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#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 > ENDOCRINOLOGY > Flashcards

ENDOCRINOLOGY Flashcards

1
Q

ADA recommendation for diabetes screening

A

>45 years every 3 years

* Screening should be earlier if overweight (BMI>25) + one additional risk factors for DM

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2
Q

Most common pattern of dyslipidemia in DM

A

hypertriglyceridemia and reduced high-density lipoprotein (HDL)

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3
Q

best initial therapy for type 2 diabetes.

A

Diet, exercise, and weight loss

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4
Q

preferred initial pharmacologic agent for T2DM

A

Metformin

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5
Q

DM drugs that promotes weight gain

A

o Sulfonylureas

o TZD

o Insulin

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6
Q

Promotes weight loss

A

o Metformin

o SGLT2 inhibitor

o GLP1 receptor agonist

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7
Q

Weight neutral drug

A

DPP-4 inhibitor

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8
Q
  • Insulin secretagogues: increases insulin secretion
  • can cause Hypoglycemia, Weight gain
A

Sulfonylureas (SU)

  • Gliclazide
  • Glibenclamide
  • Glimepiride
  • Glipizide

Non-Sulfonylureas

  • Repaglinide
  • Nateglinide
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9
Q

Insulin sensitizers

A

Biguanides - metformin

Thiazolidinediones - Pioglitazone

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10
Q

Inhibits intestinal absorption of sugars

A

Alpha-glucosidase inhibitors

  • Acarbose
  • Voglibose
  • Miglitol
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11
Q

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

A

DPP-IV Inhibitors

  • Sitagliptin Saxagliptin Linagliptin Vildagliptin

GLP-1 agonists

  • Exenatide SC Liraglutide SC
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12
Q

Treatment goals for DM

A
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13
Q

Increases urinary glucose excretion

A

Na-Glucose Transporter-2inhibitors (SGLT2i)

  • Dapagliglozin, Canagliflozin, Empagliflozin
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14
Q

first defense against hypoglycemia.

A

Decrease in insulin secretion

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15
Q

second defense against hypoglycemia; Epinephrine is third.

A

Glucagon

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16
Q

play no role in defense against acute hypoglycemia.

A

Cortisol and growth hormones

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17
Q
A
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18
Q

The most serious complication of therapy for DM

A

hypoglycemia

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19
Q

Drugs proven to decrease rate of progression of nephropathy

A

ACE inhibitors dilate the efferent arteriole and ↓ intraglomerular hypertension (ACE and ARB)

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20
Q

The most effective therapy for diabetic retinopathy

A

prevention

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21
Q

The most common form of diabetic neuropathy

A

distal symmetric polyneuropathy

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22
Q

one of the earliest signs of diabetic neuropathy

A

Erectile dysfunction and retrograde ejaculation

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23
Q

The most common skin manifestations of DM

A

xerosis and pruritus.

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24
Q

pathophysiology of DKA

A

Relative or absolute insulin deficiency combined with counterregulatory hormone excess (glucagon, catecholamines, cortisol, and growth hormone)

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25
Q

Triad of DKA

A

o Hyperglycemia

o Metabolic acidosis (high anion gap)

o Ketosis

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26
Q

predominant ketone in ketosis.

A

3-hydroxybutyrate

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27
Q

in DKA, once the blood glucose reaches 250 mg/dl, what fluid should be added?

A

D5 containing fluid

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28
Q

5 I’s for precipitating factors of DKA:

A

o Infection

o Ischemia

o Infarction

o Ignorance (poor control)

o Intoxication

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29
Q

The major nonmetabolic complication of DKA therapy

A

cerebral edema

* Sudden reduction in hyperglycemia can lead to vascular collapse with shift of water intracellularly

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30
Q

What symptoms are Notably absent in HHS compared to DKA?

A

nausea, vomiting, and abdominal pain and the Kussmaul respirations characteristics of DKA

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31
Q

Management of DKA/ HHS

A
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32
Q

Metabolic Syndrome definition

A
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33
Q

method of choice when it is important to determine thyroid size accurately

A

UTZ

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34
Q

What is the initial test of choice for hyperthyroidism?

