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Endocrinology > UW > Flashcards

UW Flashcards

1
Q

Drugs for neuropathic pain

A
  1. TCA (be careful in older because anti-cholinergic)
  2. anticonvuslants (gabapentin, pregabalin) (BEST)
  3. opioids
  4. capsaicin tpical
  5. lidocaine topical
    consider anticonvulstants or TCA for initial
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2
Q

radioablation for graves - SE

A
  1. permanent hypothyroidism over months to years (resolution of hyperth in 6-18 wks) (this is not happening in toxic adenoma or goiter because only the adenomas take iodine)
  2. worsening of Graves opthalmopathy due to increased of TSI (if mild: give steroids, if severe: prefer surgery)
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3
Q

Diagnostic approach of hypocalcemia

A

low Mg, medications, Recent blood transfusion (citrate)?

  • YES –> correct it
  • NO –> measure PTH
    low: surgical, autoimmune, infiltrative (metast, wilson, hemochromatosis)
    high: vit d def, renal failure, pancreatitis, sepsis, tumor lysis syndrome
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4
Q

hyperthyroidism with high TSH and high hormones - next step

A

brain MRI

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5
Q

hyperthyroidism with low TSH and high hormones - next step

A

graves signs (goiter, ophtalmopathy)?
- yes –> graves
- NO RAIU
high uptake: graves or nodular or adenoma
low uptake: measure thyroiglobulin (low: exogenous hormone, high: thyroditis or iodide exposure)

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6
Q

hyperthyroidism effect on BP

A

increased Myocardial contractility
decreased peripheral resistance
(in contrast, hypothyroidism causes hypertension due to increased peripheral resistance)

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7
Q

PAC/PRA ratio

A
  • plasma aldosteron / plasma renin concentration

- 1st test for hypertension and hypokalemia

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8
Q

best initial test for patient with DM and new toe ulcer

A

monofilament (it predicts the risk of future ulcers: higher pressure threshold)

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9
Q

toe ulcer - vascular or DM

A

arterial are usually on the tips

DM: plantar

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10
Q

diagnosis of hypercalcemia

A
  1. confirm it (repeated tests + correct for albumin)
  2. measure PTH
  3. if low PTH: measure PTHrp, vitD25, vitD1,25
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11
Q

MCC of PTH-independent malignancy

A

homural hypercalcemia of malignancy (PTHrp)

PTHrp does not induce Vit D activation

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12
Q

a cause of hypercalcemia after accidents

A

immobilization (PTH independent) due to inccreased osteoblastic resorption
(4 weeks after immobilization, but in 3 days in patients with chronic renal failure)
treatment: biphosphanates

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13
Q

MCC of death in acromegaly

A

cardiovascular disease

but decreasing of the levels rapidly reduces the risk

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14
Q

euthyroid sick syndrome

A

any patient with acute severe illness may have abnormal thyroid function test
NORMAL TSH AND T4
fall in total and free t3

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15
Q

acute vs chronic thyrotoxic myopathy

A

acute: severe distal or proximal weakness, without bulbar or resp involvement
chronic: proximal

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16
Q

DDX for hyperandrogenism in women

A
  1. PCOS 2. Acromegaly 3. Cushing
  2. Hyperprolactinemia 5. ovarian/adrenal tumors
  3. Non-classic CAH
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17
Q

hypomagnesimia mediated hypoparathyroidism vs other causes of hypoparathyroidism

A

hypoparthyroidism associated with low Mg has normal or low P

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18
Q

milki alkaly syndrome

A

it is caused by excessive intake of calcium and absorable alkali. It can be seen in patient taking calcium bicarbonate for osteoporosis.
manifestation: symptomatic hypercalcemia, met alkalosis, acute kidney injury

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19
Q

thionamides - agranoulocytosis

A

routine WBC check it is not cost effective
- if fever + sore throat –> stop the drug and check the WBCs
if less than 1000 –> stop permanently
if more than 1500 –> it is not the cause

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20
Q

DM2 - when to add insulon to metformin

A

when HBAC1 is more than 8.5%

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21
Q

the MC electrolytic abnormality in primary adrenal insufficiency

A

hyponatremia in 90%

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22
Q

following cortisol discontinuation, the axis me be abnormal up to

A

6-12 months

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23
Q

suppurative (infectious) thyroditis

A

fever erythema and severe pain, often with asymmetric goiter due to abscess formation (usually in children and immunocompromised)
USUALLY EUTHYROD

