exam 3 Flashcards
what is somogyi?
the notion that nocturnal hypoglycemia causes hyperglycemia the following morning - has been discredited
dawn phenomenon
an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes. It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia.
FSH, LH, ACTH, TSH, prolactin and GH are all hormones from the :
Anterior pituitary
Posterior pituitary produces:
oxytocin, ADH
causes of hyperprolactinemia:
anterior pituitary adenoma, hypothyroidism,
mass effect
various drugs( SSRIs, antipsychotics, cocaine, alpha-methyldopa)
amenorrhea is a symptom of anterior pituitary adenoma in:
women
best initial test for hyperprolactinemia:
prolactin level
most accurate test is MRI
hyperprolactinemia tx:
dopamine agonists
excess GH secretion due to a macro adenoma is:
Acromegaly
onset of acromegaly is usually between __ and __ yrs old:
20 -40
Skeletal changes, coarsening of facial features, enlargement of hand/feet, deepening of voice, carpal tunnel syndrome, CHF are all s/s of :
acromegaly
best initial test for acromegaly:
IGF-1 level
MRI needed for definitive diagnosis
tx for acromegaly:
best initial and most effective therapy is transphenoidal resection.
best medical therapy is octreotide
posterior pituitary stores and releases ______ and ______ made by the hypothalamus:
oxytocin and ADH
causes of central diabetes insipidous:
trauma or tumor make up 50% of cases
25% idiopathic
25% come from anoxia, meningitis, radiation
pt with otherwise normal physical who reports polyuria, polydipsia, nocturne, enuresis, is consuming lots of water and peeing often, likely has:
diabetes insipidus
labs to evaluate for diabetes insipidus:
CMP, UA, plasma ADH
low ADH: central DI
normal/high ADH: nephrogenic ADH
dx for diabetes insipidus:
clinical - water deprivation test
Of the medications metformin, glyburide, rosiglitazone, and NPH insulin, which should be used with caution in a person with severe sulfa allergy?
glyburide
the mechanism of pioglitazone is as a:
insulin sensitizer
the meglitinide analogues are particularly helpful adjuncts in DM2 care to minimize risk of:
postprandial hyperglycemia
what is the most common adverse effect noted with alpha-glucosidase inhibitor use?
GI upset
GLP agonists such as bydureon and victor are contraindicated in pts with _______
gastroparesis
in a healthy person, what percentage of the body’s total daily physiological insulin secretion is released as basally?
50-60%
of metformin, glipizide, insulin and pioglitazone, which medication is less likely to be effective in controlling plasma glucose after five yrs or more of DM2?
glipizide
the most common presentation of hyperparathyroidism is:
asymptomatic elevation of serum calcium
name the three ways PTH raises serum calcium concentration:
1) by acting directly on bone to release Ca into the extracellular fluid
2) by acting directly on the kidney to decrease renal loss of calcium
3) by acting directly on the intestinal tract, through the activation of Vit D, to increase dietary calcium absorption
the inappropriate secretion of PTH in the setting of hypercalcemia is:
primary hyperparathyroidism
the appropriate increased secretion of PTH in the setting of low or normal serum calcium concentration is:
secondary hyperparathyroidism,
can be caused by Vit D deficiency or renal failure
prolonged secondary hyperparathyroidism in which hypercalcemia develops is:
tertiary hyperparathyroidism
inappropriately low secretion of PTH in the setting of hypocalcemia
hypoparathyroidism
in 80% of cases of primary hyperparathyroidism, excess PTH is caused by :
a single parathyroid adenoma
amenorrhea or low volume menstrual flow; hyperreflexia with a characteristic “quick out-quick back” action; proximal muscle weakness and tachycardia is most likely:
hyperthyroidism
menorrhagia; overall hyporeflexia with characteristic slow relaxation phase, the “hung up” patellar deep tendon relfex and bradycardia in severe cases is most likely:
hypothyroidism
the measurement of _____ is the most helpful test to confirm an abnormal TSH level:
free T4
on a thyroid scan, a “cold spot” is most consistent with:
thyroid cyst
a painless thyroid mass and TSH level of less than 0.1IU/mL in a 35 yr old F is most consistent with:
autonomously functioning adenoma
fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise suspicions of :
thyroid malignancy
what is the most cost effective method of distinguishing a malignant from a benign thyroid nodule?
fine needle aspiration biopsy
_____ ______ is a possible side effect of excessive levothyroxine use:
bone thinning
at what interval should TSH be reassessed after a levothyroxine dosage is adjusted?
