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First Aid Step 2 🐰 > Rapid Review Endocrine > Flashcards

Rapid Review Endocrine Flashcards

1
Q

Most common cause hypothyroidism

A

Hashimotos

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2
Q

Lab findings in Hashimotos

A

High TSH, low T4, anti-TPO ab, antimicrosomal ab

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3
Q

Exopthalmos, pretibial myxedema, decreased TSH, thyroid bruits

A

Graves

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4
Q

Most common cause Cushing’s syndrome

A

Iatrogenic corticosteroid administration

2nd: Cushing’s disease

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5
Q

Pt presents w/ signs hypocalcemia, high P, low PTH

A

Hypoparathyroidism

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6
Q

Stones, bones, groans, psychiatric overtones

A

S/S hypercalcemia

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7
Q

Pt c/o HA, weakness, polyuria; exam: HTN, tetany; Labs: hyperNa, hypoK, metabolic alkalosis

A

Primary hyperaldosteronism (due to Conn’s syndrome of bilateral adrenal hyperplasia)

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8
Q

Pt presents with tachycardia, wild BP swings, HA, diaphoresis, altered mental state, sense of panic

A

Pheochromocytoma

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9
Q

First in Tx of pheochromocytoma

A

Alpha antagonist: phentolamine or phenoxybenzamine

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10
Q

Pt w. Hx lithium use presents with copious amounts of dilute urin

A

Nephrogenic DI

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11
Q

Tx central DI

A

DDVAP and free water restriction

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12
Q

Postop pt with significant pain presents with hyponatremia and normal volume status

A

SIADH due to stress

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13
Q

Antidiabetic agent associated with lactic acidosis

A

Metformin

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14
Q

Pt presents with weakness, N/V, weight loss, new skin pigmentation. Labs show hyponatremia and hyperkalemia. Tx

A

Primary adrenal insufficiency- Addision’s

Tx: glucocorticoids, mineralocorticoids, IVF

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15
Q

Goal HgA1c for DM

A

<7.0

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16
Q

Beta blockers CI in DM

A

Mask hypoglycemia Sx

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17
Q

HLA association with DM I

A

HLA DR 3,4,DQ

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18
Q

4 ways to dx DM

A
  1. Random plasma glc >=200 with sx DM
  2. FPG>=126 on 2 occasions
  3. Plasma glc >=200 after 74 g OGT
  4. HgA1c >=6.5^
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19
Q

Mechanism biguanides

Adverse effects

A

METFORMIN
Dec hepatic gluconeogenesis, inc insulin activity, reduce LDL and raise HDL

GI, lactic acidosis, dec b12 absorption,

CI Renal and liver insufficiency

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20
Q

Sulfonylureas
Mechanism
Adverse effects

A

Glyburide, glimepiride, glipizide
Stimulate insulin release, reduce glucagon, inc insulin binding on tissue receptors

Adverse: hypoglycemia

CI: renal and hepatic insufficiency due to in risk hypoglycemia

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21
Q

Thiazolidinediones
Mechanism
Adverse

A

“Glitazones”
Increase tissue uptake of glc, dec gluconeogenesis

Adverse: weight gain, fluid retention (CI CHF), inc LDL, rare liver toxicity

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22
Q

Oral hypoglycemic associated with increased risk MI

A

Rosiglitazone

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23
Q

DPP IV inhibitors
Mechanism
Adverse effects

A

“Gliptin”
Inhibits degradation of incretin–>dec glucagon, inc insulin, delays gastric emptying

Adverse: diarrhea, constipation, edema

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24
Q

Incretin mimetics
Mechanism
Adverse

A

Exenatide, liraglutide
Agonizes GLP 1 receptor- same as DPP IV inhibitors

Adverse: mild weight loss, n, hypoglycemia, GI, risk pancreatitis

SC injection!!

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25
Q

Alpha glucosidase inhibitors

A

Acarbose
Decreases GI absorption of starch and disaccharides

Adverse: diarrhea flatulence, GI

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26
Q

Meglitinides
Mechanism
Adverse

A

Stimulate insulin release

Adverse: hypoglycemia, expensive with little added benefit over sulfonylureas

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27
Q

HHNS vs DKA labs

A

HHNS: glc >800. No acidosis
DKA: glc 300-800, dec Na, normal or inc K (total body K decreased), dec P, anion gap metabolic acidosis, serum and urine ketones

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28
Q

2 types diabetic retinopathy

Tx

A

Background retinopathy: no neovascularization, tx by controlling risks
Proliferation retinopathy: neovascularization which increases risk hemorrhage, tx photo coagulation

