Clin Med Flashcards by Sam Stanfield

Nervous system for ______ homeostasis responses

quick

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Endocrine system for _______ homeostasis responses

long

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Endocrine system is mostly _______ hormones (transferred via the blood).

trophic

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Epinephrine, dopamine, T3 and T4 are examples of?

Amines (modified amino acids)

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Aldosterone, cortisol, estradiol, and testosterone are examples of?

Steroid hormones

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There are two big groups of hormones – ones that come from ________ and ones that come from ________.

amino acids

cholesterol (aka amines/peptides and steroids)

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How do modes of action differ between polar and non-polar molecules?

Polar bind to membrane receptors/cell surface receptors and non-polar pass through the membrane and bind to intracellular receptors.

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All the lipid soluble molecules are derived from ________.

cholesterol

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________ comes from the cortex and the adrenal gland. _________ and _________ come from the adrenal medulla.

Cortisol

Norepinephrine and Epinephrine

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Growth hormone stimulates the liver to produce what hormone?

IGF-1

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What hormone inhibits the anterior pituitary?

Somatostatin

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When is growth hormone secreted and what/when is it inhibited?

Secreted: hypoglycemia, fasting, starvation, stress

Inhibited: increased glucose levels, free fatty acid release, obesity, cortisol

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Growth hormone excess before puberty is known as?

Growth hormone after puberty is known as?

Gigantism

Acromegaly

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Gigantism effects what type of bones?

Acromegaly effects what type of bones?

Long bones

Bones in the extremities

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What inhibits intestinal calcium absorption, inhibits osteoclasts, and stimulates osteoblast activity in bones?

Calcitonin

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What is the most common cause of hypothyroidism?

Hashimoto’s (in the US) but i’m pretty sure it’s iodine deficiency world wide

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Most common cause of hyperthyroidism?

Graves Disease

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What increases catabolism of fat and muscle tissues, free fatty acids and their use for energy, gluconeogenesis, and blood glucose level?

Cortisol

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Hypotension, high CRH levels, and hypoglycemia are all symptoms of?

Addison’s

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What element is essential for manufacture of thyroid hormones?

Iodine

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What are the most informative tests of thyroid function?

TSH (extremely sensitive) and free T4

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What is a normal range of thyroid hormone?

0.27-4.2 mU/L

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Thyroid stimulating hormone receptor antibodies will be elevated in 80% of patients with ____________.

Graves Disease

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What is the definitive test for evaluating thyroid nodules and is essential for diagnosing thyroid cancer?

Fine needle aspiration

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What disease will have elevated levels of TPO and Tg antibodies?

Hashimoto's

Cold intolerance, constipation, dry skin, and hair loss are symptoms of?

Hashimoto's

What drug do we use to treat hypothyroidism?

Levothyroxine

Is it essential to detect congenital hypothyroidism to prevent?

Cretinism

If you're trying to determine between a thyroid nodule and Graves disease, what test can we do?

Do a radioactive isotope scan -- if there's a nodule involved, only the nodule will light up

Can we as PA's treat Graves?

Nah. Have to refer to endooooo

What is a clinical syndrome associated with excessive levels of thyroid hormone?

Thyrotoxicosis

What do we mean by "factitious" hyperthyroidism?

Someone has hyperthyroidism by taking too much thyroid hormone

Hyperactivity, irritability, restlessness, and anxiety are symptoms of?

Graves Disease

Proptosis/exophthalmos and "lid-lag" are symptoms of?

Graves Disease

What drugs do we use to treat hyperthyroidism?

Propylthiouracil (PTU) or Methimazole

What is common side effect of Thiourea drugs?

Pruritis

Important to monitor patients for signs and symptoms of _____ ______ during the initial 6 months of thiourea use

liver injury

Methimazole or PTU is associated with birth defects?

Methimazole

What is the treatment of choice for Graves?

Radioactive Iodine

What is the treatment of choice for Graves in children or hyperthyroidism during pregnancy when symptoms can't be controlled with drugs?

Thyroid surgery

What does the prognosis look like for Graves patients?

Recurrences common if only treatment is thioureas

If we have a toxic thyroid nodule, how do we treat it?

If the patient is younger than 40 years old surgery is preferred over RAI. If older than 40 RAI is preferred over surgery.

What is the most common type of thyroid cancer?

Papillary

What is a risk factor for thyroid cancer?

Prior head and neck radiation or radiation exposure.

Aldosterone is secreted from where in the kidney?

Outer layer of adrenal cortex

Cortisol is secreted from where in the kidney?

Middle and inner adrenal cortex

Is Cushing's syndrome more commonly associated with endogenous or exogenous sources?

Exogenous --> glucocorticoid administration

What is the difference between Cushing's Disease and Cushing's syndrome?

Cushing's disease is a tumor on the pituitary secreting excessive ACTH and Cushing's syndrome is a tumor on the adrenal gland. Note: there are other causes of cushing's syndrome --

What are some signs and symptoms of Cushing's Disease?

