PPP ROSH- Endo Flashcards by brandon lovin

What PE finding is seen w/ Primary Adrenal Insufficiency but no Secondary Insufficiency

How are Primary and Secondary different

What medication can falsely lower free T4

Skin pigmentation: inc ACTH releases MSH, inc pitgment

1: intact HP axis, dec cortison, inc ACTH
2: HPAxis not intact, dec ACTH

Anticonvulsants

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Hyperthyroid

Sub-clinical hyperthyroid

Central hypothryoidism

Low TSH, High T4/3

Low TSH, Normal T4/3

Low TSH, T3/4

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Subclinical hypothyroid

Primary hypothyroid

TSH producing adenoma

High TSH, Norm/Norm

High TSH, low/low

High High High

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How is Hashimotos Dx confirmed

What layer of adrenal gland do Pheos arise from

How are Pheos Dx

Thyroid peroxidase or,
Thyroglobulin Abs

Medulla

Fractionated metanephrine, catecholamines in 24hr urine
Plasma fractionated metanephrine

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Graves Dz is AKA ?

What causes this Dz

What is the classic triad

Toxic diffuse goiter- MCC of hyerthyroidism

Ab to thyroid hormone receptors

Pretibial myxedema
Exophthalmos
Diffuse goiter

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What causes the exophthalmos and pretibial edema in Graves Dz

Only DM medicatin proven to reduce mortality

What test differs DMT1 from DMT2

Glycosaminoglycan accumulation

Metformin

C-peptide: absent in DMT1

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Lab results for SIADH

Lab results for dehydration

Lab results for DI

Dec serum NA/Osmolality; Inc urine osmolality

All three inc’d

Inc serum Na/Osm, dec urinary osm

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Biguanides

Sulfonylureas

Thiazolidinediones

Metformin- dec hepatic production, inc muscle/fat insulin sensitivity

ide: inc insulin secretion (2nd Gen starts w/ G)
litazone: inc insulin sensitivity at muscle/fat

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Meglitinides

A-glucosidase inhibitors

DPP-4 inhibitor

-glinidine: inc insulin secretion (hypoglucose, weight gain)

Acarbose, Miglitol: dec intestinal absorption of carbs

-gliptin: inc insulin secretion (can induce pancreatitis)

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Glucagon-like peptide 1 agonists

Insulin

Gliflozin

-tide: inc insulin secretion, dec glucagon secretion (c/i in Pts w/ MedHx of pancreatitis)

Inc glucose uptake

-flozin: dec absorption of filtered glucose in prox tubules to inc excretion/dec plasma levels

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Criteria for Dx DMT2

Pathophys of Acromegaly

What is the initial and confirmatory Dx test

Sxs w/ random ≥200
≥200 2hrs after 75g glucose
Fasting ≥126
A1c ≥6.5%

Post-pituitary pituitary release of GF, causes IGF-1 release

IGF-1;
PO glucose then test GF

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What labs are used to confirm Hypothyroid Dx

What is the name of the sign when lateral eye brows thin out

How is HyperCa d/t malignancy Tx when bisphosphonates are C/i

Inc anti-microsomal/thyroglobulin Ab titers

Queen Anne

Denosumab

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Define Androgen Insensitivity Syndrome

How do Pts appear on PE

MOA of Metoclopramide

46XY: female phenotype, male genotype d/t x-link recessive androgen receptor dysfuntion

Male brain w/ female body: breast development, no body hair, blind pouch

Inhibits dopamine receptors, inc sympathetic activation

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Primary adrenal Insufficiency lab results

How are Pts Tx during crisis

What is the best Dx test for adrenal insufficiency

HyperK, HypoNa, HypoGlu; Dec adlosterone/cortisol; Inc ACTH w/ intact HPA

Hydrocortisone

Serum cortisol

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What DM meds can lead to Hypoglycemia

E+ abnormality seen w/ rhabdo

? is the most important lab for determining thyroid function

Sulfonylureas
Insulin
Neglitinides

Hyper K

Free T4- active form of thyroxine

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? PE finding aids w/ Dx of hyperthyroidism

What diabetic meds work through the incretin system

What are the two naturally occurring incretins

Anterior neck bruit

DPP4 inhibitor- gliptins

Glucagon-like peptide, Glucoinsulinotropic peptide- enhance B-cell secretion after glucose ingestion

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Define the Incretin Effect

How are the two naturally occurring incretins cleared from the body

Define Chronic Autoimmune Thyroiditis

inc’d insulin secretion after glucose absorption

Dipeptidyl peptidase- enzymatically inactivates incretins

Hashimotos- inc TRH/TSH, dec T3/4; Tx: Levo

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DKA vs HHS levels

How does Tx differ by K levels

DKA: >150mg
HHS: >500mg

> 5.2: begin insulin

3.3-5.2: 20-30mEq K w/ each L of fluid

<3.3: hold insulin, supplemental K 2-30mEq/hr until >3.3

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Peds formula for Hypoglycemia fluid replacement

