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
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
3
Q
What is the most common pattern of dyslipidemia in DM
A
Hypertriglyceridemia
Reduced HDL
4
Q
[Diagnosis of DM]
HbA1c
A
> = 6.5%
5
Q
[Diagnosis of DM]
FBS
A
> =126
6
Q
[Diagnosis of DM]
2hour plasma 75g OGTT
A
> = 200
7
Q
[Diagnosis of DM]
RBS
A
> = 200 with 3 Ps
8
Q
What are the contraindications of metformin monotherapy?
A
- Renal insufficiency
- Any form of acidosis
- Unstable CHF
- Liver disease
- Severe hypoxemia
9
Q
[DM Treatment]
First line monotherapy drug
A
Metformin
10
Q
[DM Treatment]
When will you start dual combination therapy in DM?
A
A1C >= 9%
11
Q
[DM Treatment]
When will you start combination injectable therapy in DM?
A
A1C >= 10%
12
Q
Metformin is considered for the prevention of T2DM in ____
A
Prediabetics
- BMI >35
- Age <60
- Prior GDM
- Rising HbA1c
13
Q
Promotes weight gain
A
Sulfonylureas
TZD
Insulin
14
Q
Promotes weight loss
A
Metformin
SGLT2 inhibitor
GLP1 receptor agonist
15
Q
Weight neutral
A
DPP4 inhibitor
16
Q
What are the effects of incretins affect __ insulin and ___ glucagon
A
Increase insulin
Decrease glucagon
17
Q
What are the effects of GLP affect __ glucose, ___ FFA, glucagon
A
GLP increases glucose
GLP increases FFA
GLP decreases glucagon
18
Q
What are examples of sulfonylureas?
A
Gliclazide
Glibenclamide
Glimepiride
Glipizide
Secretagogues
19
Q
What are examples of non-sulfonylureas?
A
Repaglinide
Nateglinide
Secretagogues
20
Q
What are examples of biguanides?
A
Metformin
insulin sensitizers
21
Q
What are examples of TZD?
A
Pioglitazone
insulin sensitizers
22
Q
What are examples of alpha-glucosidse inhibitors?
A
Acarbose
Miglitol
inhibit intestinal absorption of sugar
23
Q
What are examples of DPP-IV inhibitors?
A
Sitagliptin
Saxagliptin
Linagliptin
Vildagliptin
Incretin-related drugs; prolongs endogenous action of GLP-1
24
Q
What are examples of GLP-1 agonist?
A
Exenatide
Liraglutide
Incretin-related drugs; prolongs endogenous action of GLP-1
25
What are examples of SGLT2 inhibitors?
Dapagliflzin
Canagliflozin
Empagliflozin
increase urinary glucose excretion
26
What are examples of rapid acting insulin?
Lispro
Aspart
Glulisine
27
What are examples of short acting insulin?
Human regular
28
What are examples of intermediate-acting insulin?
isophane/Human NPH
29
What are examples of basal insulin analogs?
Glargine
Detemir
Degludec
30
What is the first defense of the body against hypoglycemia?
decrease insulin secretion
31
What is the second defense of the body against hypoglycemia?
glucagon
32
What is the third defense of the body against hypoglycemia?
epinephrine
33
[Goals for treatment]
HbA1c
<7
34
[Goals for treatment]
preprandial capillary plasma glucose
80-130
35
[Goals for treatment]
postprandial capillary plasma glucose
<180
36
[Goals for treatment]
BP goal in patients with DM
<140/90
37
[Goals for treatment]
frequency of eye exam
annual
38
[Goals for treatment]
frequency of foot exam
every visit
| which is 2-3 months
39
[Goals for treatment]
frequency of follow-up
every 2-3 months
40
Whipple Triad of hypoglycemia
1. Symptoms of hypoglycemoa
2. Low plasma glucose
3. relief of symptoms after plasma glucose is raised
41
What is the action of ACEi in the efferent arteriole?
dilate the efferent arteriole
42
What is the most common form of diabetic neuropathy is
distal symmetric polyneuropathy
43
One of the earliest sign of diabetic neuropathy
1. erectile dysfunction
| 2. retrograde ejaculation
44
what is the most common skin manifestation of DM
1. Xerosis
| 2. Pruritus
45
[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
Dx: DKA
| Next step: IV hydration, insulin administration
46
[Management of DKA]
How will you hydrate the patient
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
47
[Management of DKA]
How will you give the insulin?
Regular insulin IV (0.1 units/kg) bolus then continous infusion
48
[DKA vs HHNS]
Nausea/vomiting, abdominal pain
Glucose >450
pH < 7.3
fruity breath, dehydration
DKA
49
[DKA vs HHNS]
Glucose >900
Hyperosmolarity >320
pH >7.3
HHNS
50
What are the components of metabolic syndrome?
