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Internal Med > OME - Endocrine > Flashcards

OME - Endocrine Flashcards

1
Q

What can cause Nephro DI?

Treat how?

A

Li toxicity, Demeclocycline

Diuretics - HCTZ and amiloride

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2
Q

When should total insulin deman be 0.3 units/kg?

A

Cr > 1.5
Age > 65
bG > 180

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5
Q

What is the Somogyi Effect?

W/u how?

Will show what?

D/t what?

A

Morning hyperglycemia

3AM bG test

will be LOW

Too MUCH insulin at night

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6
Q

Find a PRLoma, 1st step in w/u?
Then?
Best?

A

PRL level
TSH/T4
MRI

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7
Q

What is the thyroglobulin level like in the following?

Thyroiditis

Factitious

Struma Ovarii

A

Inc

Dec

Inc

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8
Q

Hypoglycemia defined how?

Treat how?

A

bG < 70 or sx of hypoglycemia (palpitations, perspiration, presyncope)

PO glucose if awake, IV D50 if in coma

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11
Q

Describe the following in cirrhosis/nephrosis:

Protein

Total T4

Normal Free T4

A

Dec

Dec

Normal

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12
Q

Sx of Adrenal insufficiency?

A

HoTN, fatigue, N/V

Hyperpigmentation, Hyperkalemia

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14
Q

How do you treat prediabetes?

A

Diet/exercise AND Metformin

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17
Q

DDP-4-i SE?

Names?

A

Weight NEUTRAL

GLIPTIN

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18
Q

Pt in DKA, what readings can you get?

What is Tmax of renal tubules of glucose?

A

Serum ketones > UA

180

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19
Q

Pt w/refractory HTN or diastolic HT and HoKalemia has what?

Differentiate this how?

A

Conn’s

HIGH Aldo:Renin ratio > 20

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20
Q

MC cause of Adrenal insufficiency in US is what?
Worldwide?

Can also occur when?

A

Autoimmune adrenalitis

TB

B/L adrenal hemorrhage

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21
Q

What is the DAWN phenomenon?

W/u how?

Will show what?

D/t what?

A

Morning hyperglycemia

3AM bG test

will be HIGH

Too little insulin at night

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22
Q

What type of cosyntropin test indicates primary Adrenal failure?

Treatment?

A

No change in cortisol

Prednisone and Fludrocortisone

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23
Q

Describe the following in pregnancy:

Protein

Total T4

Normal Free T4

A

Inc

Inc

Normal

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24
Q

A pt that presents w/stupor, nuchal rigidity, HA, N/V and decompensating rapidly has what endocrine disorder?

A

Apoplexy d/t pre-existing tumor

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25
Q

Fasting glucose screen, what is Pre-diabetes level?

2 hour GTT?

A1c?

A

100-124

140-199

5.7-6.4

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28
Q

Pt w/primary hyperaldosteronism needs what test next?

Best test is what?

A

CT/MRI of ABD/Pelvis

Adrenal Vein sampling

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29
Q

Symptoms of diabetes w/Random glucose screen: what is diabetes level?

Fasting glucose?

2 Hour GTT?

A1c?

A

> /= 200

> /= 125

> /= 200

> /= 6.5

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36
Q

SE of Sulfonylurea drugs?

Names?

A

Hypoglycemia

Glyburide, Glipzide

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38
Q

Pt w/suspected Cushing’s ACTH level after test is still high means what?

If low?

A

Not adrenal tumor - do high dose DST test

Adrenal tumor

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39
Q

RAIU scan of toxic goiter appears how?

A

Multiple nodules or 1 BIG adenoma

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40
Q

What meds disinhibit PRL?
What does that mean?

What directly stimulates PRL production?

A

Dopamine antagonists
More PRL is made

TRH

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41
Q

Pt w/already established diabetes OR prediabetes Dx, what is the A1c goal?

A

< 7%

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44
Q

Thyroid lesion that is considered low risk for malignancy has what features?