How is anion gap calculated

(2 x Age-yrs) +8

> 8yrs; D50 1ml/kg
1-8yrs: D25 2ml/kg
<1yr: D10 2-5ml/kg
2yrs old= 24ml of D25

Na - (Cl + BiCarb);
Norm: 3-10, higher= acidosis

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? lab needs to be checked in Pts w/ hyperlipidemia despire adherence to statin therapy

Correct medication sequence for thyroid storm

What meds are used to Tx residual acromegaly after surgery

TSH

BB/PTU/Methimazole
Iodine/steroid, bile acid sequestrate
(BB, PPU, Iodine, HydroCor)

Somatostatin: Octreotide
Dopamine analogue
GF antagonist

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What causes Pts to develop jaundice during thyroid storms

When Tx Pts w/ DM and already on PO meds, what additional medication regiment is preferred

? is the MC pituitary adenoma and ? Tx has the most efficacy

Hepatic hypoxia d/t peripheral O2 consumption and congestion 2/2 high output HF

Continue PO meds, add long acting insulin

Prolactinoma- Carbergoline > Bromocriptine (dopamine agonists)

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BB MOA during hyperthyroid

PTU MOA during hyperthyroid

Methimazole MOA during hyperthyroid

Dec sympathetic activity, dec T4-3 conversion

Blocks thyroid hormone synthesis, dec T4-3 conversion

Blocks thyroid hormone synthesis

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Iodine MOA during hyperthyroidism

Steroid MOA during hyperthyroidism

What PE finding is more likely suggestive of hypothyroid

Inhibits thyroid hormone release

Dec peripheral T4-3 conversion and adrenal insufficiency

Dec DTR relaxation

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Name of the procedure for transphenoid resection of pituitary tumors

3 types of vision loss and location of mass

Hardy

L eye blind: L optic nerve

Bitemporal hemianopia: chiasm compression

Homonymous hemianopia: L cerebrovascular

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MC precipitating event to thyroid storms ? presenting factor is most predictive of mortality during myxedema coma What are the four stages of TSH, T3, T4 during De Quervains thyroiditis

Infection Severe hypothermia 1: Dec, Inc Inc 2: N N N 3: Inc Dec Dec 4: N N N

Why is cholestyramine given after thyroid storms Addisons two AKAs How is a Thyroid Storm 2/2 exogenous hormone abuse Tx

Dec enterohepatic recirculation of thyroid hromone Primary adrenal insufficiency, Hypocortisolism BB, Dexamethasone

? DM meds are c/i in Pts w/ Hx of pancreatitis MOA of Bisphosphonates for HyperCa MOA of Calcitonin for HyperCa

GLP-1s: -tides Inhibit Ca release from bone Inhibit bone resorption

What needs to be avoided when Tx HyperCa When is dialysis indicated What are the 4 cells found in the Islets of Langerhans and what does each release

Thiazides >18mg A: glucagon B: insulin D: somatostatin Epsilon: ghrelin

Pentad for Dx of Hashimotos Define Myxedema Coma How do Pts present w/ this

Inc TSH, Low T4 + anti-peroxidase Abs + anti-thyroglobulin Abs Hypothyroidism decompensating metabolic/mental status Bradycardic AMS Hypo-temp, tension

How are Myxedema Comas Tx If TSH dose is increased during hypothyroid Tx, when are Pts f/u What is the first/initial screening test for Pts w/ RFs for Pheos

Hydrocortison w/ Levo q6wks until normal TSH range Plasma fractionated metanephrines

What medication is recommended for Dm Tx when Metformin is C/i Primary Hypogonadism lab results Secondary Hypogonadism lab results

Sufonylurea: Glipizide Inc FSH/LH, dec T Low/Norm FSH/LH Dec T

? are the two MC polyneuropathies What are the two MCC of this MC ? Sx suggests a CNS d/o

Chronic, axonal injury DM, Uremia Spasticity d/t upper motor neuron involvement

Two major s/e of using Sulfonylureas for DM Tx ? DM emergency has a higher mortality rate Pt presentation for Pituitary Apoplexy and initial Tx

Hypoglycemia, Weight gain HHS Sudden HA, N/V, 2* Adrenal insufficiency, HyperK, HypoGlu; Tx: Hydrocortisone

Pts w/ recurrent hypoglycemic episodes while taking Glimepiride need ? med What can cause DM A1c levels to be artificially low Initial and test of choice to for suspected Addisons