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29
Q

EM findings in diabetic nephropathy

A

Kimmelstiel Wilson nodules in glomeruli

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30
Q

Changes of diabetic kidney

A

Inter capillary glomerulosclerosis, mesangial expansion, BM degeneration

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31
Q

3 types diabetic neuropathy and define S/S

A
  1. Sensory: stocking glove, pain and vibration
  2. Motor: weakness or loss coordination
  3. Autonomic: postural hypotension, impotence, incontinence, gastroperesis
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32
Q

Infections associated with onset DM I

A

Rubella
Coxsackie
Mumps
-Destroy beta islet cells

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33
Q

What increasesTBG? Decreases

What happens to T4 levels

A

Pregnancy, OCP increase; nephrotic syndrome and androgen use decreases TBG

Total will either increase or decrease with amt of TBG, amt of free T4 always same

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34
Q

Painful goiter, mild hyperthyroidism Sx, neck pain, fever, increased ESR, decreased uptake on thyroid scan

A

Subacute thyroiditis

de Quervain

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35
Q

Increased uptake on thyroid scan

A 
Graves
Toxic adenoma (Plummer), toxic multinodular goiter
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36
Q

anti-TPO

A

Hashimoto

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37
Q

Antithyroglobulin

A

Hashimoto

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38
Q

2 complications of thyroid surgery

A

Hoarseness: recurrent laryngeal
Hypocalcemia: hypoparathyroidism 2/2 surgery

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39
Q

Indications that nodule is malignant

A

Cold
Male
Age 20-60
Solid on US

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40
Q

Best prognosis thyroid cancer

A

Papillary

41
Q

Worst prognosis thyroid cancer

A

Anaplastic

42
Q

Parafollicular C cells

A

Medullary

43
Q

Columnar gland cells

A

Papillary

44
Q

Undifferentiated cells

A

Anaplastic

45
Q

Most common thyroid cancer

A

Papillary

46
Q

Makes calcitonin

A

Medullary

47
Q

Increased calcium with decreased PTH

A

Hyperparathyroidism 2/2

  • Malnutrition
  • Malabsorption
  • Renal disease
48
Q

Inc Ca, Dec P, Inc PTH

A

hyperparathyroidism

49
Q

Dec Ca, Inc P, Dec PTH

A

HYpoparathyroidism

50
Q

Dec Ca, Inc P, Inc PTH

A

Pseudohypoparathyroidism

51
Q

Pseudo vs hypoparathyroidism

A

Pseudo: nonresposiveness to PTH
Hypo: not making enough

52
Q

Associated pseudohypoparathyroidism

A

Albright Hereditary Osteodystrophy

53
Q

Chvostek’s

A

Tap facial n cause spasm

54
Q

Trousseau

A

Carpal spasm with BP cuff inflation

55
Q

Drugs block DA synthesis

A 
Haloperidol
Risperdone
Verapamil
Phenothiazines
Methyldopa
Verapamil
56
Q

Major complication acromegaly

A

Cardiac failure

57
Q

Order of hormone def in hypopituitarism

A

GH–>LSH/FH–>TSH–>Prolactin–>ACTH

58
Q

Main product of zona glomerulosa

A

ACTH - conserve Na

59
Q

Main product zona fasciculata

A

Cortisol

60
Q

Main product zona reticularis

A

Androgens

61
Q

Function of medulla

A

Epi and NE

62
Q

Causes Cushing syndrom

A

Iatrogenic
Pituitary adenoma- Cushing disease
Paraneoplastic ACTH production
Adrenal tumor

63
Q

Dec K, INc Na, metabolic alkalosis, inc aldo:renin ratio

A

Hyperaldosteronism (Conn’s if adrenal adenoma)

64
Q

Addison vs. secondary and tertiary adrenal insufficiecy

A

Addison: AI destruction adrenal cortices (hyperpigmentation)

2nd: insufficient ACTH from pit
3rd: insufficient CRH from hypothal

ACTH inc w/ Addison, dec 2nd and 3rd
Tx ACTh analogue (cosyntropin) decreases cortisol in 2nd and 3d, not Addison

65
Q

Why is cortisol deficiency in CAH not symptomatic?

