3rd year Internal final Flashcards
(146 cards)
1
Q
Tretment for hyperprolactinoma?
A
Dopamine agonist= Bromocriptine
Also Quinagolid
2
Q
What is the name of the surgical removing of pituitary mass?
A
Trans-Sphenoidal resection
3
Q
Physiological causes for Hyperprolactinaemia?
A
Pregnancy
Stress
4
Q
Which drugs can cause Hyperprolactinaemia?
A
Dopamine receptor antagonist- Metoclopramide
Dopamine blockers- Methyl-Dopa, Estrogen
5
Q
Which disease can cause Hyperprolactinaemia?
A
Primary hypothyroidism
Chronic kidney failure
Cirrhosis hepatis
Pituitary adenoma
6
Q
Cortisol production pathway
A
Hypothalamus-> CRH
Pituitary-> ACTH
Z.F of Adrenal gland-> Cortisol
7
Q
Cushing disease=
A
Pituitary adenoma produces too much ACTH
ACTH stimulates Z.F -> Cortisol
8
Q
Cushing syndrome can be ___ or ____
A
ACTH dependant or independant
9
Q
ACTH dependant Cushing=
A
Cushing disease
ACTH secreting pituitary adenoma
Ectopic ACTH secretion
10
Q
ACTH independant Cushing=
A
Adrenal adenoma Adrenal carcinoma Adrenal hyperplasia Drugs exposure Increased CRH
11
Q
Cushings clinical signs
A
DM Muscle weakness Moon face Central obesity Osteoporosis Striae
12
Q
What test can we use to diagnose Cushings?
A
Dexamethasone test
13
Q
Cushings treatment and examples of drugs
A
Control excessive production of cortisol from the adrenal glands
Ketoconazole
Mitotane
14
Q
Acromegaly=
A
Excess GH after the growth plates have closed
15
Q
Treatment for Acromegaly?
A
Bromocriptine
Octreotide
16
Q
Diabetes insipidus is characterized by
A
Large amounts of dilute urine and increased thirst
17
Q
Types of Diabetes insipidus
A
Central DI
Nephrogenic
18
Q
Central DI=
A
Lack of Vasopressin
19
Q
Nephrogenic DI=
A
Kidneys do not respod properly to Vasopressin
20
Q
Lab results of DI
A
Urine > 3500 ml/day
Urine specific gravity < 1010
Urine osmolarity < 300 mosmol
21
Q
Treatment for DI
A
Arginine vasopressin
Desmopressin
Thiazide
22
Q
Most common type of thyroid malignancy
A
Papillary thyroid carcinoma
23
Q
How can we treat SIADH?
A
Fluid restriction
Salt tablets
ADH antagonist
24
Q
ADH antagonists=
A
Tolvaptan
Conivaptan
25
What goes down first in chronic hypopituitirism?
GH and LH/FSH
26
How can we diagnose chronic hypopituitirism?
Insulin stimulation test.
| Give insulin->Glucose should go down->GH should go up (If healthy)
27
Symp. of mass effect in case of pituitary adenoma?
Loss of pituitary hormones
| Bitemporal hemianopis
28
Pituitary adenoma most commonly due to
Lactotrophs -> Prolactin
29
Prolactinoma symp. in women
Galactorrhea
Amenorrhea
Acne
Facial hair growth
30
Prolactinoma symp. in men
Decreased libido
31
Dopamine agonists=
Bromocriptine
| Carbegoline
32
What hormone causes PRL to be secreted?
TRH
33
What endocrine case can lead to hyperprolactinaemia?
Hypothyroidism bcs. there is no Negative FB on TRH
34
Prolactinoma diagnosis
Meds (Maybe we are doing it to the patient)
TSH (check hypothy.)
PRL
MRI
35
Define Cushing disease
ACTH secreting pituitary adenoma
36
Ectopic ACTH secretion is usually from
Small Cell Lung Cancer
37
Cushing symp.
```
Cholesterol up
Urinary free cortisol up
Skin change
HTN
Immunosuppression
Neoplasm
Growth radiation
Sugar up
```
```
Amenorrhea
Moon face
Buffalo hump
Osteoporosis
Obesity
Hirsutism
```
38
Cushing diagnosis 1st step
24-h free urine cortisol
Late night salivary cortisol
1 mg LOW dose dexamethasone suppresion test
39
Cushing diagnosis 2nd step
Measure ACTH
40
Cushing diagnosis 3rd step
HIGH dose dexamethasone suppresion test
41
If HIGH dose dexamethasone suppresion test suppress what does that mean?
Cushing disease
42
dexamethasone suppresion test=
dexamethasone can suppress pituitary from secreting ACTH
43
Acromegaly symp.
```
Large tongue
Deep voice
Big hands and feet
Impaired glucose tolerance
HTN
Colorectal polyp risk
```
44
Acromegaly diagnosis
ILGF-1 up
Failure to suppress GH following glucose intake
Pituitaru mass on MRI
45
Acromegaly treatment besides surgery
Octeroides= Somatostatins inhibit GH
46
DI symp.