Octreotide: inhibits glucose stimulated insulin release to prevent hypoglycemia Hemoglobinopathies: inc RBC turnover, dec life span Initial: Morning serum cortisol Toc: rapid ACTH stim test

ADA recommends screening DMT2 in ? populations Primary Hyperaldosteronism Is AKA and presents as ? What meds can be used for Tx

BMI <25 and Triglycerides >250 Conn Dz: aldosterone producing adenoma HTN HypoK, Met alkalosis Spironolactone/Eplerenon; Adrenalectomy

MC type of thyroid Ca ? type has a poor prognosis How would Growth Hormone Deficiency post-head trauma present

Papillary Anaplastic Low GH, IGF-1, IGF binding protein

How is Growth Hormone Deficiency Dx MCC of Cushing Syndrome MC Endogenous cause is ?

Low IGF-1 Insulin tolerance test GHRH-arginine test Exogenous, Iatrogenic from long term CCS therapy Cushing Dz: excessive ACTH secretion

Red flags for thyroid nodule

Size >4cm hard/fixed Invasive Sx; dysphagia, hoarse Rapid growth FamHx Age <20, >65 Radiation Male

ACTH/Cortisol trends between Primary/Secondary/Tertiary d/os What would biopsy results show in Hashimotos Define Riedels Thyroiditis

Primary: opposite 2/3ry: same Lymphocytic infiltration w/ germinal and Hurthle cells- enlarged epithelial cells w/ eosinophilic granular cytoplasm Rock hard, rapidly growing thyroid nodule w/ poor movement during swallowing

How is Riedel's Thyroiditis Dx What are the only two thyroid nodules that present as "rock hard"? MC presentation of Graves Dz

IgG4 serum levels Anaplastic Ca, Riedels thyroiditis Afib

Risk of PTU during Hyperthyroidism Tx First/Second line Tx for Central DI How is Nephrogenic DI Tx

Liver toxicity/failure DDAVP, Carbamazepine, Chlorpropramide Hydrochlorothiazide, Indomethacin, Amiloride

How does Cretinism present These Pts are at inc risk for developing ? later in life Then Tx w/ PO Thyroxine, pt may develop ? d/t meds

Birth hypothyroidism: hypotonia, coarse facial features, wide sutures, umbilical herniea NHL Papillary Ca

Role of Aldosterone Function of Cortisol Adrenal crisis are caused by ?

Na reabsorption, K excretion Stims gluconeogenesis- inc protein break down and inc FA mobilization while dec ImmSystem Insufficient cortisol

Primary Adrenal Insufficiency Secondary Adrenal Insufficiency Tertiary Adrenal Insufficiency

Addisons; autoimmune induced dec cortisol secretion causing inc ACTH Dec ACTH from pituitary causing low low ACTH and cortisol levels (adenoma, d/c steroids) Dec CRH induced low ACTH and cortisol

Initial Dx testing for Primary Adrenal Insufficiency include ? What meds are used in sequence for Tx Lab result triad for Cushing's Syndrome

8am serum cotisol w/ plasma ACTH levels then, High dose ACTH stim test Hydrocortisone- 1st, Fludrocortisone- Addison's only Inc cortiosl/aldosterone (Na reabsorb- HTN), dec K (Cushing Dz- inc ACTH from pituitary adenoma)

How is Cushing's Syndrome Dx What are the three etiologies of Cushing's Syndrome

24hr urine w/ low dose Dexameth suppression High dose suppression: Dec ACTH- adrenal tumor Norm/Inc ACTH- ectopic ACTH tumor Pituitary tumor: inc ACTH, Inc Cortisol Adrenal tumor: Dec ACTH, Inc Cortisol Ectopic ACTH: Inc ACTH, Inc Cortisol; (SCLCa) won't respond to Dexameth suppression test

Cushing's Syndrome high dose result interpretation How is Cushing's Syndrome Tx How is Cushings Dz Tx

Pituitary: dec ACTH, dec cortisol Adrenal: dec ACTH, inc cortisol (no change) Ectopic: inc ACTH, inc cortisol Ectopic/Adrenal: resection or Ketoconazole Transphenoidal surgery

Gigantism/Acromegaly is caused by pituitary adenoma releasing GH or non-pituitary tumor releasing ? How are non-operable Pts Tx Secondary Adrenal Insufficency lab results

GHRH Octreotide, Lanreotide Dec ACTH, cortisol; Normal aldosterone

DEXA categories MOA of Bisphosphonates Dawn Phenomenon and Syomogyi Effect

Penia: -1 - -2.4 Porosis: ≤-2.5 Sev: ≤-2.5 w/ Fx Dec bone resorption to preserve bone mass D: Dec insulin sensitivity, surge of regulatory hormones; inc bed time insulin/avoid bedtime snack S: hypo to hyper glycemia d/t GH, inc bedtime insulin/take snack 3AM dose; rises at 3AM= Dawn; Low= Somogyi

