PANCE_endocrine 7% Flashcards
(RR)
name two types of hypOthyroidism
Hashimoto thyroiditis
silent thyroiditis
(RR)
key features of toxic thyroid adenoma
palpable thyroid nodule
lab values consistent with hyperthyroidism (low TSH, elevated T3, elevated T4)
(RR)
“You are treating a patient with type 2 diabetes mellitus. He is currently on metformin, but his hemoglobin-A1c is not at goal. You decide to add insulin. [What] is the best approach when considering this management plan?”
continue oral medications, add long-acting insulin
(RR)
severe hyperglycemia with serum glucose usually >600 mg/dL
hyperosmolar hyperglycemic state
(RR)
two signs of hyperosmolar hyperglycemic state
AMS
profound dehydration
(RR)
lab findings of hyperosmolar hyperglycemic state
glucose > 600 mg/dL
negative ketones
(RR)
“A 19 y/o F presents to the ED w/ severe flushing, tremors, and vision changes. V/S: BP 240/110 mm Hg, HR 104 bpm, RR 20 breaths per minute, and T 100.4F. She was recently found to have a mass on her kidney. [What] is the most appropriate course of treatment in this patient?”
“PHENTOLAMINE FOLLOWED BY LABETALOL”
“Must obtain alpha-blockade prior to beta-blockade, classically done by administering phenoxybenzamine, which is an alpha-1 and alpha- 2 blocker, or phentolamine, a nonspecific alpha-blocker….
….followed by a beta blocker, such as labetalol or propranolol”
(RR)
Graves is ….
“an autoimmune condition in which autoantibodies to the THYROTROPIN RECEPTOR cause increased thyroid hormone synthesis and secretion and diffuse thyroid growth”
classic triad of Graves disease
goiter
orbitopathy
pretibial myxedema (infiltrative dermopathy)
(RR)
what are pituitary adenomas?
benign tumors of the anterior pituitary gland
(RR)
MC cell type of pituitary adenomas
LACTOTROPH (PROLACTIN-SECRETING ADENOMAS)
(making up 50% of pituitary adenomas)
(RR)
clinical manifestations of lactotroph adenomas
hyperprolactinemia (galactorrhea)
hypogonadism (amenorrhea, infertility, vaginal dryness, decreased bone mineral density)
(RR)
most important initial intervention for a pt with hyperglycemic hyperosmolar state
aggressive IV NS fluids
(RR)
What is the most appropriate therapy for pts with a prolactin-secreting pituitary adenoma
CABERGOLINE
(a dopamine agonist)
(“bromocriptine has historically been used, but cabergoline has been shown to be more effective and have fewer side effects”
(RR)
“What is the most likely neurological symptom from a pituitary adenoma?”
“loss of peripheral vision, as the mass intrudes on the optical chiasm”
(RR)
lab findings for acromegaly
increased IGF-1
(RR)
a pt is in DKA 2/2 a UTI….what is first step in management? and after that? and once the glucose is about 200 mg/dL?
first - NS bolus
next - insulin drip at 5U/hr
after glucose is ~200mg/dL, change fluids to a 5% dextrose in a 0.45% NaCl and decrease insulin drip dose (“to avoid iatrogenic hypoglycemia and cerebral edema”)
(RR)
in treatment of DKA, what considerations should be made for K+?
replete K+ deficit (usually falsely elevated)
do not start insulin if K+ is <3.3 mEq/L
(CME)
“Which of the following thyroid carcinomas is most common?
a) medullary carcinoma
b) follicular carcinoma
c) papillary carcinoma
d) anaplastic carcinoma”
C) PAPILLARY CARCINOMA
(CME)
“Which of the following best explains the Somogyi effect?
f) The Somogyi effect is due to relative insulin excess in the morning
g) The Somogyi effect is due to insulin deficiency at midnight
h) The Somogyi effect is due to rebound nocturnal hypoglycemia
i) None of the above”
H) THE SOMOGYI EFFECT IS DUE TO REBOUND NOCTURNAL HYPOGLYCEMIA
(CME)
“Which serologic test should be initially ordered if you suspect primary hypothyroidism?
a) serum T4
b) serum T3
c) free serum T4
d) serum TSH
e) serum TBG”
D) SERUM TSH
(CME)
“glucocorticoids are known to do all of the following EXCEPT
f) cause hyperglycemia
g) cause euphoria
h) decrease testosterone and LH
i) promote peptic ulcer disease
j) decrease intraocular pressure”
J) DECREASE INTRAOCULAR PRESSURE
(CME)
“Which of the following is most associated with a high aldosterone level?
a) hyperkalemia
b) hypernatremia
c) hypotension
d) Cushing syndrome
e) muscle weakness”
E) MUSCLE WEAKNESS
(CME)
“Which lab value is associated with Cushing’s Disease?
f) decreased glucose
g) elevated ACTH
h) decreased cortisol
i) elevated ALT
j) decreased TSH”
G) ELEVATED ACTH
(RR)
what 3 lab findings are expected in primary adrenal insufficiency
hyponatremia
hypoglycemia
hyperkalemia
(sodium and glucose DOWN, potassium UP)
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increased pigmentation at mucus membranes and palmar creases….what is this a sign of?
primary adrenal insufficiency, or Addison disease
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how do we manage primary adrenal insufficiency?
hydrocortisone
supportive care
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if a pt has primary adrenal insufficiency or Addison disease, what is happening to the adrenal gland?
the immune system is destroying the adrenal cortex, causing a reduction of cortisol and aldosterone
if a pt has DMI or some other autoimmune condition, think about Addison’s
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what is acute adrenal insufficiency?
insufficient plasma cortisol, and it’s a medical emergency
(RR)
“Which exam finding is associated with Cushing’s syndrome?
a) distal atrophy and weakness
b) dry skin
c) hypotension
d) supraclavicular fat pads”
D) SUPRACLAVICULAR FAT PADS
(not dry skin - skin findings are usually skin atrophy, purple striae and bruisability)
(RR)
MC cause of Cushing’s Syndrome?
exogenous glucocorticoids
(CME)
What is Cushing’s DISEASE?