```
Polydipsia
Polyuria
No glucose in urine
Normal BG
Low urine osmol.
```
47
DI types
Central
| Nephrogenic
48
Nephrogenic DI can be due to
Lithium poisoning
49
Central DI treatment
DDVAP= Desmopressin
50
Thyroid nodules. When do we suspect cancer?
```
Patient had raddiation to head and neck
Family history
Hoarasness
20>Age>60
Fixed, Firm, Hard mass
Size> 2cm
Irregular borders
```
51
1st diagnosis tool in case of thyroid nodule
TSH
52
thyroid nodule, TSH is low. what next?
RAIU
Hot- Hyperthroidism
Cold- FNA
53
thyroid nodule, TSH is high. what next?
Biopsy it
54
How can we diagnose thyroid cancer?
FNA
55
Thyroid cancer types
Papillary carcinoma- orphan Annie
Follicular carcinoma- Invades capsule, hematogenous spread
Medullary carcinoma- parafollicular C cells
Anaplastic carcinoma- old patients. Rapidly progressive
56
Graves diease=
Thyroid stimulating Immunoglobulins
57
TSH-R are found where and what are the symp.
Thyroid-> Goiter, Hyperthyroidism
Dermal fibroblasts-> Peritibial mixedema
Orbital fibroblasts-> Exopthalmus
58
Thyroid storm treatment
4 P's
Propranodol- B blocker
Prednisolone
Potassium iodide
59
RAIU in case of Graves
Iodine uptake all over thyroid
60
Other causes for hyperthyroidism
Thiroiditis (At the beginning)
MNG
Toxic adenoma
61
Hushimotos
Antithyroid peroxidase Ab
Antithyroglobulin Ab
HLA-DR3/5
Non-tender thyroid
62
Symp. of hypothyroidism
```
Bradycardia
Constipation
Cold intolerance
DTR decrease
Weight gain
```
63
Severe form of hypothyroidism
ixedema coma (hypothermic)
64
hypothyroidism diagnosis
TSH up
| T3/4 down
65
hypothyroidism treatment
Levothyroxine
66
other causes for hypothyroidism
Postpartum thyroiditis
Cretinism
Riedel thyroiditis
De Quervain
67
Primary hyperparathyroidism is due to
Parathyroid adenoma usually
68
Primary hyperparathyroidism symp.
```
Hypercalciuria
Polyuria
PTH up
ALP up
Bone pain
Weakness
Constipation
Psichiatric overtone
```
69
Cystic bone space filled with brown fibrous tissue
Osteitis fibrosa cystica
70
PTH binds
Osteoblasts
| Increases expression of RANK-L
71
Main metabolite of serotonine
5-HIAA
Hydroxy Indole Acetic Acid
72
Secindary hyperparathyroidism is due to
Chronic kidney disease
73
Secindary hyperparathyroidism tratment
Calcium
| Vitamin D
74
Hypoparathyroidism is due to
Injury
Surgery
Autoimmune
DiGeorge syndrome
75
Hypoparathyroidism symp.
```
Tetany
Hypocalcemia
Hyperphosphatemia
Chvostek sign
Trosseau sign
```
76
Osteoporosis=
Trabecular and cortical bone lose mass
77
In case of Osteoporosis, where do we preform DEXA?
Lumbar spine
Total hip
Femoral neck
T score < -2.5
78
Osteoporosis treatment
Biphosphonate
79
Osteoporosis can lead to
Vertebral compression fracture
80
Cushings causes
1. Small cell lung cancer-> ACTH
2. Adenoma-> ACTH
3. Steroids
4. Adrenal tumor-> Cortisol
81
Primary aldestronism causes (2)
1. Tumor (Conn's syndrome), hyperplasia
| 2. Renovasculae HTN (Secondary)
82
Primary aldestronism symp.
Hypokalemia
2ndary HTN
Metabolic alkalosis
83
Renin is normal but Aldosterone is high=
Conns
84
Renin is high and Aldosterone is high=
Renovascular HTN
85
How to confirm Conns syndrome?
Salt suppression test
MRI
Adrenal vein sampeling
86
Hyperaldestronism treatment
Spironolactone
| Eplerenone
87
Adrenal insufficiency symp.
```
Weakness
Fatigue
Hypotension
Muscle ache
Weight loss
Sugar and salt craving
```
88
Primary adrenal insufficiency chronic is also called=
Addison disease
Hyperpigmentation
TB is a cause
89
Secondary adrenal insufficiency due to
Less ACTH production
Secondary Spares the Skin
90
Why hyperpigmentation in Addison?
MSH is a byproduct of ACTH production from POMC
| MSH upregulates melanin synthesis
91
Tertiary adrenal insufficiency is due to
Tertiary is due to Treatment
92
Adrenocortical carcinoma can cause
Conns syndrome
Cushings
Virilization
Feminization
93
Pheochromocytoma rule of 10
```
10% malignant
10% bilateral
10% extra adrenal
10% calcify
10% kids
```
94
Pheochromocytoma derived from what cells?
Chromaffin
95
Pheochromocytoma assocaited with
MEN2A
MEN2B
NF-1
96
Pheochromocytoma symp.