A

TSH

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35
Q

When do you repeat thyroid function test after staring treatment?

A

4-6 weeks

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36
Q

What is the most common sign of thyrotoxicosis?

A

Tachycardia

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37
Q

ovarian tissues houses active thyroid tissues secreting FT4 and FT3. The ectopic thyroid tissue acts like a target organ hence classified as primary hyperthyroidism

A

Struma ovarii

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38
Q

happens when an iodine-deprived thyroid is exposed suddenly to an iodine-rich diet. The thyroid avidly takes up more iodine and the thyroid machinery produces more FT4 and FT3.

A

Jod Basedow phenomenon

39
Q

thyrotoxic hypokalemic periodic paralysis (THPP) is associated with

A

Graves disease

40
Q

Most common cardiovascular manifestation of graves disease

A

sinus tachycardia

41
Q

EXCLUDES Graves’ disease as a cause of diffuse goiter

A

normal TSH

42
Q

Evaluation of thyrotoxicosis

A
43
Q

definitive treatment for graves

A

Radioiodine (RAI)

  • To reduce amount of thyroid tissue
  • Avoid in patients with moderate to severe ophthalmopathy
  • Contraindicated: Pregnancy and breast feeding
44
Q

What treatment will reduce adrenergic manifestation and peripheral conversion of T4 to T3?

A

Propranolol

45
Q

most serious manifestation of Grave’s ophthalmopathy and may lead to permanent loss of vision if left untreated

A

Optic nerve compression

46
Q

aplasia cutis congenita is a side effect of what drug?

A

methimazole

47
Q
  • Fever; Painful, enlarged thyroid
  • Associated with URTI
A

SUBACUTE THYROIDITIS (de Quervain thyroiditis, viral thyroiditis)

Treatment:Aspirin, Glucocorticoid

48
Q

What treatment blocks thyroid hormone synthesis via WolffChaikoff effect?

A

Stable Iodide

49
Q

Burch-Wartofsky score parameters

A

o < 25 storm unlikely

o 25-44 impending storm

o >45 high likelihood of storm

50
Q

Tx for thyroid storm that stops the production of thyroid hormone:

A

o Propylthiouracil (PTU) PO/ per rectum

o Methimazole

o Hydrocortisone

51
Q

tx for thyroid storm that Inhibits hormone release

A

o Saturated solution of potassium iodide (SSKI), one hour after first dose of PTU.

o Sodium iodide

52
Q
  • Fever; Painful, enlarged thyroid
  • Associated with URTI
A

SUBACUTE THYROIDITIS (de Quervain thyroiditis, viral thyroiditis)

  • Treatment: Aspirin, Glucocorticoid
  • inflammatory probably by virus. Initial hyperthyroidism, then transient hypothyroidism.
53
Q
  • Non-tender thyroid gland
  • Seen 3-6 months postpartum
A

SILENT THYROIDITIS (painless thyroiditis)

54
Q

Signs and symptoms of hypothyroidism

A
55
Q

Signs and symptoms of thyrotoxicosis

A
56
Q

approach to hypothyroidism

A
57
Q

Presence of Thyroid peroxidase (TPO) Ab

A

(>90% of autoimmune hypothyroidism)

58
Q

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

A

>1cm in diameter

59
Q

The greatest concern in a patient with a thyroid nodule is

A

risk of malignancy.

60
Q

Most common early consequence of estrogen deficiency

A

vertebral fracture

61
Q

increased uptake = hyperfunctioning = almost never malignant

A

“Hot” nodule

62
Q

decreased uptake = hypofunctioning = 1020%: malignant

A

“Cold” nodule

63
Q

What is the operation definition of Osteoporosis?