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24
Q

the main substance for gluconeogenesis

A

alanine (from proteins breakdown), glutamine (from proteins breakdown), lactate (from anaerobic), glycerol-3-P (from lipids break down)

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25
Q

alanine is converted into …. during gluconeogenesis

A

pyruvate

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26
Q

clinical suspicion of acromegaly - algorithm

A 
measure IGF-1
- normal (exclude)
- elevated --> oral glucose suppression test 
adequate GH suppression --> exclude 
inadequate GH suppression --> BRAIN MRI
if pituitary mass --> surgery 
if no mass --> search for other source
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27
Q

metabolic syndrome - features

A

3 out to 5

  1. abdominal obesity (waist more than 40 in males and 35 in females
  2. fasting glucose more than 100-110
  3. BP more than 13/8
  4. TG more than 150
  5. HDL cholesterol lower of 40 in male and 50 in women
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28
Q

how to measure corrected calcium

A

calcium + 0.8 (4-serum albumin)

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29
Q

VIPoma - clinical presentation

A
  1. watery diarrhea
  2. hypo or achrolorhydia due to low gastric acid secretion
  3. flushing, lethargy, nausea, vomiting, muscle wekaness
    PANCREATIC CHOLERA
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30
Q

VIPoma Labs

A
  1. low K+
  2. high Ca2+
  3. high hyperglycemia (increased glycogenolysis)
  4. diarreha: increased sodium + osm gap less than 50
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31
Q

VIPoma - diagnosis

A
  1. watery diarrhea with VIP level more than 75

2. abdominal CT or MRI

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32
Q

Difference in labs between insulinomas and sulfonylurea

A

in sulfo, the proinsulin is less than 20% of the total insulin immunoreactivity
the diagnosis is confirmed by sulfonylurea measurement

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33
Q

severe SE caused by PTU (but not by methimazole

A
  1. hepatic failure

2. ANCA mediated vasculitis

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34
Q

in which situations, thyroidectomy is prefered against RAI for Graves

A
  1. very large goiter
  2. severe ophtalmopathy
  3. coexisting nodule and suspicion for malignancy
  4. pregnant who cannot tolerate drugs
  5. coexisting 1ry hyperpara
  6. obstructive symptoms
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35
Q

x-ray findings of osteomalacia

A
  1. decreased bone density with thining of cortex
  2. eventual codfish vertebral bodies (concave shape)
  3. pseudofractures (Looser zones)
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36
Q

screening for DM is recommended in ….

A
  1. patients with sustained BP more than 135/80
  2. may considered in all patients over age 45
  3. additional risk for DM
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37
Q

osteolytic metastasis can cause hypercalcemia - mechanism

A

stimulation of osteoblast by cytokine production

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38
Q

paroxysms of severe hyperteneion in pheo can be precipitated by

A

increases in intra-abdominal pressure (tumor palpation, position changes etc), surgical procedures, and a number of drugs, especially anesthetics

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39
Q

what should be done in people with medullary thyroid cancer before the surgery

A

check for pheo with a plasma fractionated metanephrine essay –> if found pheo, it should be resected first

40
Q

thyroid peroxidase antibodies - disease?

A
  1. Hashimoto

2. painless thyroditis

41
Q

thyroid antibodies that are associated with miscarriage

A

anti-peroxidase

42
Q

small vs large fibers regarding symptoms when damaged

A

small –> positive symptoms (pain and paresthesia)

large -> negative symptoms (numbness, loss of propioception and vibratory sense, and diminished ankle reflex)

43
Q

benefits of tight glycemic control in macrovascular and microvascular complications

A

decreases incidence of microvascular (retinopathy)

uncertatin for macro

44
Q

hypothyroidism - lipids

A
  • hypercholesterimia alone or hepercholisterimia with hyperTG
  • hyperTG alone is rare
45
Q

normal prolactin levels are less than 15. prolactin 45 + low LH + Low TSH - diagnosis

A

nonfunctional tumor
(slightly high prolactin due to compression on the axon)
diagnostic levels for prolactinoma are more than 200

46
Q

nonfunctioning pituitary adenoma usually arises from

A 
GnRH cells (they secrete only tha α-unit)
in nonfunctioning pituitary adenomas, prolactin could be high due to compression of the axon (low dopamine)
47
Q

diagnosis of conn - what is the ration of aldosterone to renin

A

more than 20

48
Q

hyperthyroidism - bone

A

increased osteoclastic activity –> rapid bone loss + hypercalcemia

49
Q

best markers for response to DKA therapy

A
  • anion gap

- beta hydroxybutrate level (the predominant ketone)

50
Q

diabetic gastroparesis - treatment

A

metoclopramide
erythromycin (esp acute)
cisapride (restricted in USA due to risk of arrhythmia and death)

51
Q

confirm of hyperaldosteronism

A

adrenal suppression test (by salt loading)

52
Q

prolactinoma - surgery or carbegolide?

