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Diagnosis & Management 2 > exam 3 > Flashcards

exam 3 Flashcards

1
Q

what is somogyi?

A

the notion that nocturnal hypoglycemia causes hyperglycemia the following morning - has been discredited

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2
Q

dawn phenomenon

A

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.

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3
Q

FSH, LH, ACTH, TSH, prolactin and GH are all hormones from the :

A

Anterior pituitary

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4
Q

Posterior pituitary produces:

A

oxytocin, ADH

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5
Q

causes of hyperprolactinemia:

A

anterior pituitary adenoma, hypothyroidism,
mass effect
various drugs( SSRIs, antipsychotics, cocaine, alpha-methyldopa)

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6
Q

amenorrhea is a symptom of anterior pituitary adenoma in:

A

women

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7
Q

best initial test for hyperprolactinemia:

A

prolactin level

most accurate test is MRI

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8
Q

hyperprolactinemia tx:

A

dopamine agonists

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9
Q

excess GH secretion due to a macro adenoma is:

A

Acromegaly

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10
Q

onset of acromegaly is usually between __ and __ yrs old:

A

20 -40

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11
Q

Skeletal changes, coarsening of facial features, enlargement of hand/feet, deepening of voice, carpal tunnel syndrome, CHF are all s/s of :

A

acromegaly

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12
Q

best initial test for acromegaly:

A

IGF-1 level

MRI needed for definitive diagnosis

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13
Q

tx for acromegaly:

A

best initial and most effective therapy is transphenoidal resection.

best medical therapy is octreotide

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14
Q

posterior pituitary stores and releases ______ and ______ made by the hypothalamus:

A

oxytocin and ADH

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15
Q

causes of central diabetes insipidous:

A

trauma or tumor make up 50% of cases
25% idiopathic
25% come from anoxia, meningitis, radiation

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16
Q

pt with otherwise normal physical who reports polyuria, polydipsia, nocturne, enuresis, is consuming lots of water and peeing often, likely has:

A

diabetes insipidus

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17
Q

labs to evaluate for diabetes insipidus:

A

CMP, UA, plasma ADH

low ADH: central DI
normal/high ADH: nephrogenic ADH

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18
Q

dx for diabetes insipidus:

A

clinical - water deprivation test

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19
Q

Of the medications metformin, glyburide, rosiglitazone, and NPH insulin, which should be used with caution in a person with severe sulfa allergy?

A

glyburide

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20
Q

the mechanism of pioglitazone is as a:

A

insulin sensitizer

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21
Q

the meglitinide analogues are particularly helpful adjuncts in DM2 care to minimize risk of:

A

postprandial hyperglycemia

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22
Q

what is the most common adverse effect noted with alpha-glucosidase inhibitor use?

A

GI upset

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23
Q

GLP agonists such as bydureon and victor are contraindicated in pts with _______

A

gastroparesis

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24
Q

in a healthy person, what percentage of the body’s total daily physiological insulin secretion is released as basally?

A

50-60%

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25
Q

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?

A

glipizide

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26
Q

the most common presentation of hyperparathyroidism is:

A

asymptomatic elevation of serum calcium

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27
Q

name the three ways PTH raises serum calcium concentration:

A

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

28
Q

the inappropriate secretion of PTH in the setting of hypercalcemia is:

A

primary hyperparathyroidism

29
Q

the appropriate increased secretion of PTH in the setting of low or normal serum calcium concentration is:

A

secondary hyperparathyroidism,

can be caused by Vit D deficiency or renal failure

30
Q

prolonged secondary hyperparathyroidism in which hypercalcemia develops is:

A

tertiary hyperparathyroidism

31
Q

inappropriately low secretion of PTH in the setting of hypocalcemia

A

hypoparathyroidism

32
Q

in 80% of cases of primary hyperparathyroidism, excess PTH is caused by :

A

a single parathyroid adenoma

33
Q

amenorrhea or low volume menstrual flow; hyperreflexia with a characteristic “quick out-quick back” action; proximal muscle weakness and tachycardia is most likely:

A

hyperthyroidism

34
Q

menorrhagia; overall hyporeflexia with characteristic slow relaxation phase, the “hung up” patellar deep tendon relfex and bradycardia in severe cases is most likely:

A

hypothyroidism

35
Q

the measurement of _____ is the most helpful test to confirm an abnormal TSH level:

A

free T4

36
Q

on a thyroid scan, a “cold spot” is most consistent with:

A

thyroid cyst

37
Q

a painless thyroid mass and TSH level of less than 0.1IU/mL in a 35 yr old F is most consistent with:

A

autonomously functioning adenoma

38
Q

fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise suspicions of :

A

thyroid malignancy

39
Q

what is the most cost effective method of distinguishing a malignant from a benign thyroid nodule?