"moon facies", abdominal protuberance, "buffalo hump", supraclavicular fact. Hypertension, oligomenorrhea, osteopenia and osteporosis

What tests do we do to diagnose Cushing's?

Dexamethasone suppression test can also do a 24 hour urine free cortisol/creatinine

If you have a patient with fatigue, weakness, and hypotension -- what must you keep in your DDx?

Adrenal insufficiency

What patients are at risk for adrenal insufficiency?

those taking exogenous corticosteroids

Chronic adrenal insufficiency ---- you think of?

Addison's disease and JFK. my he RIP.

Signs and symptoms of Addison's?

Weakness, fatigue, wt. loss, myalgias -- symptoms are very non-specific. Low BP, orthostasis, hyperpigmentation of skin

Low AM cortisol level -- think of?

Addison's

What is a diagnostic test we can do for Addison's?

Cosyntropin (synthetic ACTH) stimulation test -- provides measure of renal reserve

What is the name of a tumor of the adrenal medulla that releases excessive amounts of norepineprhine/epinephrine into the circulation?

Pheochromocytoma

What is the hallmark of Hypoparathyroidism?

Low ionized Ca

What is the hallmark of hyperparathyroidism?

elevation of serum total and ionized Ca

Does hyperparathyroidism cause chronic trabecular or cortical bone resorption?

Cortical

If i say "moans, groans, stones, and bones" you say?

Hyperparathyroidism

What has to be on you DDx with hypercalcemia?

Malignancy -- tumor mets to bone (breast, lung, pancreas, kidney)

What is the most common metabolic bone disease?

Osteoporosis

Osteoporosis leads to breakdown of trabecular or cortical bone more?

Trabecular

What drug is the best at rebuilding bone density?

Teriparatide

What percentage of Trabecular bone is lost over 10 years?

25-30%

What percentage of Cortical bone is lost over 10 years?

10-15%

What is first line therapy for osteoporosis?

Calcium and Vitamin D

What bones does a DEXA scan look at?

Spinal bone, proximal femur, and other bones risk for fracture

How do bisphosphonates work?

They inhibit osteoclastic bone resporption

When we prescribe Fosamax what instructions do we have to give?

Take 30 minutes before AM meal with eight ounces of water and remain upright for 30 minutes to prevent esophagitis and do the chicken dance and chug a PBR.

Serum IGF-1 5x normal is associated with?

Acromegaly

How do we treat acromegaly?

Transsphenoidal microsurgery

What is the most common cause of hyperprolactinemia?

Pituitary microadenoma

In resting state, muscle energy is supplied by?

Fatty acids

Circulating _______ will prevent ketosis not hyperglycemia?

insulin

What is a major factor in insulin resistance?

Central/visceral obesity

What range of A1c is considered pre-diabetes?

5.7-6.4%

Why do we put diabetics on aspirin?

Because they have abnormal platelet function

What are the ABC's of diabetes?

1. Aspirin 2. Blood pressure 3. Cholesterol

What drug do we use as adjunct therapy to metformin, and has adverse effects such as hypoglycemia and weight gain?

Second generation Sulfonylureas -- Glipizide

What drug to treat diabetes causes flatulence and diarrhea and 60% of people d/c the drug because of these problems?

Alpha-Glucosidase Inhibitors (acarbose)

What drugs act primarily on peripheral tissues, decrease insulin resistance and increase insulin sensitivity?

TZD's (pioglitazone)

Is hypoglycemia associated with TZDs? Is weight gain?

No hypoglycemia, but yes weight gain

What oral diabetic agent causes weight loss?

SGLT2-inhibitors (Canaglifozin, Dapaglifozin)

Are GLP-1 Receptor Agonists an oral medication?

No! Injection -- alternative to insulin. Do not cause weight gain and show to have a decreased incidence of hypoglycemia.

What is the best way to prevent retinopathy?

Tight glycemic control

Nephropathy develops as a result of chronic ________ and uncontrolled _________.

hyperglycemia, hypertension

What is the test of choice for Nephropathy?

Spot AM urine for albumin/Cr

If our patient is only losing a teeny tiny bit of protein in their urine do we have to start an ACE? What if their BP is normal, do we still start an ACE?

YUP YEAH DOG

Decreased sensation in "stocking glove" distribution should make you think of?

Neuropathy

What happens to your lipids with hyperthyroidism?

Low HDL and high total triglycerides

"Fruity breath" should make you think of?

DKA

DKA will result in ________ acidosis with an _________ anion gap.

Metabolic, increased

When referring to glycemic control in type 2 diabetes, we want their postprandial plasma glucose to be less than....

180

When referring to glycemic control in type 2 diabetes, we want their preprandial plasma glucose to be between...

80 and 130

What drug decreases hepatic glucose production and increase insulin sensitivity?

Metformin

What class of drugs increase insulin sensitivity, glucose uptake, and improves metabolism?

TZD's which is confusing because modest weight gain is associated with TZDs

What kind of patients can we not use TZD's in?

Those with CHF and hepatic disease

Fluid retention should make you think of what class of drugs?

TZD's

Clin Med Flashcards

(100 cards)