A
  • asymptomatic microprolactinoma (less than 10mm) –> no treatment
  • macroprolactinoma or sympromatic micro:
    sugery only if is larger than 3 cm or increases during medication
53
Q

primary hyperaparathyroidism - indications for parathyroidectomy

A
  1. age less than 50
  2. symptomatic hypercalcemia
  3. complications: osteoporosis, nephrolithiasias/calcinosis, GFR less than 60
  4. elevated risk for complications: calcium more than 1 mg/dl above normal, urinary excretion of Ca more than 400 per day
54
Q

glucagonoma - anemia?

A

normocytic normochronic anemia due to likely anemia of chronic disease or glucagon directly affecting erythropoiesis

55
Q

glucagonoma - diabetes

A

mild, with normal to slightly high insulin levels and is controlled with lifestyle changes and oral medications (rarely requires insulin)

56
Q

glucagonoma - how to confirm diagnosis

A

serum glucagon more than 500

57
Q

DDX of myopathy (and ESR, CK)

A
  1. glucocorticoid induced (normal, normal)
  2. polymyalgia rheumatic (increased, normal)
  3. inflammatory myopathies (increased, increased)
  4. statin induced (normal, increased)
  5. hypothyroid (normal, increased)
58
Q

glucocorticoid myopaty

A
  • progressive proximal weakness + atrophy
  • NO PAIN OR TENDERNESS
  • lower extremities are more involved
  • normal ESR and CK
59
Q

polymyalgia rheumatic myopathy

A
  • muscle pain + stiffness in shoulder + pelvic
  • tenderness with decreased range of motion
  • responds rapidly to steroids
  • normal CK, elevated ESR
60
Q

inflammatory myopathies

A
  • muscle pain, tenderness
  • proximal weakness
  • skin rash + infl arthritis
  • increased ESR + CK
61
Q

statin induced myopathy

A
  • prominent muscle pain/tenderness with or without wekaness
  • rare rhabdomyolysis
  • normal ESR, elevated CK
62
Q

Hypothyroid myopathy

A
  • muscle pain, cramps, weakness involving the proximal muscles
  • delayed tendon reflexes + myoedema
  • occasionally rhabdomyolysis
  • normal ESR, increased CK
63
Q

DKA + hyperosmolar - management - IV fluids

A

0.9% NS initially

add dextrose when glucose less than 200

64
Q

DKA + hyperosmolar - management - insulin

A
  • initial IV
  • switch to SQ if: able to eat, less than 200, normal anion gap, HCO3 more than 15
  • overlap SQ + IV insulin by 1-2 h
65
Q

DKA + hyperosmolar - management - potassium

A

add K+ if less than 5.2

Hold insulin for serum k+ less than 3.3

66
Q

DKA + hyperosmolar - management - phosphate

A

if less than 1, cardiac dysfunction or respiratory depression
(monitor calcium)

67
Q

Diabetic foot ulcers - RF

A
  1. Diabetic neuropathy
  2. arterial insufficiency
  3. ESRD on dialysis
  4. smoking
68
Q

Diabetic foot ulcers - management

A
  1. mechanical offloading
  2. debridement
    3, wound dressing
  3. antibiotics if infection
69
Q

common causes of hypogonadism is men - categories

A
  1. primary (testicular)
  2. secondary (pituitary/hypothalamus)
    3, combined
70
Q

common causes of hypogonadism is men - 1ry (testicular)

A
  1. congenital (klinefelter, cryptorchidism)
  2. drugs (alkylating, ketoconazole)
  3. orchitis (mumps), trauma, torsion)
  4. chronic kidney disease)
71
Q

common causes of hypogonadism is men - 2ry (pituitary, hypothalamic)

A
  1. gonadotroph damage (tumor, trauma etc)

2. gonadotropin suppression (exogenous androgens, hyperprolactinemia, DM, obesity etc)