```
Pressure
Pain
Perspiration (sweating)
Palpitations
Pallor
```
97
Pheochromocytoma before surgery what do we give
a- blockers
B- blockers
A before B
98
Irreversible a-blocker
Phenoxybenzamine
99
Causes for primary male hypogonadism
Klinefelter sundrome
Undesendant testicles
Mumps orchitis
Hemochromatosis
100
Causes for secondary male hypogonadism
Pituitary disorders
Inflammation
Medication
Aging
101
Tertiary male hypogonadism
HYpothalamic
Kallman syndrome
Prader-Willi syndrome
102
male hypogonadism symptoms
```
Azoospermia (decreased sperm count)
Delayed puberty
Infertility
Low libido
Loss of body hair
```
103
male hypogonadism diagnosis
Testosteron (free and total)
FSH/LH
17-ketosteroids in urine
104
PCOS=
Hyperinsulinemia -> alter FB mechanism -> LH:FSH rise -> Androgens rise from theca interna cells -> Decreased rate of follicular maturation -> cysts+anovulation
105
PCOS symptoms
```
Amenorrhea
Hirsutism
Low fertility
Obesity
Acanthosis nigricans
```
106
PCOS treatment
Weight loss
OCP's
Clomiphene
Spironolactone
107
Turner syndrome symptoms
```
Short stature
Ovarian dysgenesis
Aortic coarctation
Lymphatic defects
Shield chest
Amenorrhea
```
108
In Turner syndrome
| What causes high LH and FSH
Low estrogen
109
Epidemiology of DM2
* 90-95% from DM is Type 2
* Mostly over 35 years old
* Twin concordance 90%
* No HLA association
110
Etiology/ Pathology factors:
Genetic (mono and poly)
Obesity
Sedentary lifestyle
Fetal malnutrition
111
Complications
| Acute
- Hypoglycemia
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar Hyperglycemic State (HHS)
- Metformin-associated Lactic Acidosis (MALA)
112
Complications
| Chronic
• Microvascular
- Retinopathy
- Nephropathy
- Neuropathy
• Macrovascular
- Coronary Artery Disease (8/10 die from cardiac events)
- Stroke
- Peripheral Artery Disease
113
DM diagnosis
Glucose at any time > 11.1 mmol/L
Fasting glucoe > 7 mmol/L
HbA1c > 6.5%
Peptide C levels
114
LADA etiology
Latent Autoimmune Diabetes of Adults
Slowly progress
15% of DM2
115
LADA diagnosis
Glucose values
C peptide measures are low
AutoAb
116
DM2 acute complication
Hyperosmolar Hyperglycemic state
117
DM chronic complication are due to
Nonenzymatic glycation
| Osmotic damage
118
OGGT- how much glucose?
75 g
119
Fasting BG of prediabetic
5.6-7 mmol/L
120
DMT1 Ab
GAD
| IA-2
121
Prediabetes treatment
Lifestyle change
| Metformin
122
HbA1c is not getting better
| Which agent do we add?
Metformin
Glipizide (Sulfonylurea)
Glitazone
123
How can we check DM nephropathy
Albumin/Creatinine ratio
124
How can we check DM neuropathy
Monofilament test
125
Long lasting Insulin
Lentis
| Lemevir
126
Rapid acting Insulin
Novolog
| Humalog
127
Mixed acting Insulin
Novolin
| Humalin
128
DKA diagnosis
Arterial Blood Gases
BG
Ketones in urine
129
DKA treatment
Insulin
Fix the anion gap
K+
130
Insulin brings what into the cell (not glucose)
K+
131
Hyperosmolar Hyperglycemic state
```
No ketons
No acidosis
Much slower
Worse diarrhea
Very high glucose >30 mmol/L
Severe dehydration
```
132
Hypoglycemia values
< 3.6 mM Altered
< 2,2 mM
< 0.55 mM Coma
133
Hypoglycemia symptoms
Palpitations
Sweatig
Presyncope
134
Non-diabetes hypoglycemia
Faking it
| Insulinoma
135
Insulinoma diagnosis
C peptide
Proinsulin
BG
Sulfonurea levels
136
Hyperlipidemia symptoms
Xanthomas on eyelids
Tendinous xanthoma- lipid deposition
Corneal arcus
137
GI Neuroendocrine tumors
Carcinoid
| Gastrinoma
138
Pancreas NET
Insulinoma
139
Lung NET
Small cell carcinoma
140
NET treatment
Surgery
| Somatostatin analogs
141
Describe gastrinoma
Gastrin
Stomach acid increases
Zollinger Allison syndrome
142
Risk factor for pancreatic NET
MEN1
143
Carcinoid syndrome, Neuroendocrine cells secrete
5-HT=Serotonin
Kallikrein
144
Carcinoid syndrome symptoms
```
Diarrhea
Wheezing
Rapid heart beat
Pink skin
Heart disease
```
145
Diagnosis of carcinoid syndrome
Urine 5-HIAA
146
5-HIAA
Hydrozyl
Indole
Acetic
Acid