“Cushing’s syndrome due to excessive pituitary ACTH secretion, due to a pituitary tumor”
(RR: “if cause of Cushing Syndrome is a pituitary tumor, then it’s called Cushing Disease”)
(CME)
5 common s/s of Cushing’s Syndrome
obesity 90%
hyperlipidemia 70%
glucose intolerance 79%
skin changes 60%
hirsutism 75%
(women get male-like s/s)
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how do we diagnose Cushing Syndrome?
24-hour urine cortisol
testing ACTH levels
(RR)
most noniatrogenic cause of Cushing Syndrome
hypercortisolism from ACTH-secreting pituitary tumor
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how do we treat Graves disease in pregnant ladies?
1st trimester - PTU
2nd & 3rd trimesters - methimazole
(these are THIONAMIDES)
“initiating therapy during the first trimester because the associated fetal anomalies are less severe than with methimazole”. Once organogenesis is complete, switch to methimazole, b/c it “is associated with a lower risk of maternal hepatotoxicity”
(RR)
what hyperthyroidism treatment is recommended for lactating patients?
METHIMAZOLE is recommended for pts who are lactating
(RR)
most appropriate initial treatment for
hyperthyroidism
block sympathetic hyperactivity, control symptoms and heart rate, with a beta blocker (i.e. propanalol)
“While thionamide medications can be used, symptom control with a beta-blocker is the most appropriate initial treatment. Once symptoms are controlled, medications to inhibit thyroid hormone synthesis can be initiated.”
(RR)
when do we use radionuclide scans for thyroid nodules?
if a pt has low TSH
” Patients with a thyroid nodule and a low TSH level (suggesting subclinical or overt hyperthyroidism) can undergo radionuclide scanning to determine if the nodule is hyperfunctioning.”
(RR)
when do we FNA biopsy a thyrod nodule?
if the pt has a normal TSH
(RR)
if a pt is on amlodipine, ASA, furosemide, metformin and saxagliptin, and you want to add empagliflozin to get better glycemic control, what med should be adjusted?
furosemide
empagliflozin is a Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor, which in combination with loop diuretics can cause hypotension (dehydration and volume depletion)
(RR)
“What class of antihypertensive medications can negate the antidiabetic effects of empagliflozin?”
thiazide diuretics
(RR)
Which complication is most likely to develop from untreated hyperthyroidism?
a) bone loss
b) coronary artery disease
c) loss of vision
d) megacolon
e) myxedema coma
A) BONE LOSS
“Complications of hyperthyroidism include bone loss, hypercalcemia, cardiac dysrhythmias, and thyroid crisis.”
NOT myxedema coma, which is a life-threatening complication of hypOthyroidism
(RR)
what kind of drug is pioglitazone? What is it’s black box warning?
a thiazolidinedione antidiabetic agent
The single black box warning for pioglitazone is congestive heart failure. (…“can cause or exacerbate heart failure…”)
(RR)
what two drugs are in the thiazolidinedione drug category?
pioglitazone
rosiglitazone
(RR)
“What is the etiology of type 1 diabetes?”
“pancreatic beta cell destruction, which prohibits patients from producing insulin”
(RR)
what three antidiabetic drugs carry risk of hypoglycemia?
sulfonylureas
meglitinides
insulin
(RR)
name two sulfonylureas and give the treatment for recurrent hypoglycemic episodes with sulfonylureas
glyburide & glipizide
Tx: octreotide
Recurrent hypoglycemic episodes from sulfonylureas should be treated with octreotide, a somatostatin analog. Octreotide inhibits glucose-stimulated insulin release, thus, preventing recurrent hypoglycemia.
(NCCPA practice exam)
In addition to encouraging a 16 y/o pt in therapeutic lifestyle changes, the most appropriate intervention in terms of initiating therapy for DM II would be _____?
(CME)
biguanides, i.e. metformin
(NCCPA practice exam)
“Which of the following conditions stimulates the physiologic release of vasopressin from the post pit gland?
a) hyperkalemia
b) hyponatremia
c) hypo-osmolality of the blood
d) hypovolemia
e) metabolic alkalosis”
d) HYPOVOLEMIA
vasopressin = ADH
(NCCPA practice exam)
“A 40 y/o F is admitted to the hospital b/c she has had multiple episodes of anxiety, palpitations, flushing, and HA during the past 6 months. After an extensive workup, pheochromocytomas is diagnosed. FH of which of the following conditions is most likely in this pt?
a) Hashimoto thyroiditis
b) MEN type 2
c) SLE
d) DM II
e) ulcerative colitis”
b) multiple endocrine neoplasia type 2 (MEN2)
“The approximate frequency of pheochromocytoma in these disorders is 10 to 20 percent in VHL syndrome, 50 percent in MEN2, and 2 to 3 percent with NF1”
VHL = von Hippel-Lindau
NF1 = neurofibromatosis 1 (UpToDate)