Rapid Acting insulin Short Acting insulin Intermediate Acting insulin Long Acting insulin

Lispro, Aspart, Glulisine: 5-15, 45-75, 2-4hrs; same time as meal Regular: 30min, 2-4hrs, 5-8hrs; <60min prior to meal NPH, Lente; 2hr, 4-12hr, 8-18hr; covers half day/night, often used at bedtime Detemir, Glargine: 2h, 3-9h, 6-24hrs; 2hr, none, >20hrs

Only insulin w/out peak effect Which one can cover one full day What types should not be mixed w/ other types of insulin

Glargine Detemir Long Acting

Hypoglycemia in non-DM can be screened for w/ ? test How is severe hypoglycemia Tx Paget's MC affects ? part of the body

C-peptide: elevation w/ endogenous insulin production Bolus D50 or Glucagon Femur Lung Pelvis Skull

How is Paget's identified on PE What form of Ca are Pts prone to How is this Dx

Warm extremities, Deafness Osteosarcoma Inc Alk Phos, X-ray lytic lesion/thick cortices

How is Paget's Tx Define Hyperparathyroid Dz What are the three types by etiology

Bisphosphonates and Calcitonin Excess PTH secretion increasing Ca levels (Sxs tart at 12) Primary: parathyroid adenoma (Inc PTH/Ca, Dec Phos) Secondary: MC d/t CKDz (N/Dec Ca, Inc Phos/PTH) Tertiary: PTH produced regardless of Ca (all inc)

Triad of Hypoparathyroidism What are the 3 PE signs How are Pts x

Dec Ca/PTH, Inc phosphate Chvostek's, Trousseaus, Inc DTRs Vit D, Ca, Synthetic PTH Tetany= IV Ca gluconate

What two lab results may be seen w/ Dx of Hypothyroidism What are the 3 P's of MEN 1 Define MEN 2

Normo-Normo anemia, High cholesterol (primary) Overactive exocrine glands: Hyperparathyroidism- MC Pancreatic tumors- 2nd MC Prolactinomas Overactive endocrine gland d/t RET proto-oncogene: Medullary ca, Pheo, Neuroma, Marfanoid habitus

What presentation can hint at MEN 2 Dx ? is the MC tumor of the pituitary What lab results would be seen w/ this MC

Medullary thyroid ca in infancy Prolactinoma- adenoma of lactotroph cells Inc prolactin, Dec FSH/LH

What are the etiologies of SIADH What does this cause to occur How are Pts Tx by severity

Excess ADH release d/t: CNS: MC; d/t subarachnoid hemorrhage Pulm: SCLCa Dec serum osmolality, inc urine osmolality Mild: water restriction Mod-Sev: AHD receptor antagonist (Coni/Tol-vaptan) Sev: IV hypertonic saline w/ Furosemide

How is Chronic SIADH Tx MC type of thyroid Ca Thyroid Ca w/ distant mets more common

Demeclocycline Papillary after radiation exposure Follicular- 2nd MC, incidence w/ iodine deficiency; Lung>Liver>Brain>Bone

Medullary thyroid Ca is d/t ? genetic mutation and will have ? lab result What marker is used to track for recurrence after total thyroidectomy MC type of thyroid nodule

RET mutation, Inc calcitonin Calcitonin Follicular/Colloid- rapid growth w/ no movement during swallowing

What med is avoided during Tx of thyroid storms MCC of suppurative thyroiditis How is this Dx for Tx planning

ASA- displaces thyroid hormones off of carrier proteins Staph A- F/C/pain worse w/ extension, relieved w/ flexion Leukocytosis, Inc ESR, FNA w/ Gram stain

What are the only two painful thyroid conditions What types of tumors release ACTH to induce Cushings Syndrome

Subacute (Granulomatous, Dequervain) Suppurative thyroiditis Small Cell Lung Ca

Cushings Syndrome dexamethasone etiologies and suppression test results

Etiology: Pituitary tumor: inc ACTH, inc Cortisol Adrenal tumor: dec ACTH, inc Cortisol Ectopic ACTH: inc ACTH, inc Cortisol Low dose suppression: Pituitary: inc ACTH, inc Cortisol Adrenal: dec ACTH, inc Cortisol Ectopic: inc ACTH, inc Cortisol High dose suppression Pituitary: dec ACTH, dec Cortisol Adrenal: dec ACTH, inc Cortisol Ectopic: inc ACTH, inc Cortisol