A

Bone mineral density < 2.5 SDs from normal peak bone mass or T-score less than -2.5

T-Scores : Compare individual results to those in a young population that is matched for RACE and SEX

Z-Scores: Compare individual results to those of an AGE-MATCHED population that also is matched for RACE and SEX

64
Q

Most common cause of medication induced osteoporosis

A

steroids

65
Q

the only adrenal-inhibiting medication that can be administered to pregnant women with Cushing’s syndrome

A

Metyrapone inhibits cortisol synthesis at the level of 11βhydroxylase

66
Q

novel agent; human monoclonal antibody to RANKL, inhibiting formation of osteoclast

A

Denosumab

67
Q

Osteopenia Dual-energy x-ray absorptiometry (DEXA scan) score

A

T score between -1 to -2.5 SD

68
Q

prevention and treatment of osteoporosis and reduction of invasive breast cancer occurrence

A

Selective-estrogen modulator (Raloxifene)

69
Q

What is the best initial diagnostic test for cushing syndrome?

A

1 mg overnight Dexamethasone suppression test and 24hour urine cortisol

70
Q

What is the most accurate diagnostic test for cushing syndrome?

A

24-hour urine cortisol

71
Q

excess cortisol from ACTH-producing pituitary adenoma.

A

Cushing’s disease

72
Q

Adrenal, Pituitary and Ectopic cushing syndrome response to diagnostic tests

A
73
Q

DIAGNOSTIC ALGORITHM FOR PATIENT WITH SUSPECTED CUSHING’S SYNDROME

A
74
Q

Most common cause of cushingoid features

A

Iatrogenic hypercortisolism

75
Q

The most common cause of Cushing’s syndrome Overall

A

Medical use of glucocorticoids for immunosuppression or for the treatment of inflammatory disorders

76
Q

Account for 70% of patients with endogenous causes of Cushing’s syndrome

A

Pituitary corticotrope adenomas

77
Q

Majority of patients with ACTHindependent cortisol excess

A

Cortisol-producing adrenal adenoma

78
Q

Most important first step in the management of suspected Cushing’s syndrome

A

Establish the correct diagnosis

79
Q

Investigation of choice in ACTHDependent Cortisol Excess

A

MRI of the PITUITARY

80
Q

Primary cause of DEATH in Cushing

A

Cardiovascular Disease

81
Q

Treatment of choice for Cushing’s Disease

A

Selective Transsphenoidal Resection of pituitary tumor

82
Q

DOC for pheochromocytoma

A

α-adrenergic blockers (Phenoxybenzamine)

83
Q

first described pheochromocytoma-associated syndrome associated with multiple neurofibromas, café au lait spots, axillary freckling of the skin, and Lisch nodules of the iris

A

Neurofibromatosis Type 1 (NF 1)

84
Q

MEN 2A

A

o Medullary thyroid carcinoma (MTC): seen in virtually all patients

o Pheochromocytoma: occurs in only about 50%

o Hyperparathyroidism

85
Q

MEN 2B

A

o Medullary thyroid carcinoma (MTC)

o Pheochromocytoma

o Multiple mucosal neuromas

o Marfanoid habitus

o Typically lacks hyperparathyroidism

86
Q

What is the most common cause of mineralocorticoid excess?

A

Primary hyperaldosteronism (excess aldosterone by the adrenal zona glomerulosa)

87
Q

What is the clinical hallmark of mineralocorticoid excess?

A

Hypokalemic Hypertension

88
Q

Medical treatment of hyperaldosteronism consists primarily of?

A

Spironolactone

89
Q

Differentiate primary vs secondary hyperaldosteronism

A
90
Q

useful screening test for hyperaldosteronism

A

Ratio of plasma aldosterone to plasma renin activity (PA/PRA)

* PA:PRA is INCREASED IN PRIMARY HYPERALDO BECAUSE Of THE NEGATIVE FEEDBACK

91
Q

Differentiate Primary, secondary and tertiary adrenal insufficiency

A
92
Q

Risk factors for DM

A
93
Q

Criteria for DM diagnosis

A

#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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