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Endocrinology > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

WU for thyroid nodule

A
  1. TFT’s = TSH and T4

2. If normal - Bx gland with FNA

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2
Q

What is a hot nodule

A

Non-cancerous
Produces excess thyroid hormone
Shows up on scan - takes up isotope

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3
Q

What is a cold nodule

A

Cancerous
Nonfunctioning
Defects/holes in scan
Solid

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4
Q

Follicular thyroid cancer

Spread

A

Hematogenous spread to Lung, Brain, Bone
Invasion of tumor capsule and BVs
Encapsulated

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5
Q

Papillary Thyroid cancer

A

Unencapsulated
Local LN involved
Psamomma bodies = ground glass cytoplasm, pale nuclei with inclusion bodies

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6
Q

MC thyroid cancer

A

Papillary Thyroid cancer

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7
Q

MCC of hypercalcemia

Other causes

A

Primary Hyperparathyroidism

Others: Vit D toxicity, Sarcoidosis, Thiazides, Lithium, Hyperthyroidism, Mets to bone, MM

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8
Q

Presentation of of hypercalcemia

A 
Confusion
Stupor, Lethargy
Constipation, N/V, Pancreatitis
Short QT syndrome, HTN
Osteoporosis
Nephrolithiasis, DI, Renal insufficiency
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9
Q

Tx for Hypercalcemia

A
  1. Saline hydration w Loops (furesomide) if crackles are heard
  2. Bisphosphonates - inhibit bone digestion by encouraging osteoclasts to undergo apoptosis
  3. Calcitonin to inhibit osteoclasts if above not working
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10
Q

Hyperparathyroidism Labs

EKG

A 
High PTH, Calcium
Low/N Phosphorus
High Chloride
High BUN/Cr
High AP
EKG short QT
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11
Q

What is osteitis fibrosa cystica?

Presentation?

A

Increased osteoclastic bone resorption

Bone pain, Fx, swelling, bone cysts, brown tumors

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12
Q

Hyperparathyroidism TX

A

Surgical removal of glands

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13
Q

Causes of Hypoparathyroidism

A

Neck surgery
Hypomagnesiumemia
Renal Failure

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14
Q

Role of Magnesium and PTH

A

Mg needed for PTH to be released from gland

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15
Q

Renal Failure and Calcium

A

RF causes hypocalcemia

kidney converts 25 OH to 1,25 OH Vit D

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16
Q

Albumin and Calcium relationship

A

Low albumin causes decrease in total Calcium

Free Calcium Normal

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17
Q

EKG for Hypocalcemia

A

Prolonged QT

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18
Q

Diff b/t Cushing Dz and Syndrome

A 
Dz = Pituitary overproduction of ACTH
Syndrome = Hypercortisolism
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19
Q

MCC of hypercortisolism

A

Pituitary ACTH = Cushing DZ

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20
Q

Best initial test Hypercortisolism

A

24-Hour Urine Cortisol
Or
1 mg overnight dexamethasone suppression test

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21
Q

Most specific test for Hypercortisolism

A

24 hour urine cortisol

- Elevation confirms Dx

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22
Q

Best initial test to determine source or location of hypercortisolism

A

ACTH testing:
High then source is:
- Pituitary
- Ectopic Production - Lung, carcinoid

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23
Q

If ACTH is elevated, next step?

A

MRI brain

- Pituitary lesion - this is the source

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24
Q

If MRI brain does not show a lesion, next step in hypercortisolism

A

Inferior Petrosal Sinus sample for ACTH

  • High ACTH = pituitary is source
  • if not - scan chest
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25
Q

Where does Inferior Petrosal sinus drain from

A

From Cavernous sinus

Joins sigmoid sinus to form internal Jugular Vein

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26
Q

Effects of hypercortisolism - Labs

A 
Hyperglycemia
Hyperlipidemia
Hypokalemia
Metabolic Alkalosis
Luekocytosis
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27
Q

Cortisol relationship w insulin and aldosterone

A

Antiinsulin

Aldosteronelike effects -> Kidney’s distal tubule = excretes Potassium and Hydrogen ions

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28
Q

TX for hypercortisolism if pituitary source

A

Transphenoidal surgery

29
Q

TX for hypercortisolism if Adrenal source

A

Laparoscopic surgery

30
Q

Low ACTH

High-dose dexamethasone: No suppression

A

Adrenal source

31
Q

High ACTH
High ACTH in petrosal sinus
High-dose dexamethasone: Suppresses

A

Pituitary source

32
Q

High ACTH
Low ACTH in petrosal sinus
High-dose dexamethasone: No suppression

A

Ectopic source

33
Q

Hypoadrenalism etiology

A 
Addison Dz
AI destruction of gland
Infxn
Adrenoleukodystrophy
Mets
34
Q

Hypoadrenalism Presentation

A 
Weakness
Fatigue
AMS
N/V/Anorexia
HypoTN
Hyponatremia
Hyperkalemia
Eosinophilia 
Hyperpigmentation
35
Q

