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PPP ROSH- Endo Flashcards

1
Q

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

A

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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2
Q

Hyperthyroid

Sub-clinical hyperthyroid

Central hypothryoidism

A

Low TSH, High T4/3

Low TSH, Normal T4/3

Low TSH, T3/4

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3
Q

Subclinical hypothyroid

Primary hypothyroid

TSH producing adenoma

A

High TSH, Norm/Norm

High TSH, low/low

High High High

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4
Q

How is Hashimotos Dx confirmed

What layer of adrenal gland do Pheos arise from

How are Pheos Dx

A

Thyroid peroxidase or,
Thyroglobulin Abs

Medulla

Fractionated metanephrine, catecholamines in 24hr urine
Plasma fractionated metanephrine

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5
Q

Graves Dz is AKA ?

What causes this Dz

What is the classic triad

A

Toxic diffuse goiter- MCC of hyerthyroidism

Ab to thyroid hormone receptors

Pretibial myxedema
Exophthalmos
Diffuse goiter

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6
Q

What causes the exophthalmos and pretibial edema in Graves Dz

Only DM medicatin proven to reduce mortality

What test differs DMT1 from DMT2

A

Glycosaminoglycan accumulation

Metformin

C-peptide: absent in DMT1

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7
Q

Lab results for SIADH

Lab results for dehydration

Lab results for DI

A

Dec serum NA/Osmolality; Inc urine osmolality

All three inc’d

Inc serum Na/Osm, dec urinary osm

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8
Q

Biguanides

Sulfonylureas

Thiazolidinediones

A

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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9
Q

Meglitinides

A-glucosidase inhibitors

DPP-4 inhibitor

A

-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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10
Q

Glucagon-like peptide 1 agonists

Insulin

Gliflozin

A

-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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11
Q

Criteria for Dx DMT2

Pathophys of Acromegaly

What is the initial and confirmatory Dx test

A

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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12
Q

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

A

Inc anti-microsomal/thyroglobulin Ab titers

Queen Anne

Denosumab

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13
Q

Define Androgen Insensitivity Syndrome

How do Pts appear on PE

MOA of Metoclopramide

A

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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14
Q

Primary adrenal Insufficiency lab results

How are Pts Tx during crisis

What is the best Dx test for adrenal insufficiency

A

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

Hydrocortisone

Serum cortisol

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15
Q

What DM meds can lead to Hypoglycemia

E+ abnormality seen w/ rhabdo

? is the most important lab for determining thyroid function

A

Sulfonylureas
Insulin
Neglitinides

Hyper K

Free T4- active form of thyroxine

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16
Q

? PE finding aids w/ Dx of hyperthyroidism

What diabetic meds work through the incretin system

What are the two naturally occurring incretins

A

Anterior neck bruit

DPP4 inhibitor- gliptins

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

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17
Q

Define the Incretin Effect

How are the two naturally occurring incretins cleared from the body

Define Chronic Autoimmune Thyroiditis

A

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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18
Q

DKA vs HHS levels

How does Tx differ by K levels

A

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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19
Q

Peds formula for Hypoglycemia fluid replacement

How is anion gap calculated

A

(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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20
Q

? 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

A

TSH

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

Somatostatin: Octreotide
Dopamine analogue
GF antagonist

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21
Q

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

A

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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22
Q