A

Adrenal hypperplasia can maintain cortisol in low to normal range

66
Q

Amenorrhea, ambiguius genitalia, HTN

A

17 alpha def

67
Q

Inc Na, dec K, dec androgens

A

17 alpha def

68
Q

Tx 17 alpha def

A

cortisol to suppress ACTH
Estrogen prog if female
Reconstructive surg if male

69
Q

Ambiguous genitalia and virilization in females
Macrogenitalia and precocious puberty in males
HYPOTENSION

A

21 alpha def

70
Q

Dec Na, Inc K, Inc androgens

A

21 alpha def

71
Q

Tx 21 alpha def

A

Cortisol to suppress ACTH
Mineralocorticoids- fludrocortisone
Reconstructive genital surgery

72
Q

Ambiguous genitalia and virilization in females
Macrogenitalia and precocious puberty in males
HTN

A

11 beta def

73
Q

Inc deoxycortisone, deoxycortisol, androgens

A

11 beta def

74
Q

Tx 11 beta def

A

Cortisol- hydrocortisone or dexamethasone

HTN Tx

75
Q

Most common def from CAH

A

21 alpha

76
Q

Pheochromocytoma rule of 10s

A 
10%:
Malignant
Multiple
Bilateral
Extra-adrenal
Children
Familial
Calcify
77
Q

Test for pheochromocytoma

A

24 hr urinary catecholamines and metanephrines - inc VMA and free metanephrines

78
Q

MEN I

A

Parathyroid hyperplasia
Pancreas or GI tumors
Pituitary dysfcn

79
Q

MEN II A

A

Medullary thyroid cancer
Parathyroid hyperplasia
Pheochromocytoma

80
Q

MEN II B

A

Mucosal neuroma
Medullary thyroid cancer
Pheochromocytoma

81
Q

Zollinger ellison
Define
Which MEN

A

Caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration
MEN I

82
Q

Congenital hypothyroid 2/2 I def or hereditary defect thyroid hormone synthesis

A

Cretinism

83
Q

Ab found in serum of DM I

A

Anti islet

Anti glutamic acid decarboxylase

84
Q

Cannot be detected on UA protein dipstick

A

Microalbuminemia

85
Q

Dawn phenomenon

A

Morning hyperglycemia due to nocturnal release hormones that increase IR and glc
Tx: increase NPH in pm

86
Q

Somogyi phenomenon

A

Rebound hyperglycemia from excess exogenous insulin; results in hypoglycemia overnight that cause hormones to be release that increase glc
Tx: decrease NPH in pm

87
Q

Metabolic syndrome

A

Need 3 of 5

  1. ABD obesity >40 M, >35 Fe
  2. TG >=150
  3. HDL =130/85 or requirement HTN meds
  4. FG>=100
88
Q

Causes primary hyperthyroidism

A 
Graves
Toxic multinodular goiter
Toxic adenoma
Amiodarine
Postpartum thyrotoxicosis
Postviral thyroiditis
89
Q

Causes primary hypothyroidism

A

Hashimoto
Iatrogenic - ablation/excision
Drugs - lithium and amiodarone

90
Q

Major complication hypothyroidism

A

myxedema coma

Tx: Levothyroxine and IV hydrocortisone

91
Q

Papillary thyroid cancer
What cells?
Prognosis

A

Papillary cells- produce thyroid hormone
Prognosis good - same as papillary
?Subtype papillary

92
Q

The Ps of thyroid neoplasm

A 
Popular is papillary:
Palpable LN
Papillae (branhing_
Pupil nuclei- Orphan Annie
Psammoma bodies 
Positive Prognosis
93
Q

Man presents increased serum calcium, normal PTH and low urinary calcium

A

Familial hypocalciuric hypercalcemia

94
Q

Labs primary vs secondary vs tertiary hyperparathyroidism

A

All inc PTH

1: inc calcium; other dec or WNL
1: dec phosphate, other inc phosphate

95
Q

Hyponatremia, eosinophilia, hyperkalemia

A

Adrenal insufficiency

Hyperkalemia only addison, not 2 or 3

96
Q

4 S’s of adrenal crisis management

A

Salt=0.9% saline
Steroids: IV hydrocortisone 100 mg q 8 hr
Support
Search for cause

97
Q

5 P pheo

A 
Pressure-BP
Pain-HA
Perspiration
Palpations
Pallor
98
Q

Ovarian tumor that secrete thyroid hormone

A

Struma ovarii

99
Q

Caused by maternal IgG autoAb

Infant presents with goiter, tachynpnea, tachycardia, cardiomegalt, diarrhea, poor weight gain 1-2 d after birth

A

Neonatal thyrotoxicosis

First Aid Step 2 🐰 (22 decks)

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