A

fine needle aspiration biopsy

40
Q

_____ ______ is a possible side effect of excessive levothyroxine use:

A

bone thinning

41
Q

at what interval should TSH be reassessed after a levothyroxine dosage is adjusted?

A

6 to 8 weeks

42
Q

“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?

A

primary hyperparathyroidism

43
Q

factors associated with increased risk of thyroid cancer include:

A
  • 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.
44
Q

first step in evaluating a thyroid nodule:

A

Check TSH levels

thyroid ultrasonography

45
Q

if a thyroid nodule larger than 1 cm is found, then:

A

proceed to fine needle aspiration

46
Q

regardless of thyroid nodule size, the nodule should be biopsied if ultrasonography suggests:

A

extra capsular invasion by the lesion or shows cervical lymphadenopathy

47
Q

hyper functioning thyroid nodules ______ need to be biopsied

A

do not

48
Q

thyroid nodules, regardless of size, should be biopsied if pt has hx of _______, _______ or ________ in a first degree relative

A

head and neck irritation, thyroid cancer, MEN type 2

49
Q

first line tx for hyper functioning thyroid nodules:

A

radioactive iodine 131 ablation

50
Q

thyroid nodules 4 cm or larger is an independent predictor of ________

A

malignancy

-diagnostic lobectomy is recommended, FNA can miss a malignant focus, result in false benign

51
Q

benign nodules should be followed with repeat ultrasonography _________ after initial FNA

A

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
52
Q

31 yr old F with insomnia, tremor, weight loss despite increased appetite, goiter, sensitivity to heat, menstrual changes and exophthalmos most likely has:

A

Graves dx

PE: high HR, goiter, warm/moist skin and fine tremor

53
Q

Best initial test for graves dx is _______ ;the most accurate test is ___________________

A

TSH level

serology for thyroid stimulating immunoglobulin.

54
Q

Best initial therapy for graves dx:

A

propanolol to control sx

55
Q

best therapy for graves dx:

A

radioiodine ablation

should not be used in children and pregnant women, definitive therapy in theses cases would be subtotal thyroidectomy

56
Q

best medication for pregnant women with graves dx who cannot have radio iodine ablation:

A

PTU or methimazole

57
Q

in graves dx, a radioactive uptake iodine scan is done if TS immunoglobulins test is not available and result would be:

A

confluent, no hot spots, nodules

58
Q

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?

A

no need to biopsy because carcinomas are non functional

59
Q

_________ thyroiditis, ________ thyroiditis and ______ thyroiditis can all present with transient hyperthyroidism

A

subacute ( will present with pain and tenderness around thyroid)

lymphocytic/postpartum

Hashimoto’s

60
Q

the uptake in a RAIU thyroiditis scan is:

A

low, because gland is damaged.

this differentiates it from Graves dx, where uptake is high.

61
Q

medications that can trigger thyroiditis include: ________, _________, ________ and ________

A

lithium, interferon alfa, interleukin -2, and amiodarone

62
Q

A ____ and _____panel should be obtained before starting an antithyroid med:

A

CBC with Diff

Hepatic panel

63
Q

Free T4 and total T3 should be obtained ____ weeks after starting a thionamide and every ___ to ____ weeks after with dosage adjusted based on results

A

4 weeks

4-6 weeks

64
Q

an antithyroid med would be continued for ___ to ___ months, then tapered or discontinued if the ____ level is normal at the time.

A

12 to 18 months

TSH level

65
Q

_______ ________ ________ should be suspected in older adults with a markedly elevated white blood cell count and an enlarged liver or spleen.

A

Chronic lymphocytic leukemia

66
Q

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.

A

ketonuria and weight loss

Diagnosis & Management 2 (4 decks)

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