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
51
Recite the Hypothalamic-Pituitary-Thyroid Axis
TRH >>> TSH >>> Thyroid gland >>> T4 and T3
Peripherally, T4 >>> T3
52
T4 an T3 has negative feedback to the ___
pituitary gland and the hypothalamus
53
T4 an T3 has negative feedback to the ___
pituitary gland and the hypothalamus
54
Hyperthyroidism due to excessive intake of exogenous iodine
Jod-Basedow phenomenon
55
What are the different grading for the ophthalmologic findings in Graaves?
```
1=No signs
2=Only signs (lid lag)
3= Soft tissue involvement (periorbital)
4 = EOM (diplopia)
5 = corneal involvement
6 = sight
```
56
Iodine-deprived thyroid is exposed suddenly to an iodine-rich diet
Jod-Basedow phenomenon
57
T4 an T3 has negative feedback to the ___
pituitary gland and the hypothalamus
58
Iodine-deprived thyroid is exposed suddenly to an iodine-rich diet
Jod-Basedow phenomenon
59
what is the most common cardiovascular manifestation of graves disease?
sinus tachycardia
60
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound, high
Primary thyrotoxicosis
61
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound normal
T3 high
T3 toxicosis
62
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound normal
T3 normal
subclinical hyperthyroidism
63
[Diagnose: thyrotoxicosis]
TSH normal
T4 unbound high
1. TSH-secreting primary adenoma
| 2. Thyroid hormone resistance syndrome
64
What is the most serious manifestation of Grave's ophthalmopathy?
optic nerve compression
65
Damage to parathyroid glands can lead to what electrolyte imbalances?
1. HypoCa
| 2. HyperPhos
66
What is the drug of choice for thyroid storm?
PTU
67
What is the DOC to reduce adrenergic manifestation of graves and decrease peripheral conversion of T4 to T3?
Propranolol
68
What treatment blocks thyroid hormone synthesis via Wolff-Chaikoff effect?
Stable iodide
69
Cite the Burch-Wartofsky score
```
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
what is the most common cardiovascular manifestation of graves disease?
sinus tachycardia
71
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound, high
Primary thyrotoxicosis
72
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound normal
T3 high
T3 toxicosis
73
[Diagnose: thyrotoxicosis]
TSH low
T4 unbound normal
T3 normal
subclinical hyperthyroidism
74
[Diagnose: thyrotoxicosis]
TSH normal
T4 unbound high
1. TSH-secreting primary adenoma
| 2. Thyroid hormone resistance syndrome
75
What is the most serious manifestation of Grave's ophthalmopathy?
optic nerve compression
76
Damage to parathyroid glands can lead to what electrolyte imbalances?
1. HypoCa
| 2. HyperPhos
77
What is the drug of choice for thyroid storm?
PTU
78
What is the DOC to reduce adrenergic manifestation of graves and decrease peripheral conversion of T4 to T3?
Propranolol
79
most common early consequence of estrogen deficiency
vertebral fractures
80
Cite the Burch-Wartofsky score
```
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
To inhibit hormone release, KISS is initiated how many hours after PTU administration?
1 hour
82
Antithyroid drug class that inhibits organification
1. Iodide
| 2. Thioamides
83
What is the treatment for subacute thyroiditis?
1. Aspirin
| 2. Glucocorticoid
84
[diagnosis]
32F fatigue, weakness, weight gain, menstrual abnormality for the past 3 months.
PE: puffy eye lids, dry skin, enlarged thyroid, bradycardia, delayed DTRs
Dx: hypothyroidism
best screening test: TSH
Tx: Levothyroxine
85
What is the size of the nodule to be detectable on palpation?
>1cm in diameter
86
After obtaining low TSH, what is the next step in the evaluation of a thyroid nodule
Thyroid scan
87
If a thyroid scan was done and the TSH is high, what is the next step?
ultrasound-guided FNAB
88
What is the operational definition of osteoporosis?
BMD <2.5 SD from normal peak bone mass
T-score less than -2.5
89
What are the target sites of PTH in the body
1. Proximal tubules of kidney
2. Osteoclasts
3. Intestine
90
What is the net effect of PTH?
To increase Calcium by
1. Reabsorption in kidneys
2. Bone resorption
3. Dietary absorption
91
What are the target sites of calcitonin?
1. Distal convoluted tubules
| 2. Osteoblast
92
What is the net effect of calcitonin?
To decrease serum calcium
1. Secretion in urine
2. Bone formation
93
most common early consequence of estrogen deficiency
vertebral fractures
94
[Diagnose]
High calcium
low phosphate
high alkaline phosphatase
Hyperparathyroidism
95
[diagnose]
normal to low calcium, high alkaline phosphatase
osteomalacia
96
[diagnose]
very high alkaline phosphatase
paget disease
97
Drug that is a selective-estrogen modulator used in the prevention of osteoporosis and reduction of invasive breast CA
Raloxifene
98
[diagnose]
cortisol: HIGH
ACTH: High
High dose DST: No effect
CRH: No response
Ectopic Cushing Syndrome
99
What is the best initial diagnostic test if cushing's syndrome is considered?
1. 1mg overnight Dexamethasone suppresion test
| 2. 24 hours urine cortisol
100
What is the next best step if the patient has hypercortisolism?
