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MTB STEP 2 (R) > MTB 2 CK - Endocrinology > Flashcards

MTB 2 CK - Endocrinology Flashcards

1
Q

GH deficiency clinical picture

A

Central obesity, Inc. LDL/Cholesterol levels, reduced muscle mass (Dwarfisim in children)

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2
Q

Cortisol profile in Pituitary insufficiency

A

Increased in recent disease, Decrease with chronicity (atrophy)

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3
Q

Adrenal stimulation test using _______________ agent to check integrity of adrenals in ACTH deficiency

A

Cosyntropin

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4
Q

Low GH levels are assessed with ______________ infusion test

A

Arginine and GHRH

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5
Q

Low Prolactin levels are assess with ________________ infusion test

A

TRH

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6
Q

ACTH levels shoud normally ____________ (rise/fall) in response to mytyrapone

A

Increase (cortisol production inhibited -11b-hydroxylase deficiency)

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7
Q

_____________ (thyroxine/cortisone) replacement should precede the other in panhypopituitarism

A

Cortisone before thyroxine

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8
Q

Electrolyte disturbances that can cause nephrogenic DI

A

Hypercalcemia, Hypokalemia

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9
Q

Rx for Nephrogenic DI

A

HCTZ, Amiloride, Prostaglandin inhibitors like NSAIDs

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10
Q

Best initial test for acromegaly

A

Low IGF-1 (Prolactin also cosecreted by adenoma -levels also tested)

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11
Q

Confimatory test for acromegaly

A

Glucose suppresion test

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12
Q

Rx for Acromegaly

A

Cabergoline, Osteotride Pegvisomant (GH antagonist inhibiting release of IGF-1)

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13
Q

_____________ Thyroid derangement causes prolactinoma

A

Hypothyroidism (elevated TRH levels)

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14
Q

Prolactin levels can be elevated by _____________ drugs

A

Antipsychotics, Methyldopa, Metochlopromide, opioids, TCAs, Verapamil

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15
Q

Systemic conditions that elevate Prolactin levels

A

Renal insufficiency, Cirrhosis

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16
Q

Increased prolactin levels subsequent labs needed

A

Thyroid function, Pregnancy, BUN/Creatinine, Liver Function (Do MRI only after excluding sec. causes and pregnancy)

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17
Q

Prolactinoma Treatment

A

Cabergoline (dopamine agonist), Transphenoidal resection

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18
Q

Hypothyroidism effects on menstruation

A

Increased flow (apart from effects on all other body systems)

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19
Q

Thyroid replacement indications based on lab results

A

Normal T4 and Very high TSH; moderately high TSH + Antithyoid peroxidase/antithyroglobulin Ab

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20
Q

Rx for Graves Ophthalmopaathy

A

Steroids

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21
Q

Rx for Graves Thyroid Disease

A

Radioactive Iodine

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22
Q

Thyroid Nodule biopsy is indicated with ______________ Thyroid profile results

A

Normal TSH/T4 levels (euthyroid nodules can be malignant, hyperfunctioning cannot)

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23
Q

Acute symptomatic hypercalcemia presentation

A

Confusion, stupor, lethargy, constipation

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24
Q

Rx for acute hypercalcemia

A

Saline hydration, Bisphosphonates (pamidronate), Calcitonin

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25
Q

CVS findings of acute hypercalcemia

A

short QT syndrome, HTN (unknown etiology)

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26
Q

GI effects of hyperparathyroidism

A

Peptic ulcers (Ca stimulates gastrin)

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27
Q

Rx for hyperparathyroidsm when surgery is not feasible

A

Cinacalcet

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28
Q

Decreased _____________ ion levels can lead to hypoparathyroidsm

A

Mg2+ (also causes inc. Ca2+ loss)

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29
Q

Liver function effects on blood Calcium levels

A

Low albumin levels cause hypoparathyroidism&raquo_space; dec. Ca2+

30
Q

Ophthalmologic findings of parathyroid abnormalities

A

Early cataracts on slit lamp in hypoparathyroidism (hypocalcemia)

31
Q

Cushing’s Disease presents as _____________ (hypertension/hypotension)

A

Hypertension (Glucocorticoid insufficiency = hypotension)

32
Q

Best initial test for Hypercorticolism

A

24h urinary cortisol excretion

33
Q

_____________ (los dose dex. suppression/24h urine cortisol) is more specific for hypercortisolism

A

24h urinary cortisol

34
Q

Causes of false positives in low dose dex. suppression test

A

Depression, alcoholism, obesity

35
Q

Cortisol level that suppresses with high dose dexa: Source of ACTH is ____________