Dx Tests for Hypoadrenalism

A

Cosyntropin Stimulation test

  • synthetic ACTH
  • measure cortisol before and after
  • Normal - rise in cortisol after cosyntropin admin
36
Q

Labs in Hypoadrenalism

A 
Hypoglycemia
Hyperkalemia
Metabolic Acidosis
Hyponatremia
High BUN
37
Q

Tx for Hypoadrenalism

A
  1. Replace steroids with hydrocortisone

2. Fludrocortisone - high in mineralocorticoid/aldosterone like effect

38
Q

MCC of Primary Hyperaldosteronism

A

Solitary Adenoma

39
Q

Presentation of Primary Hyperaldosteronism

A

High BP + Low Potassium

40
Q

Best initial test in Primary Hyperaldosteronism

A

Ratio of plasma Alosterone to Renin

PAC: PRA

41
Q

Most accurate test in Primary Hyperaldosteronism to confirm unilateral adenoma

A

Sample of venous blood draining adrenal

- High Aldosterone

42
Q

TX for Primary Hyperaldosteronism

A

Unilateral adenoma: Laparoscopy

Bilateral hyperplasia: Eplerenone or Spironolactone

43
Q

Best initial test for Pheochromocytoma

A

Free metanephrines in plasma

44
Q

Tx for Pheochromocytoma

A 
Alpha blocker
- non-selective
- non-competitive 
Beta blocker
CCB
Surgical removal w pre op tx of alpha blocker
45
Q

Diff b/t DM type I and II

A

Type I = insulin deficiency

Type II = insulin resistance

46
Q

Dx of Diabetes

A 
2 fasting glucose > 125 
OR
1 glucose > 200 + Sx's
OR 
Increased glucose on tolerance test
47
Q

Metformin AEs and MOA

A

AEs: Metabolic Acidosis
MOA: blocks gluconeogenesis

48
Q

Which hypoglycemic drug increases obesity

A

Sulfonylureas - increase insulin release from pancreas, driving glucose

49
Q

Hypoglycemic drug that is CI in CHF

A

Thiazoladinediones (glitazones)

50
Q

Hypoglycemic drug ass’d with increased risk of MI

A

Rosiglitazone

51
Q

Hypoglycemic drug helps in weight loss

A

Incretins - Exenatide, Sitagliptin

52
Q

Which insulin gives steady state for entire day

A

Glargine

53
Q

Which insulin has shortest onset of action

A

Lispro
Aspart
Glulisine
Onset = 5-15 mins, peak at 1 hr, last 3-4 hours

54
Q

DKA TX

A
  1. Large volume saline and insulin
    Insulin - Continuous, rapid IV drip until AG corrected. Then bolus 5-10 units regular insulin
  2. Replace K+
55
Q

What electrolyte indicates elevated Anion Gap

A

HCO3-

56
Q

If DKA pt is stabilized on IVF and insulin, but blood glucose is increasing, what is best next step?

A

Add D5 to IVF

57
Q

When is HCO3- given in DKA?

A

Severe acidosis where pH < 7 Or losing in stool Or kidneys

Usually wrong answer

58
Q

What is goal LDL and TGs be in DM pts

A

LDL -< 100 mg/dL

TG - <150

59
Q

What is goal BP be in DM pts

A

< 130/80

If greater - start ACEi/ARB

60
Q

Next step if urine microalbumuria

A

ACEi or ARB

61
Q

ASA in DM?

A

Daily over 30 yoa

62
Q

What is cause of Diabetic Osteomyelitis

A

Contiguous spread - poor tissue perfusion b/c of arterial insufficiency -> Immune system can’t combat infxn in area around ulcer - soft tissue entry to bone
Neuropathy - decreases sensation causing ulcers

63
Q

ACEi or ARB effect on kidney

A

Decrease rate of progression of nephropathy by decreasing intraglomerular HTN
Increase Renal Blood Flow

64
Q

Tx for Gastroparesis

A

Metoclopromide

Erythromycin

65
Q

Diabetic Retinopathy-Nonproliferative
Presentation
TX

A

Cotton wool spots, exudates, less severe and more common

TX: Tight glucose control

66
Q

Diabetic Retinopathy - Proliferative
Presentation
TX

A

Neovascularization
Vitreous Hemorrhages
Tx: Laser Photocoagulation

67
Q

TX for Diabetic Neuropathy

A

Pregabalin
Gabapentin
TCAs - Amitryptiline
Persistent - Narcotics, Tramadol

68
Q

What are Charcot’s Joints

Ass’d with?

A

Loss of sensation due to recurrent injury
Chronic, progressive arthropathy
Ass’d with Syphilis, Tabes Dorsalis, Syringomyelia,

69
Q

Presentation of Charcot’s Joints

A

Decreased proprioception, pain and temp

Deformed joints, arthritis, mild pain, Fx, DJD

Endocrinology (2 decks)

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