BB MOA during hyperthyroid

PTU MOA during hyperthyroid

Methimazole MOA during hyperthyroid

A

Dec sympathetic activity, dec T4-3 conversion

Blocks thyroid hormone synthesis, dec T4-3 conversion

Blocks thyroid hormone synthesis

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23
Q

Iodine MOA during hyperthyroidism

Steroid MOA during hyperthyroidism

What PE finding is more likely suggestive of hypothyroid

A

Inhibits thyroid hormone release

Dec peripheral T4-3 conversion and adrenal insufficiency

Dec DTR relaxation

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24
Q

Name of the procedure for transphenoid resection of pituitary tumors

3 types of vision loss and location of mass

A

Hardy

L eye blind: L optic nerve

Bitemporal hemianopia: chiasm compression

Homonymous hemianopia: L cerebrovascular

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25
Q

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

A

Infection

Severe hypothermia

1: Dec, Inc Inc
2: N N N
3: Inc Dec Dec
4: N N N

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26
Q

Why is cholestyramine given after thyroid storms

Addisons two AKAs

How is a Thyroid Storm 2/2 exogenous hormone abuse Tx

A

Dec enterohepatic recirculation of thyroid hromone

Primary adrenal insufficiency,
Hypocortisolism

BB, Dexamethasone

27
Q

? DM meds are c/i in Pts w/ Hx of pancreatitis

MOA of Bisphosphonates for HyperCa

MOA of Calcitonin for HyperCa

A

GLP-1s: -tides

Inhibit Ca release from bone

Inhibit bone resorption

28
Q

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

A

Thiazides

> 18mg

A: glucagon
B: insulin
D: somatostatin
Epsilon: ghrelin

29
Q

Pentad for Dx of Hashimotos

Define Myxedema Coma

How do Pts present w/ this

A

Inc TSH, Low T4
+ anti-peroxidase Abs
+ anti-thyroglobulin Abs

Hypothyroidism decompensating metabolic/mental status

Bradycardic
AMS
Hypo-temp, tension

30
Q

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

A

Hydrocortison w/ Levo

q6wks until normal TSH range

Plasma fractionated metanephrines

31
Q

What medication is recommended for Dm Tx when Metformin is C/i

Primary Hypogonadism lab results

Secondary Hypogonadism lab results

A

Sufonylurea: Glipizide

Inc FSH/LH, dec T

Low/Norm FSH/LH
Dec T

32
Q

? are the two MC polyneuropathies

What are the two MCC of this MC

? Sx suggests a CNS d/o

A

Chronic, axonal injury

DM, Uremia

Spasticity d/t upper motor neuron involvement

33
Q

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

A

Hypoglycemia, Weight gain

HHS

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

34
Q

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

A

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

35
Q

ADA recommends screening DMT2 in ? populations

Primary Hyperaldosteronism Is AKA and presents as ?

What meds can be used for Tx

A

BMI <25 and Triglycerides >250

Conn Dz: aldosterone producing adenoma
HTN HypoK, Met alkalosis

Spironolactone/Eplerenon; Adrenalectomy

36
Q

MC type of thyroid Ca

? type has a poor prognosis

How would Growth Hormone Deficiency post-head trauma present

A

Papillary

Anaplastic

Low GH, IGF-1, IGF binding protein

37
Q

How is Growth Hormone Deficiency Dx

MCC of Cushing Syndrome

MC Endogenous cause is ?

A

Low IGF-1
Insulin tolerance test
GHRH-arginine test

Exogenous, Iatrogenic from long term CCS therapy

Cushing Dz: excessive ACTH secretion

38
Q

Red flags for thyroid nodule

A

Size >4cm hard/fixed
Invasive Sx; dysphagia, hoarse
Rapid growth

FamHx
Age <20, >65
Radiation
Male

39
Q

ACTH/Cortisol trends between Primary/Secondary/Tertiary d/os

What would biopsy results show in Hashimotos

Define Riedels Thyroiditis

A

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

40
Q

How is Riedel’s Thyroiditis Dx

What are the only two thyroid nodules that present as “rock hard”?

MC presentation of Graves Dz

A

IgG4 serum levels

Anaplastic Ca, Riedels thyroiditis

Afib

41
Q

Risk of PTU during Hyperthyroidism Tx

First/Second line Tx for Central DI

How is Nephrogenic DI Tx

A

Liver toxicity/failure

DDAVP, Carbamazepine, Chlorpropramide

Hydrochlorothiazide, Indomethacin, Amiloride

42
Q

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

A

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

NHL

Papillary Ca

43
Q

Role of Aldosterone

Function of Cortisol

Adrenal crisis are caused by ?

