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EOR - Internal Med > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

sx associated w. gigantism

A

HA
visual defects
wt gain
enlarged forehead/hands/feet/tongue
diaphoresis

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2
Q

acromegaly and gigantism are caused by

A

1. mc - pituitary adenoma that secretes GH
2. non pituitary tumors secreting GnRH

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3
Q

gigantism is GH secretion in:
acromegaly is GH secretio in:

A

gigantism: childhood (before epiphyseal closure)
acromegaly: adulthood

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4
Q

dx for gigantism/acromegaly

A

-GH test 2 hr after glucose load
-increased IGF-1
-MRI/CT

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5
Q

tx for gigantism/acromegaly

A

pituitary tumor removal

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6
Q

primary adrenal insufficiency is aka

A

addison’s dz

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7
Q

25 yo M w. fatigue, wt loss, recurrent n/v, and weakness - PE shows darkened skin - BP 90/70

A

addison’s dz

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8
Q

hallmark labs of addison’s

A

hyponatremia
hyperkalemia

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9
Q

pathophys of addison’s

A

AI destruction of adrenal cortex -> loss of cortisol

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10
Q

6 nonspecific sx of addison’s

A

hyperpigmentation
hypotn
fatigue
myalgias
GI
wt loss

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11
Q

dx for addison’s

A

high dose cosyntropin stimulation test - cortisol measured after cosyntropin injxn

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12
Q

what is cosyntropin

A

synthetic ACTH

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13
Q

normal response to cosyntropin test

A

rise in blood and urine cortisol after injxn

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14
Q

addison’s dz findings of consyntropin test

A

little to no increase (<20 mcg) in cortisol levels after cosyntropin injxn

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15
Q

tx for addison’s: maintenance vs crisis

A

maintenance: hydrocortisone/prednisone daily
crisis: IV saline, glucose, steroids

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16
Q

collection of s/sx due to prolonged exposure to cortisol

A

cushing’s syndrome

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17
Q

ACTH secreting pituitary microadenoma

A

cushing’s dz

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18
Q

cushing’d dz is aka

A

secondary cushing’s

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19
Q

hallmark features of cushing’s dz

A

obesity
buffalo hump
moon facies
supraclavicular fat pads
htn
excessive thirst
polyuria
pigmented striae

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20
Q

sx of cushing’s dz

A

backache
HA
oligomenorrhea/amenorrhea
ED
emotional lability
psychosis

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21
Q

gs dx for cushing’s dz

A

1. 24 hr urine free cortisol - gs/initial
2. ACTH level to confirm cortisol source

alt: low dose dexamethasone suppression test

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22
Q

what do high and low ACTH levels indicate when working up cushing dz

A

high: ACTH dependent cause (pituitary adenoma) -> order a brain MRI
low: ACTH independent cause (adrenal mass) -> order adrenal CT

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23
Q

how does the low dose dexamethasone suppression test work

A
  1. give low dose dexamethasone
  2. failure of steroid to decrease cortisol -> dx of cushing’s ->
  3. order high dose dexamethasone suppression test -> 4. no cortisol suppression = cushing’s syndrome
  4. suppression of cortisol -> exclude cushing’s
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24
Q

tx for cushing’s dz

A

transsphenoidal selective resection of pituitary tumor

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25
Q

diabetes insipidus is caused by

A

deficiency/resistance to vasopressin (ADH) -> decreases kidney reabsorption of water -> massive polyuria

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26
Q

2 types of diabetes insipidus

A

central - mc
nephrogenic

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27
Q

deficiency of ADH from posterior pituitary/hypothalamus -> no ADH production

A

central diabetes insipidus

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28
Q

cause of central diabetes insipidus

A

AI destruction of posterior pituitary:
head trauma
brain tumor
infxn
sarcoidosis

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29
Q

lack of reaction to ADH -> partial vs complete insensitivity to ADH

A

neprogenic diabetes insipidus

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30
Q

4 causes of nephrogenic diabetes insipidus

A

drugs
hypercalcemia
hypokalemia
ATN

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31
Q

2 drugs mc associated w. nephrogenic diabetes insipidus

A

lithium
ampho b

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32
Q

dx for diabetes insipidus

A

-high serum osmolality: unable to stop secretion of water into kidneys
-water deprivation test: continued production of dilute urine despite water deprivation
-desmopressin stimulation test

