Rahhal Study guide / Lecture Review Flashcards
What are the 3 sulfonylureas to know??
glipizide, glyburide, glimepiride
What is the action of the sulfonylureas?
insulin secretagogues- lead to glucose independent insulin release (can cause hypoglycemia - eat when taking it)
Side effects of sulfonylureas
can cause hypoglycemia - eat when taking it
How do you monitor nephropathy in diabetes patients?
by checking urine microalbumin every year.
how do you treat diabetic neuropathy?
-ACE inhibitor or ARB
What are the “statin benefit groups”? -4
- all people with atherosclerotic cardiovascular disease
- all people with LDL >190
- People 40-75, with LDL>70, and Diabetes
- People 40-75, LDL >70, without diabetes or heart disease, but 10 year risk of atherosclerotic CVD is >7.5% (use calculator.
What is the differential for PTH independent hypercalcemia? -5 categories
- malignancy/ cancer - overproduction of PTH-rP/ 1,25 OH D
- granulomatous disease - production of 1,25OH D
- drug induced (vitamin D toxicity, vitamin A toxicity)
- immobilization for long time
0milk alkali syndrome (excess Ca intake
what is the most common cause of hypercalcemia in inpatients in the hospital?
malignancy/cancer
acute treatment of hypercalcemia
fluids to dilute the serum calcium, induce urine excretion of Ca and correct dehydration.
Differential diagnosis of hypocalcemia with elevated PTH.
- Calcium deficiency
- vitamin D deficiency
Differential of hypocalcemia with low or normal PTH.
hypoparathyroidism
treatment for hypoparathyroidism.
- oral calcium
- 1,25 OH vit D - active form since there is no PTH to activate vitamin D in the kidney.
What is the treatment goal for hypoparathyroidism?
Ca at the low end of normal - any higher would increase the urine calcium and risk kidney stones and nephrocalcinosis)
There is a risk for these since in the absence of PTH, there will be increased urine Ca, since it normally increases reabsorption of calcium in the kidney.)
In clinic, you see a thyroid nodule. You get a TSH. It is high. What is the next step?
Fine Needle Aspiration of the tumor.
If the serum TSH is normal or high, you need to do FNA, since malignant nodules typically don’t produce thyroid hormone.
In clinic, you see a thyroid nodule. You get a TSH. It is low. What is the next step?
Get a radionuclide scan.
If it is cold (no increased uptake), then get a Fine Needle Aspirate test, to check for cancer.
If it is hot (increased uptake) it is not malignant. Treat hyperthyroidism
Cushing’s disease is?
hypercortisolism (can be due to many causes)
What are the symptoms of Cushing disease (elevated cortisol)
- weight gain
- round face
- striations
- thin skin/bruising
- mood disturbances, insomnia
- bone loss/fractures.
- hypertension
- diabetes/hyperglycemia
NOTE: ectopic cushings (cancer) may present with weight loss due to malignancy/ rapid onset.
What is the treatment for hypoparathyroidism?
Calcium + calcitriol (active vitamin D, since kidney can’t activate it without parathyroid hormone.)
T/F: proptosis (exopthalmos) and lid retraction are hyperthyroid signs associated exclusively with graves disease.
False.
proptosis is exclusively in Graves, but lid retraction happens in all hyperthyroid cases, due to increased sympathetic activity.
Three types of thyroiditis
- silent (painless)
- postpartum
- subacute (painful)
“lid lag” is seen in which condition?
all types of hyperthyroidism. See whites of eye when you shouldn’t
You see a case: high T4, low TSH. you posit that it is hyperthyroidism of thyroid origin. What’s on the differential? What’s the next step?
DDx
- graves (most common)
- thyroiditis
- nodular thyroid disease (single adenoma or multinodal goiter)
History will likely tell you the difference. If unsure, do radioiodine uptake test. If confident in diagnosis, treat.
Difference b/t a radioiodine uptake test and a radioiodine scan
Uptake gives you numbers - tells you the function of the gland
Scan tells you where uptake is increased/decreased, “geography” of the gland.
What is a normal thyroid uptake result?
-usually the thyroid will take up 25% of the iodine
Thyroid uptake results in Graves
> 25% (overfunctioning)
Thyroid uptake results in thyroiditis.
uptake will be
Uptake result in nodular hyperthyroidism
> 25% (like Graves)
Usefulness of radioactive thyroid uptake vs radioactive thyroid scan.
uptake differentiates b/t graves/goiter (high) vs. thyroiditis (low)
scan differentiates b/t graves (diffuse uptake) and goiter (nodular uptake))
Name 3 tests you can do to screen for Cushing’s.
- 24 hr urine cortisol
- late night salivary cortisol
- low dose dexamethasone suppression.
What are the main signs of increased prolactin?
- amenorrhea
- breast discharge
- infertility
If you see high prolactin, what labs should you get?
- pregnancy test
- TSH (hypothyroid)
- creatinine (renal failure)
- look at her medication list.
DONT get a pituitary MRI before these labs!!
Why does elevated prolactin cause amenorrhea?
high prolactin inhibits GnRH, which lowers LH / FSH, which inhibits gonadal function (inhibits estrogen, ovulation in woman.)
What is on the differential for high prolactin (possible causes)
- pregnancy
- severe hypothyroidism
- renal failure
- meds (respiridone and others)
- pituitary tumor.
-Order labs before getting pituitary MRI.
What is the best treatment for pituitary tumors?
Dopamine agonists (Cabergoline/bromocriptine)
These will decrease prolactin synthesis, cell multiplication, reducing the tumor size. (95% EFFECTIVE at achieving normal prolactin/ reducing tumor)
-surgery on pituitary carries high risk. Only do it if it is impacting the optic chiasm, etc.
Side effects of dopamine agonists
Nausea = main side effect.
T/F: Prolactinomas, and tumors secreting TSH are the only pituitary tumors for which medical treatment is preferred.
False. Prolactinomas are the only ones in which medical treatment works well. All other tumors require surgical resection.
When is it possible to treat a prolactinoma with sex hormone replacement instead of prolactin?
if the tumor is
What are the 4 I’s that can cause diabetic ketoacidosis?
- Insulin therapy stopped
- infection
- inflammation
- infarction
Name the 4 things that happen due to the absence of insulin that contribute to DKA.
- decreased glucose uptake bby muscle and fat
- increased gulconeogenesis in the liver
- increased amino acid loss (turned into glucose by the liver)
- increased lipolysis (fatty acids turned into ketones by liver—-> DKA.
What are the three long-acting insulin drugs?
- glargine (once/day)
- detemir (2x/day)
- NPH (2x/day)
What kind of diet should Type 2 diabetics go on?
a diet limited in calories (weight) and carbs (glucose)
T//F Exercise increases insulin sensitivity
True
T/F: Tighter glycemic control (hba1c
False. Only in type 1.
goal BP for diabetics
140/90 for all,
if nephropathy 130/80(slows progression).
What are the causes of secondary hypercholesterolemia?
aromatase inhibitors
-hypothyroidism
how do you check for growth hormone excess?
Check IGF-1
Which five hormones would be affected by panhypopituitaryism?
- TSH
- ACTH
- LH/FSH
- GH (leading to decreased IGF-1)
Increased prolactin!!
How does a prolactinoma present in men and women?
men - hypogonadism
women - galactorrhea