A

Na reabsorption, K excretion

Stims gluconeogenesis- inc protein break down and inc FA mobilization while dec ImmSystem

Insufficient cortisol

44
Q

Primary Adrenal Insufficiency

Secondary Adrenal Insufficiency

Tertiary Adrenal Insufficiency

A

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

45
Q

Initial Dx testing for Primary Adrenal Insufficiency include ?

What meds are used in sequence for Tx

Lab result triad for Cushing’s Syndrome

A

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)

46
Q

How is Cushing’s Syndrome Dx

What are the three etiologies of Cushing’s Syndrome

A

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

47
Q

Cushing’s Syndrome high dose result interpretation

How is Cushing’s Syndrome Tx

How is Cushings Dz Tx

A

Pituitary: dec ACTH, dec cortisol
Adrenal: dec ACTH, inc cortisol (no change)
Ectopic: inc ACTH, inc cortisol

Ectopic/Adrenal: resection or Ketoconazole

Transphenoidal surgery

48
Q

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

A

GHRH

Octreotide, Lanreotide

Dec ACTH, cortisol; Normal aldosterone

49
Q

DEXA categories

MOA of Bisphosphonates

Dawn Phenomenon and Syomogyi Effect

A

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

50
Q

Rapid Acting insulin

Short Acting insulin

Intermediate Acting insulin

Long Acting insulin

A

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

51
Q

Only insulin w/out peak effect

Which one can cover one full day

What types should not be mixed w/ other types of insulin

A

Glargine

Detemir

Long Acting

52
Q

Hypoglycemia in non-DM can be screened for w/ ? test

How is severe hypoglycemia Tx

Paget’s MC affects ? part of the body

A

C-peptide: elevation w/ endogenous insulin production

Bolus D50 or Glucagon

Femur Lung Pelvis Skull

53
Q

How is Paget’s identified on PE

What form of Ca are Pts prone to

How is this Dx

A

Warm extremities, Deafness

Osteosarcoma

Inc Alk Phos, X-ray lytic lesion/thick cortices

54
Q

How is Paget’s Tx

Define Hyperparathyroid Dz

What are the three types by etiology

A

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)

55
Q

Triad of Hypoparathyroidism

What are the 3 PE signs

How are Pts x

A

Dec Ca/PTH, Inc phosphate

Chvostek’s, Trousseaus, Inc DTRs

Vit D, Ca, Synthetic PTH
Tetany= IV Ca gluconate

56
Q

What two lab results may be seen w/ Dx of Hypothyroidism

What are the 3 P’s of MEN 1

Define MEN 2

A

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

57
Q

What presentation can hint at MEN 2 Dx

? is the MC tumor of the pituitary

What lab results would be seen w/ this MC

A

Medullary thyroid ca in infancy

Prolactinoma- adenoma of lactotroph cells

Inc prolactin, Dec FSH/LH

58
Q

What are the etiologies of SIADH

What does this cause to occur

How are Pts Tx by severity

A

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

59
Q

How is Chronic SIADH Tx

MC type of thyroid Ca

Thyroid Ca w/ distant mets more common

A

Demeclocycline

Papillary after radiation exposure

Follicular- 2nd MC, incidence w/ iodine deficiency; Lung>Liver>Brain>Bone

60
Q

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

A

RET mutation, Inc calcitonin

Calcitonin

Follicular/Colloid- rapid growth w/ no movement during swallowing

61
Q

What med is avoided during Tx of thyroid storms

MCC of suppurative thyroiditis

How is this Dx for Tx planning

A

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

62
Q

What are the only two painful thyroid conditions

What types of tumors release ACTH to induce Cushings Syndrome

A

Subacute (Granulomatous, Dequervain)
Suppurative thyroiditis

Small Cell Lung Ca

63
Q

Cushings Syndrome dexamethasone etiologies and suppression test results

A

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

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