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33
Q

most reliable test for diabetes insipidus

A

water deprivation

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34
Q

desmopressin stimulation test of central vs nephrogenic diabetes insipidus

A

central: reduction in urine output due to response to ADH
nephrogenic: continued production of dilute urine (no response to ADH)

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35
Q

tx for diabetes insipidus: central vs nephrogenic

A

central: desmopressin/DDAVP
nephrogenic: Na and pro restriction, HCTZ, indomethacin

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36
Q

what abs are associated w. T1DM

A

HLA-DR3/4/O
islet cell
GAD65
IA-2

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37
Q

what is the dawn phenomenon

A

decreased insulin sensitivity/nightly surge of counter-regulatory hormones during nighttime fasting -> elevated BG from 2-8 AM

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38
Q

management of dawn phenomenon

A

bedtime injxn of NPH insulin
avoid late night CHO

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39
Q

what is the somogyi effect

A

surge in nocturnal growth hormone -> nocturnal hypoglycemia followed by rebound hyperglycemia

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40
Q

management of somogyi effect

A

decreased nighttime NPH dose
bedtime snack

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41
Q

what is the insulin warning

A

progressive rise in BG from bedtime to morning

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42
Q

sx of DKA

A

fruity breath
wt loss
rapid respirations
hypotn

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43
Q

management of DKA

A

-admit
-large volume IVF NS
-electrolyte replacement
-insulin

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44
Q

dx for DM

A

one of the following:
-random BG > 200 x 2
-fasting BG BG > 126 x 2
-BG > 200 following 3 hr OGTT
-A1C > 6.5

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45
Q

gs dx for GDM

A

3 hr OGTT

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46
Q

high fasting C-peptide is associated with which type of DM

A

type 2

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47
Q

low or inappropriately normal fasting C-peptide levels suggest which type of DM

A

type 1

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48
Q

BG goals for DM

A

fasting: <130
postprandial: <180

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49
Q

moa for metformin

A

decreases:
hepatic glucose production
peripheral glucose utilization
intestinal glucose absorption

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50
Q

2 main s.e of metformin

A

lactic acidosis
GI

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51
Q

contraindications for metformin

A

GFR <30
Cr >1.5

not recommended for GFR 30-45

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52
Q

name 3 sulfonylureas

A

glyburide
glipizide
glimepiride

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53
Q

moa for sulfonylureas

A

insulin secretagogue

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54
Q

main s.e of sulfonylureas

A

hypoglycemia

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55
Q

name 2 thiazolidinediones

A

pioglitazone
rosiglitazone

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56
Q

moa for thiazolidinediones

A

increase peripheral insulin sensitivity

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57
Q

contraindications for thiazolidinediones

A

CHF
liver dz

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58
Q

2 s.e of thiazolidinediones

A

fluid retention
wt gain

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59
Q

name 2 alpha-glucosidase inhibitors

A

acarbose
miglitol

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60
Q

moa for alpha glucosidase inhibitors

A

delay intestinal glucose absorption

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61
Q

s.e of alpha glucosidase inhibitors to know

A

GI

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62
Q

name 2 meglitinides

A

repaglinide
nateglinide

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63
Q

moa for meglitinides

A

insulin secretagogue

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64
Q

s.e to know of meglitinides

A

hypoglycemia

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65
Q

name the GLP-1 agonists

A

exenatide
dulaglutide
semaglutide
liraglutide

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66
Q

moa for GLP-1 agonists

A

incretin mimetic -> insulin secretagogue
decrease glucagon -> delay gastric emptying

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67
Q

s.e of GLP-1 agonists

A

GI

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68
Q

caution using GLP-1 agonists in pt’s w. what condition

A

gastroparesis

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69
Q

2 benefits of GLP-1 agonists

A

wt loss
reduced CV mortality

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70
Q

name 2 DPP-4 inhibitors

A

sitagliptin
saxagliptin

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71
Q

moa for DPP-4 inhibitors

A

dipetpidylpetase inhibition -> inhibit degradation of GLP-1 -> increase insulin secretion and delay gastric emptying