36
Q

Source of elevated Cortisol level that does not suppress with high dose dexa: Source of ACTH is ___________

A

ectopic usually (but can still be pituitary); Adrenal tumor also possible

37
Q

Two ways to detect ACTH secreting pituitary lesions

A

MRI; Inferior Petrosal sinus sampling after CRH (contains pituitary drainage)

38
Q

________________ tests confirms presence of hypercortisolism

A

24h urinary cortisol excretion; low dose dexa suppression of ACTH negative

39
Q

__________________ tests establishes the sourceof elevated ACTH

A

High dose dexa suppression, Brain scan, Petrosal sinus sampling, Chest CT

40
Q

Asymptomatic adrenal lesion investigations include _____________ labs

A

Blood/urine Metanephrine levels, Renin and aldosterone levels, 1mg dexa suppression test (Can be incidentaloma)

41
Q

Dexamethasone suppression test works by detecting suppressed _____________ (Cortisol/ACTH) levels

42
Q

Acute adrenal insufficiency presentation

A

Profound hypotension, fever, confusion and coma

43
Q

Peripheral blood findings in hypoadrenalism

A

Eosinophilia

44
Q

Cosyntropin stimulation test is used to detect _____________ organ failure

A

Adrenal cortex (it is an ACTH analogue

45
Q

Pharmacologic steroids according to minerolocorticoid activity

A

Fludrocortisone > Hydrocortisone

46
Q

Cortisol/steroids increase blood pressure by ______________ mechanism (distinct from minerolocorticoid activity)

A

Permissive effects on NE on vessel wall (inc. vascular reactivity)

47
Q

Symptoms of hypokalemia

A

Muscular weakness, DI

48
Q

Diagnostics of primary hyperaldosteronism

A

Hypokalemia, High aldosterone, Low renin (high renin excludes primary hyperaldosteronism)

49
Q

Pharmacologic treatment of Conn’s Disease in _______________ pathology

A

Bilateral hyperplasia (recetion in unilateral adenoma)

50
Q

Consider Conn’s in the case of HTN with ______________ clinical picture

A

Atypical Age (under 30 or over 60); Not controlled by 2 Anti-HTN drugs

51
Q

Radionuclear options of detecting pheochromocytoma

A

MIBG scanning (detects pheochromocytoma outside adrenals)_

52
Q

Diagnostic tests in correct order for pheochromocytoma

A

Plasma metanephrines > 24h urine metanephrine (urine VMA less sensitive)

53
Q

Getting ______________ (positive/negative) on a sensitive test results in more diagnostic certainty

A

Negative (few false negatives -rules out)

54
Q

Getting ______________ (positive/negative) on a specific test results in more diagnostic certainty

A

Positive (few false positives -rules in)

55
Q

Rx for Pheochromocytoma

A

Phenoxybenzamine (irreversible alpha blocker); CCB and BB second line

56
Q

Defining lab diagnostics for DM

A

Fasting glucose > 125 mg/dL on two occassions

57
Q

First line therapy for DM type 2

A

Diet exercise and weight loss

58
Q

Best Initial treatment using drugs for DM type 2

A

Metformin (does NOT cause hypoglycemia -can cause lactic acidosis in those with renal failure)

59
Q

DM drug that increases fluid overload and can worsen CHF

60
Q

Non sulfa insulin releasing agents

A

Nateglinide, repaglinide

61
Q

_______________ DM drugs accentuate oral glucose effects on I/G balance

A

Exenatide, sitagliptin, sazagliptin (Incretins)

62
Q

_______________ DM drug is amylin analog and decreases gastric emptying, glucagon levels and appetite

63
Q

Common causes of DKA

A

Non compliance, infection, pregnancy, serious illness (stressors)

64
Q

Best initial test to assess DKA

A

Serum Bicarbonate (correlates with severity and mortality risk)

65
Q

CVS medications routine for all DM patients

A

Aspirin; Statins (if LDL>100 mg/dL -lower target); ACEi (if BP>130/80 mmHg -lower target)

66
Q

Microalbuminuria in DM management

A

Start ACEi

67
Q

Vaccines for DM patients

A

Pneumococcal vaccine

68
Q

Routine exams for DM patients

A

Slit lamp exam, foot exam

69
Q

Gastroparesis in DM treated with _______________ agents

A

Motility agents -metoclopromide, erythromycin

70
Q

Management for Retinopathy of DM

A

Good glycemic control; Laser photocagulation retards progression if proliferation present

71
Q

Rx for Diabetic neuropathy

A

Pregabalin, gabapentin, TCAs, Duloxitine

MTB STEP 2 (R) (12 decks)

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