A

Small, < 1cm for solid

< 2cm for cystic

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45
Q

When is Metformin Contraindicated?

Oral agents reduce A1c by how much?

A

CKD, CHF, Liver disease d/t risk of lactic acidosis

3%

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46
Q

Zones of the adrenal medulla from outside to inside and what’s made there?

A

G - Aldosterone
F - Cortisol
R - Testosterone

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47
Q

MEN1?

A

Pituitary
Parathyroid
Pancreatic —> ZE, Insulinoma

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48
Q

TSH stimulates thyroid to make T4 and T3 in what ratio?

Describe T4

How much is active?

A

10:1 ratio

Inactive, bound to Thyroglobulin Binding Protein

0.1%

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50
Q

What autoantibodies are assoc w/T1 DM?

A

GAD65 #1

IA-2

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53
Q

1st step in w/u of Adrenal insufficiency?

Next?

Finally?

A

3am cortisol (will be < 3)

Cosyntropin (ACTH) test

CT or MRI

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54
Q

GLP-1 analogs SE?

Names?

A

Weight loss, they are injectable

TIDEs

55
Q

Thalidizones SE?

Mech?

Names?

A

Weight gain, CHF

Inc insulin sensitivity

PioGLITazone

56
Q

How do you treat SEVERE SIADH that fails diuretics and other fluid therapy?

A

Demeclocycline - induces nephro DI

57
Q

Pt that has an incidental thyroid nodule w/normal TSH and no sx, what is the management?

A

Repeat US in 6 months

58
Q

What insulin is used for basal coverage?

Generic and brand

A

Glargine and Detemir

Lantus and Levemir

Ls Long acting

60
Q

What is the mechanism behind organomegaly in acromegaly?

A

GH tells liver to make glucose AND to make IGF—> which directly stimulates growth of organs

61
Q

What are the sx of thyroid storm?

A

Fever > 104
Delirium
HoTN

62
Q

Pt w/Pheo how do you want determine laterality?

A

MIBG scan

64
Q

How do you treat DKA if the AG has not closed but glucose is approaching normal?

A

D5 half NS

65
Q

Pt w/suspected Acromegaly: 1st step in w/u?

Next?

Finally?

Treat how?

A

ILGF-1 levels

Glucose Tolerance/suppression test

MRI

Octreotide (somatostatin) then surgery

66
Q

What is the BEST test for SCREENING diabetes?

A

Fasting glucose

67
Q

Pt w/Graves has what kind of RAIU scan?

Treat how 1st?
Then what?

For chronic Graves?
SE of treatment?

A

Diffuse

Propanolol
PTU/Methimazole

Radioablation w/radioactive iodine
Worsens ophthalmopathy

69
Q

What are the MC causes of ectopic Cushing’s syndrome?

A

Lung -> Chest Ct
Pancreatic —> ABD Ct
Adrenals —> Pelvic CT

71
Q

1st step in w/u of Cushing’s?

2nd?

3rd?

Finally?

A

24 hour free urine cortisol AND low dose (1mg) overnight Dexamethasone

ACTH

High dose dexamethasone

CT or MRI

72
Q

What is a + glucose tolerance test?

A

Failure to suppress GH levels

73
Q

What is the idiot insulin?

A

NPH / regular insulin mixture

Humulin, Novolin

74
Q

How do you approximate insulin demand?

Give when?

A

0.5 units/kg

Half at night
Half prandial

77
Q

What does insulin dependent diabetes mean?

A

Type 1

78
Q

HoGlycemia in non-diabetic defined how?

A

bG < 60 AND sx

80
Q

What insulin is used for prandial?

Generic and brand names

A

Lispro and Aspart

Humalog and Novolog

82
Q

MEN2A?

2B?

A

Parathyroid, Pheo, Medullary thyroid

Pheo, Medullary, Neuronal/Marfanoid

84
Q

What is the treatment for thyroid storm?

A

IVF and cooling blankets
1st BBlocker
2nd PTU/Methimazole
Steroids

Iodide can be given

86
Q

When should insulin be started in diabetics in relation to A1c?

