

cortisol: HIGH
ACTH: High
High dose DST: suppressed
CRH: response

A

Pituitary Cushing Syndrome

112
Q

[diagnose]

cortisol: HIGH
ACTH: High
High dose DST: No effect
CRH: No response

A

Ectopic Cushing Syndrome

113
Q

how will you conduct the Dexamethasone suppression test?

A
  1. Give 1mg dexamethasone PO at 11pm

2. Take serum cortisol at 8am

114
Q

Why will you still do a 24-hour urine cortisol test despite the Dexa suppression test?

A

To confirm that an overnight dexamethasone suppression test is not falsely abnormal

115
Q

What are the components of MEN 2B?

A
  1. Marfanoid
  2. Multiple mucosal neuromas
  3. Medullary thyroid CA
  4. Pheochromocytoma
116
Q

what is the treatment of choice for cushing disease?

A

selective removal of the pituitary corticotrope via trans-sphenoidal approach

117
Q

What is the treatment of choice in ACTH-independent disease

A

surgical removal of the adrenal tumor

118
Q

[diagnose]

Aldosterone: increased
Renin: increased
Edema: present
Na excretion: present

A
  1. Renal artery stenosis

2. Renin-secreting tumor

119
Q

What drug is a good adrenolytic agent which is also good for reducing cortisol (a derivative of DDT)

A

Mitotane

120
Q

What is the drug of choice for adrenocortical carcinoma

A

mitotane

121
Q

What is the drug of choice for pregnant women with cushing syndrome?

A

metyrapone

122
Q

What hormone is involved in defense against prolonged hypoglycemia?

A

cortisol

123
Q

What is the first diagnostic step in pheochromocytoma (traditionally)?

A

measure catecholamines

124
Q

In pheochromocytoma, what is the most sensitive and less susceptible to false-positive elevations from stress?

A

measurements of plasma metanephrine

125
Q

[Treatment of pheochromicytoma]

alpha adrenergic blocker

A

Phenoxybenzamine

126
Q

[Treatment of pheochromicytoma]

while waiting for phenoxybenzamine to take effect, what will you give?

A

Prazosin/Phentolamine

127
Q

[Treatment of pheochromicytoma]

what is the method of choice in the surgical management

A

Atraumatic Endoscopic Surgery

128
Q

What are the components of MEN 2A?

A
  1. Hyperparathyroidism
  2. Pheochromocytoma
  3. Medullary Thyroid CA
129
Q

What are the components of MEN 2B?

A
  1. Marfanoid
  2. Multiple mucosal neuromas
  3. Medullary thyroid CA
  4. Pheochromocytoma
130
Q

[diagnose]

32M LE weakness. BP 180/90 on all extremities. Serum K 2.1

A

Dx: Hyperaldosteronism
Most common cause: primary hyperaldosteronism
Hallmark: Hypokalemic hypertension
Treatment: Spironolactone

131
Q

[diagnose]

Aldosterone: increased
Renin: decreased
Edema: absent
Na excretion: no change

A

Primary hyperaldosteronism, Conn syndrome

132
Q

[diagnose]

Aldosterone: increased
Renin: increased
Edema: present
Na excretion: present

A
  1. Renal artery stenosis

2. Renin-secreting tumor

133
Q

[diagnose]

CRH: increased
ACTH: increased
Aldosterone: decreased
Cortisol: decreased
Androgens: decreased

Hypotension present
dark skin discoloration

A

Primary adrenal insufficiency, Addision

134
Q

[diagnose]

CRH: increased
ACTH: decreased
Aldosterone: normal
Cortisol: decreased
Androgens: decreased

Hypotension absent
pale skin

A

Secondary adrenal insufficiency

135
Q

[diagnose]

CRH: decreased
ACTH: decreased
Aldosterone: normal
Cortisol: decreased
Androgens: decreased

Hypotension absent
pale skin

A

Tertiary Adrenal insufficiency

136
Q

What hormone is involved in defense against prolonged hypoglycemia?

A

cortisol

137
Q

Cite causes of thyrotoxicosis without hyperthyroidism

A
  1. Subacute thyroiditis
  2. Silent thyroiditis
  3. Amiodarone
  4. radiation
  5. infarction adenoma
  6. ingestion of excess hormone or tissue

Internal Medicine (10 decks)

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