Plasma ACTH measurement
101
What is the sequence of trophic hormone failure associated with pituitary compression?
GH >>> FSH/LH >>> TSH >>> ACTH
102
in adults, what is the earliest symptom of cushing's syndrome?
hypogonadism
103
[Trace the hormone release]
To produce T3 and T4
1. TRH
2. TSH
3. T4 T3
104
[Trace the hormone release]
to produce milk
1. Prolactin-releasing factor
2. PRL
3. Mammary gland
105
[Trace the hormone release]
to produce cortisol
1. CRH
2. ACTH
3. Adrenals (fasciculata)
106
[Trace the hormone release]
to stimulate the ovary
1. GNRH
2. LH/FSH
3. Ovaries
107
What is the drug of choice for pregnant women with cushing syndrome?
metyrapone
108
What inhibits GH release?
somatostatin
109
An excess cortisol release from ACTH-producing pituitary adenoma is called
Cushing's disease
110
[diagnose]
cortisol: HIGH
ACTH: decreased
High dose DST: no effect
CRH: no response
Adrenal cushing syndrome
111
[diagnose]
cortisol: HIGH
ACTH: High
High dose DST: suppressed
CRH: response
Pituitary Cushing Syndrome
112
[diagnose]
cortisol: HIGH
ACTH: High
High dose DST: No effect
CRH: No response
Ectopic Cushing Syndrome
113
how will you conduct the Dexamethasone suppression test?
1. Give 1mg dexamethasone PO at 11pm
| 2. Take serum cortisol at 8am
114
Why will you still do a 24-hour urine cortisol test despite the Dexa suppression test?
To confirm that an overnight dexamethasone suppression test is not falsely abnormal
115
What are the components of MEN 2B?
1. Marfanoid
2. Multiple mucosal neuromas
3. Medullary thyroid CA
4. Pheochromocytoma
116
what is the treatment of choice for cushing disease?
selective removal of the pituitary corticotrope via trans-sphenoidal approach
117
What is the treatment of choice in ACTH-independent disease
surgical removal of the adrenal tumor
118
[diagnose]
Aldosterone: increased
Renin: increased
Edema: present
Na excretion: present
1. Renal artery stenosis
| 2. Renin-secreting tumor
119
What drug is a good adrenolytic agent which is also good for reducing cortisol (a derivative of DDT)
Mitotane
120
What is the drug of choice for adrenocortical carcinoma
mitotane
121
What is the drug of choice for pregnant women with cushing syndrome?
metyrapone
122
What hormone is involved in defense against prolonged hypoglycemia?
cortisol
123
What is the first diagnostic step in pheochromocytoma (traditionally)?
measure catecholamines
124
In pheochromocytoma, what is the most sensitive and less susceptible to false-positive elevations from stress?
measurements of plasma metanephrine
125
[Treatment of pheochromicytoma]
alpha adrenergic blocker
Phenoxybenzamine
126
[Treatment of pheochromicytoma]
while waiting for phenoxybenzamine to take effect, what will you give?
Prazosin/Phentolamine
127
[Treatment of pheochromicytoma]
what is the method of choice in the surgical management
Atraumatic Endoscopic Surgery
128
What are the components of MEN 2A?
1. Hyperparathyroidism
2. Pheochromocytoma
3. Medullary Thyroid CA
129
What are the components of MEN 2B?
1. Marfanoid
2. Multiple mucosal neuromas
3. Medullary thyroid CA
4. Pheochromocytoma
130
[diagnose]
32M LE weakness. BP 180/90 on all extremities. Serum K 2.1
Dx: Hyperaldosteronism
Most common cause: primary hyperaldosteronism
Hallmark: Hypokalemic hypertension
Treatment: Spironolactone
131
[diagnose]
Aldosterone: increased
Renin: decreased
Edema: absent
Na excretion: no change
Primary hyperaldosteronism, Conn syndrome
132
[diagnose]
Aldosterone: increased
Renin: increased
Edema: present
Na excretion: present
1. Renal artery stenosis
| 2. Renin-secreting tumor
133
[diagnose]
```
CRH: increased
ACTH: increased
Aldosterone: decreased
Cortisol: decreased
Androgens: decreased
```
Hypotension present
dark skin discoloration
Primary adrenal insufficiency, Addision
134
[diagnose]
```
CRH: increased
ACTH: decreased
Aldosterone: normal
Cortisol: decreased
Androgens: decreased
```
Hypotension absent
pale skin
Secondary adrenal insufficiency
135
[diagnose]
```
CRH: decreased
ACTH: decreased
Aldosterone: normal
Cortisol: decreased
Androgens: decreased
```
Hypotension absent
pale skin
Tertiary Adrenal insufficiency
136
What hormone is involved in defense against prolonged hypoglycemia?
cortisol
137
Cite causes of thyrotoxicosis without hyperthyroidism
1. Subacute thyroiditis
2. Silent thyroiditis
3. Amiodarone
4. radiation
5. infarction adenoma
6. ingestion of excess hormone or tissue