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72
Q

s.e of DPP-4 inhibitors

A

increased risk of heart failure

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73
Q

name one SGLT2 inhibitor

A

canagliflozin

74
Q

moa for SGLT2 inhibitors

A

inhibit SGLT2 -> lower renal glucose threshold -> increase urinary glucose excretion

75
Q

5 s.e of SGLT2 inhibitors

A

vulvovaginal candidiasis
UTI
bone fx
lower limb amputation
AKI
DKA

76
Q

3 benefits of SGLT2 inhibitors

A

wt loss
reduction in SBP
reduced CV mortality

77
Q

when should you add insulin to a DM med regimen

A

A1C > 9

78
Q

how often should microalbumin be checked in a diabetic

A

annually

79
Q

mc complication of DM

A

neuropathy

80
Q

leading cause of preventible blindness in adults

A

diabetic retinopathy

81
Q

diagnostic criteria for preDM (3)

A

A1C 5.7-6.4
fasting BG 100-125
2 hr OGTT 140-199

82
Q

3 screening tests that should be performed annually for DM

A

ophthalmologist
microalbumin
foot check

83
Q

med you should consider for all pt w. microalbuminuria

A

ACEI

84
Q

BP goal for DM

A

<130/80

85
Q

new statin guidelines for DM

A

recommended for DM pt’s 40-75 yo with:
LDL 70-189 but w.o clinical ASCVD

86
Q

hallmark presentation of hypercalcemia

A

stones
bones
abd groans
psychiatric moans

87
Q

EKG finding of hypercalcemia

A

shortened QT

88
Q

lab findings of hypercalcemia

A

elevated: Ca, PTH
decreased: phos

89
Q

2 causes of hypercalcemia to know

A

malignancy
hyperparathyroidism

90
Q

tx for hypercalcemia

A

IV NS
furosemide

91
Q

etiology for hypernatremia (5)

A

diarrhea
burns
diuretics
diabetes insipidus
deficit of thirst

92
Q

sx of hypernatremia

A

poor skin turgor
dry mm
flat neck veins
hypotn
BUN:Cr > 20:1

93
Q

what causes the increased BUN:Cr ratio w. hypernatremia

A

decreased volume -> decreased renal perfusion -> higher serum urea -> elevated BUN

94
Q

tx for hypernatremia

A

D5W 5%

95
Q

consequence of correcting hypernatremia too rapidly

A

crebral edema
pontine herniation

96
Q

33 yo F w. diffuse pain and fatigue - c/o bone and muscle pain, abd pain, and trouble focusing

A

hyperparathyroidism

97
Q

elevated PTH causes _ serum Ca

A

elevated

98
Q

how does increased PTH lead to elevated Ca (3)

A

bone breakdown -> Ca release
increased renal Ca reabsorption
increased intestinal Ca absorption

99
Q

2 causes of hyperparathyroidism

A

primary: parathyroid adenoma
secondary: response to hypocalcemia, vitamin D deficiency, CKD

100
Q

mcc of secondary hyperparathyroidism

A

CKD

101
Q

common presentation of hyperparathyroidism

A

bone loss -> bone pain
increased renal Ca absorption -> stones
increased GI Ca absorption -> abd groans

102
Q

UA findings of hyperparathyrodism

A

hyperphosphaturia
hypercalciuria

103
Q

tx for hyperparathyroidism: primary vs secondary

A

primary: parathyroidectomy
total = 3.5 glands

secondary: vit D/Ca supplementation, IVF. lasix, calcitonin, bisphosphonates

104
Q

etiology of hyperthyrodism (5)

A

AI (graves)
toxic adenoma
thyroiditis
pregnancy
amiodarone

105
Q

hallmark presentation of hyperthyroidism

A

heat intolerance
palpitations
diaphoresis
wt loss
tremor
anxiety
tachycardia

106
Q

3 PE findings of graves

A

diffuse goiter w. a bruit
exophthalmos
pretibial myxedema

107
Q

3 PE findings of thyroid storm

A

fever
tachycardia
delirium

108
Q

RAIU findings of graves vs toxic multinodular hyperthyroidism

A

graves: diffusely high uptake
toxic multinodular: discrete areas of high uptake

109
Q

abs associated w. graves

A

antit-thyrodtropin

110
Q

tx for hyperthyroidism (4)