Can bring down levels by how much?

A

> 9%

7%

87
Q

What normally triggers thyroditis?

1st appear how?
Then what?

RAIU looks like what?

A

Infection/trauma, drugs or subacute

Hyperthyroid (d/t release of preformed T4)
Hypothyroid

COLD

89
Q

Pt that has elevated bG w/NO Acidosis but does have AMS is in what?

Tx?

A

HHNKC

IVF and insulin

90
Q

Papillary Thyroid cancer - tell me about it (3) things

Prognosis?

A

MC, Orphan-Annie Nuclei, Psammoma bodies

Good

91
Q

Follicular thyroid cancer, tell me about it

Treat how?

A

Spreads hematogenously

Resection and radioactive iodine ablation

92
Q

When you find an adrenal incidentaloma what do you need to workup?

Treat how?

A

r/o Cushing’s, pheo, Aldo

< 4cm watch and wait
> 4cm or increase in size over time you MUST intervene

93
Q

Meglitinides SE?

Mech?

Names?

A

Hypoglycemia

Inc insulin secretion

GLINIDEs

95
Q

What type of cosyntropin test indicates secondary Adrenal failure?

Treatment?

A

Increase in cortisol after 60 minutes

Prednisone only

96
Q

In hypopitutarism what test can be used to screen 1st?

What is a + test?

Confirm with what?

A

Insulin/glucose stimulation test

Hypoglycemia fails to stimulate GH

MRI

99
Q

In hypopituitarism what hormones go 1st to last in order?

A

FSH/LH
GH
TSH
ACTH

100
Q

1st test after a nodule is discovered?

If low then what?

A

TSH

RAIU

103
Q

Medullary Thyroid cancer - tell me about it?

A

C-cell produce calcitonin
Hypocalcemia

MEN2a and MEN2b

106
Q

Main 3 symptoms of myxedema coma are what?

D/t what?

Treatment?

A

Hypothermia, HoTN, coma/AMS

Hypothyroid

IVF, high-dose T4 (IV Thyroxine)

107
Q

What PE findings are suspicious for malignancy?

A

Fixed, hard, firm
NT LNs
Painless

108
Q

What is an alternate endocrine cause of SIADH?

Mechanism?

Presents w/what lab values?

A

Hypothyroid

TSH stimulates ADH at high doses

Serum Osms low, Urine Osms high

110
Q

What hx is suspicious for thyroid cancer?

A

Radiation to H&N
Hoarseness
Under 20 y/o
Over 60 y/o

111
Q

How to do you treat a pt w/PRLoma?

What specific meds?

A

DA agonists

Cabergoline > bromocriptine

114
Q

Nodule is found with TSH level of normal or high, what does this mean?

Next step?

A

HIGH-risk

US

115
Q

Pt that has wacky thyroid and is in the ICU, what do they have?

Need to check what?

A

Euthyroid sick syndrome

Reversed T3

116
Q

When do you order a Free T3 in workup of Thyroid?

Used when you suspect what?

A

Only if Dec TSH and Normal/dec T4

Hyperthyroid but normal T4

117
Q

Pt w/thyroid nodule and Cold RAIU scan what is next step in w/u?

If suspicious then what?

A

US

FNA

122
Q

What 4 cancers spread hematogenously?

A

Follicular thyroid cancer
RCC
HCC
Choriocarcinoma

123
Q

How does high T4 effect thyroglobulin?

A

Increases it

124
Q

How does subclinical thyroid present?

Treat when?

What happens to their LDL levels?

A

Inc TSH and normal T4/T3

When hypothyroid sx start or TSH > 10

Inc

136
Q

How does T4/T4 effect metabolism?

A

Increases it

Catabolic AND thermogenic

143
Q

Pt that presents w/hypotonic hyponatremia can only have what?

A 
RATS
RTA
Addison’s
Thyroid
SIADH

Internal Med (7 decks)

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