6 to 8 weeks
“stones, bones, moans and psychiatric overtones”: nephrolithiasis, fractures, weakness, bone pain, and pain, neuronal hypo activity: confusion, lethargy
nephrogenic diabetes insipidus are all s/s of?
primary hyperparathyroidism
factors associated with increased risk of thyroid cancer include:
- hx of radiation to the head or neck ( especially in childhood)
- nodules in its younger than 20yr or older than 70
- men are at higher risk than women
- more common in its with Graves dx.
- fam hx of thyroid cancer.
first step in evaluating a thyroid nodule:
Check TSH levels
thyroid ultrasonography
if a thyroid nodule larger than 1 cm is found, then:
proceed to fine needle aspiration
regardless of thyroid nodule size, the nodule should be biopsied if ultrasonography suggests:
extra capsular invasion by the lesion or shows cervical lymphadenopathy
hyper functioning thyroid nodules ______ need to be biopsied
do not
thyroid nodules, regardless of size, should be biopsied if pt has hx of _______, _______ or ________ in a first degree relative
head and neck irritation, thyroid cancer, MEN type 2
first line tx for hyper functioning thyroid nodules:
radioactive iodine 131 ablation
thyroid nodules 4 cm or larger is an independent predictor of ________
malignancy
-diagnostic lobectomy is recommended, FNA can miss a malignant focus, result in false benign
benign nodules should be followed with repeat ultrasonography _________ after initial FNA
6 to 18 months
- if nodules have not grown significantly at the follow up exam, interval may be extended to 3-5 yrs.
- if nodule has grown, repeat FNA should be performed with US guidance
31 yr old F with insomnia, tremor, weight loss despite increased appetite, goiter, sensitivity to heat, menstrual changes and exophthalmos most likely has:
Graves dx
PE: high HR, goiter, warm/moist skin and fine tremor
Best initial test for graves dx is _______ ;the most accurate test is ___________________
TSH level
serology for thyroid stimulating immunoglobulin.
Best initial therapy for graves dx:
propanolol to control sx
best therapy for graves dx:
radioiodine ablation
should not be used in children and pregnant women, definitive therapy in theses cases would be subtotal thyroidectomy
best medication for pregnant women with graves dx who cannot have radio iodine ablation:
PTU or methimazole
in graves dx, a radioactive uptake iodine scan is done if TS immunoglobulins test is not available and result would be:
confluent, no hot spots, nodules
If a nodule(toxic adenoma) or multiple nodules( toxic multi nodular goiter/plummers dx) is appreciated upon PE, and an elevated TSH level with RAIU showing hot spots is found, should it be biopsied?
no need to biopsy because carcinomas are non functional
_________ thyroiditis, ________ thyroiditis and ______ thyroiditis can all present with transient hyperthyroidism
subacute ( will present with pain and tenderness around thyroid)
lymphocytic/postpartum
Hashimoto’s
the uptake in a RAIU thyroiditis scan is:
low, because gland is damaged.
this differentiates it from Graves dx, where uptake is high.
medications that can trigger thyroiditis include: ________, _________, ________ and ________
lithium, interferon alfa, interleukin -2, and amiodarone
A ____ and _____panel should be obtained before starting an antithyroid med:
CBC with Diff
Hepatic panel
Free T4 and total T3 should be obtained ____ weeks after starting a thionamide and every ___ to ____ weeks after with dosage adjusted based on results
4 weeks
4-6 weeks
an antithyroid med would be continued for ___ to ___ months, then tapered or discontinued if the ____ level is normal at the time.
12 to 18 months
TSH level
_______ ________ ________ should be suspected in older adults with a markedly elevated white blood cell count and an enlarged liver or spleen.
Chronic lymphocytic leukemia
unlike most Type 2 DM pts, DM1 pts often present with_____ and ______ in addition to polyuria, polydispsia and a plasma glucose of 126 mg/dL or more after an overnight fast documented on more than one occasion.
ketonuria and weight loss