A

bb
methimazole
PTU
radioactive iodine
thyroidectomy

111
Q

tx for thyroid storm

A

bb asap

112
Q

mc complication of thyroidectomy

A

injury to recurrent laryngeal nerve -> hoarseness

113
Q

tx for hyperthyroidism in pregnancy/lactation

A

first semester: PTU
after first trimester: methimazole
nursing: methimazole

114
Q

4 types of thyroiditis

A

hashimoto’s
subacute
postpartum
suppurative

115
Q

hallmark presentation of hashimoto’s thyroiditis

A

diffusely enlarged, painless nodular goiter

116
Q

hallmark presentation of subacute thyroiditis

A

young female post viral infxn
painful enlarged thyroid
dysphagia, mild fever

117
Q

tx for subacute thyroiditis

A

ASA

118
Q

hallmark presentation of postpartum thyroiditis

A

1-2 mos after delivery

119
Q

tx for postpartum thyroiditis

A

bb

120
Q

hallmark presentation of suppurative thyroiditis

A

fever
pain
erythema
fluctuant mass
leukocytosis

121
Q

tx for supporative thyroiditis

A

abx
surgical drainage

122
Q

painless thyroiditis should make you think

A

hashimoto’s

123
Q

EKG findings of hypocalcemia

A

prolonged QT

124
Q

lab findings of hypocalcemia

A

decreased: Ca, PTH
increased: phos

125
Q

PE findings of hypocalcemia

A

trosseau’s
chvostek’s

126
Q

involuntary contraction of the hand/wrist (carpopedal spasm) with compression of the arm (bp cuff)

A

trousseau’s sign -> hypocalcemia

127
Q

twitching of facial muscles with gentle tap to the cheek

A

chvostek sign -> hypocalcemia

128
Q

tx for hypocalcemia

A

IV calcium gluconate vs calcium chloride

129
Q

4 PE findings of hyponatremia

A

peripheral/presacral edema
pulmonary edema
JVD
HTN

130
Q

lab findings of hyponatremia

A

decreased Hct
decreased serum protein
decreased BUN/Cr

131
Q

2 sx of hyponatremia

A

muscle cramps
sz

132
Q

3 classifications of hyponatremia

A

hypervolemic
euvolemic
hypovolemic

133
Q

5 causes of hypervolemic hyponatremia

A

CHF
nephrotic syndrome/renal failure
cirrhosis

134
Q

3 causes of euvolemic hyponatremia

A

SIADH
steroids
hypothyroid

135
Q

causes of hypovolemic hyponatremia

A

renal vs non renal

136
Q

tx for hyponatremia

A

asymptomatic: fluid restriction
moderate: IV NS, +/- loop diuretics
severe: hypertonic 3% IV NS

137
Q

guidelines for sodium repletion for chronic hyponatremia

A

correct slowly: </= 10 mEq/L x 24 hr

138
Q

consequence of repleting chronic hyponatremia too quickly

A

osmotic demyelination syndrome

139
Q

mcc of hypoparathyroidism

A

thyroidectomy

140
Q

3 sx of hypoparathyroidism

A

tingling
tetany
cataracts

141
Q

2 PE findings of hypoparathyroidism

A

chvostek’s sign
trousseau’s sign

142
Q

lab findings of hypoparathyroidism

A

low: Ca, PTH, urinary Ca
elevated: phos

143
Q

tx for hypoparathyroidism

A

IV calcium gluconate
tetany: ABC’s

144
Q

3 causes of hypothyroidism

A

hashimoto’s
thyroidectomy
congenital

145
Q

5 PE findings of congenital hypothyroidism

A

round face
large tongue
hernia
delayed milestones
poor feeding

146
Q

2 abs associated w. hashimoto’s

A

antithyroid peroxidase
antithyroglobulin abs

147
Q

bone remodeling d.o that results in the formation of an unorganized mosaic of woven and lamellar bone that is less compact and weaker than normal bone