72
Q

common causes of hypogonadism is men - combined

A
  1. hypercortisolism

2. cirrhosis

73
Q

signs of adrenal insufficiency –> 250 μg cosynotropin and ACTH levels –>

A
  1. basal cortisol low, high ACTH, minimal cortisol response –> 1ry adrenal insuf
  2. basal cortisol low, Low ACTH, minial cortisol response –> 2ry or tertiary adrenal insuf
  3. indeterminate –> further testing to assess pituitary
  4. Normal response (cortsiol level more than 20 after cosynotropin) –> no adrenal insufficiency
74
Q

water deprivation test - when is 1ry polydispia

A

if urine osm is more than 600

75
Q

primary vs secondary male hypogonadism regarding gynecomastia

A

more common in 1ry

76
Q

DM risk factors for adults with BMI more than 25

A
  1. physical inactivity
  2. 1st degree relative with DM
  3. high risk race, ethnicity
  4. women with children’s birth wight more than 9lb
  5. history of gestational DM
  6. dyslipidemia (low HDL and high TG)
  7. History of PCOS
  8. history of glucose intolerance
77
Q

thyroid nodule - algorithm

A

First clinical evaluation, TSH + US
- if cancer RF or suspicious US –> FNA
- no RF or suspicious US –> consider TSH
Normal or elevated TSH –> FNA
low TSH –> Radio –> hot (treat hyperthyroidism) vs cold or interminate (do FNA)

78
Q

Joint national Committe 8 reccomendations for treating hypertension - initial diagnosis

A

if more than 60: more than 150 or 90

less than 60 or Chronic kidney diseas, or DM: more than 140 or 90

79
Q

Joint national Committe 8 reccomendations for treating hypertension - goal BP

A

if more than 60: less than 150/90

less than 60 or Chronic kidney diseas, or DM: less than 140/90

80
Q

Joint national Committe 8 reccomendations for treating hypertension - initial treatment choice

A
  1. black –> thiazide diruetic or CCB alone or in combination (ACEi is not 1st line)
  2. other ethnicities –> thiazide, ACEi, CCB alone or in combination
  3. all ethnicities with chronic kidney disease: ACEi alone or in combination with other drugs
81
Q

evaluation of hyperthyroidism - algorithm

A

measure TSH, fT3, fT4
if 2ry (all high) –> pituitary MRI)
if 1ry (Low TSH, the other high):
sings of graves: if yes it is graves –> if not do Radio
RADIO: HIGH: diffuse (graves) v Nodular patttern)
LOW –> measure thyroglobulin (if low is exogenous, if high is thyroditis or IODIDE EXPOSURE)

82
Q

The strongest indication for DM screening

A

HTN

83
Q

DM - metformin is not enough , what to do

A

Sulfonyl or DPP-IV inhibitors

84
Q

Anoher side effect of sulfonylureas

A

SIADH

85
Q

DM - erectile dysfunction

A
  • no routine screening except to ask

- sildanefil

86
Q

initial treatment for DM2 - effective

A

lifestyle modification –> effective to 25%

87
Q

short vs rapid acting insuling on onset

A

rapid: 5-15

short 30-60

88
Q

NPH vs glargine on onset

A

NPH: 2-4
glargie: 1-2

89
Q

Dermatopathy of graves

A

thickening and redness below the knee

90
Q

Graves - Onycholysis

A

in 10% of cases

91
Q

Klinefelter’s sundrome - treatment

A

testosterone

92
Q

Testicular feminization

A

XY that looks, feels and acts like woman (No test receptors -> no penis, prostate, scrotum)

93
Q

calcitonin vs biphosphonate regarding immediate action

A

if u need something fast, pick calcitonin

94
Q

type of cortisone in addison

A
  • acute: hydrocortisone (both gluco and mineralocorticoid effects)
  • stable: prednisone
  • if prednisone not enough –> fludrocortisone
95
Q

water deprivation test - explain

A

no water for 2-3 hours –> measure urine volume and osm every h, , and serum sodium and osm every 2
- is urine osm more than 600?
yes –> 1y polydipsia
No –> urine osm stable on 2-3 h –+ plasma osm more than 295 or Na more than 145)?
a. yes: desmopressin, monitor urine osm + volume every 30 mins for 2 hours (CDI if urine osm increases, NDI if no increase)
b. no: continue until above endpoints reached

Endocrinology (5 decks)

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