A

paget dz of the bone

148
Q

cause of paget’s

A

idiopathic vs genetic
but can be triggered by viral infxns

149
Q

4 mc locations mc affected by paget’s dz of the bone

A

pelvis
skull
spine
legs

150
Q

2 rf for paget’s dz of the bone

A

increasing age
fam hx

151
Q

common presentation of paget dz of the bone

A

bone deformities
frequent broken bones
bone pain

152
Q

complication of paget dz of the bone

A

osteosarcoma -> paget sarcoma

153
Q

what is this showing

A

lytic lesions
thickened bone cortices

paget dz of the bone

154
Q

lab findings of paget dz of the bone

A

elevated alk phos

155
Q

tx for paget dz of the bone

A

bisphosphonates
+/- calcitonin
surgery

156
Q

moa for bisphosphonates

A

reduce bone resorption

157
Q

catecholamine secreting adrenal tumor that secretes norepinephrine and epinephrine

A

pheochromocytoma

158
Q

5 p’s of pheochromocytoma

A

pressure (htn)
pain (ha)
perspiration
palpitations
pallor

159
Q

2 conditions associated w. pheochromocytoma

A

neurofibromatosis type 1
MEN 2A/B

160
Q

dx for pheochromocytoma

A
  1. 24 hr catecholamine metabolites (metanephrine, vanillylmandelic acid)
  2. MRI vs CT abdomen
161
Q

tx for pheochromocytoma

A
  1. complete adrenalectomy
  2. acute HTN crisis: phentolamine vs sodium nitroprusside vs nicardipine
162
Q

pre op adrenalectomy management of pheochromocytoma

A
  1. nonselective alpha blockade: phenoxybenzamine vs phentolamine x 7-14 days
  2. followed by bb for HTN control
163
Q

consequence of failing to administer alpha blocker before bb in pheochromoctyoma

A

unopposed beta blockade -> unopposed alpha constriction -> life threatening HTN

164
Q

noncancerous tumors in the pituitary gland that don’t spread beyond the skull

A

pituitary adenomas

165
Q

mc type of pituitary adenoma

A

functional microadenomas -> secrete pituitary hormones

166
Q

3 types of pituitary adenomas

A

functional
nonfunctional
compressive

167
Q

size of microadenomas vs macroadenomas

A

micro: <10 mm
macro: >10 mm

168
Q

mc sx of pituitary adenomas

A

visual:
diminished temporal vision
bitemporal hemianopsia

169
Q

4 types of functional pituitary adenomas

A

lactotroph/prolactinoma - mc
growth hormone secreting
corticotroph secreting (ACTH secreting)
thyrotroph (TSH secreting)

170
Q

growth hormone adenomas are associated w. what 2 conditions

A

gigantism
acromegaly

171
Q

corticotroph adenomas are associated w. what conditoin

A

cushing’s

172
Q

thyrotroph adenomas are associated w. what condition

A

hyperthyroidism

173
Q

gs dx for pituitary adenomas

A

MRI

174
Q

management of pituitary adenomas

A

-dopamine agonists (cabergoline/bromocriptine)
-transphenoidal pituitary resection

175
Q

mc rf for thyroid ca

A

XRT exposure

176
Q

sx of thyroid ca

A

hoarse voice
solitary cold nodule on RAIU

177
Q

mc type of thyroid ca

A

papillary carcinoma

178
Q

dx for thyroid ca

A
  1. US
  2. bx all lesions > 1 cm
  3. serial US for lesions < 1 cm
  4. RAIU to eval for malignancy
  5. FNA for cold lesions on RAIU
179
Q

characteristics of malignant thyroid lesions on US

A

microcalcifications
hypoechogenicity
solid cold nodule
irregular margins
chaotic intranodular vasculature
more tall than wide

180
Q

what do hot and cold lesions mean on RAIU

A

cold: does not take up iodine -> cancerous
hot: take up iodine -> benign

181
Q

management of all cold thyroid nodules

A

FNA

182
Q

tx for thyroid ca

A

complete vs partial thyroidectomy for all
anaplastic: add chemo + xrt

EOR - Internal Med (13 decks)

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