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Family Medicine Re certification > Encocrinology > Flashcards

Encocrinology Flashcards

1
Q

22 year old with a basic metabolic panel is notable for a sodium level of 131 mEq/L (N 135–145) and a potassium level of 5.1 mEq/L (N 3.5–5.0). He is having nausea, poor appetite, fatigue and dizziness

A

Addison’s disease. Autoimmune destruction of adrenal cortex. This results in the loss of mineralocorticoid, glucocorticoid, and adrenal androgen hormone production.

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2
Q

What medication treatment does an Addison’s pt need

A

People with Addison’s disease require lifelong hormone therapy with glucocorticoids and mineralocorticoids. They also require stress-dose glucocorticoids for illnesses and before surgical procedures because they are unable to mount an adequate response to stress. Generally, the treatment will be prednisone or hydrocortisone along with fludrocortisone.

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3
Q

What are the two types of primary hyperaldosteronism

A

One is aldosteronoma in the adrenal gland that needs to be surgically fixed.
Second is idiopathicadrenal hyperplasia Which may account for up to 75% of cases

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4
Q

True or false, up to 5 to 15% of secondary hypertension’s are due to hyper aldosteronism

A

True

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5
Q

Signs and symptoms of hyperaldosteronism

A 
HTN -
Hypokalemia
Hypernatremia
Weakness
Abdominal distention
Ileus from hypokalemia
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6
Q

What are the 2 main hormones that influence the kidney and change blood volume

A

two main hormones that act on the kidneys to change blood volume—antidiuretic hormone and aldosterone. Both effectively increase blood volume
aldosterone- nc. Na reabsorption (inc water by osmosis
ADH - increase water reabsorption, decrease Na
concentration

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7
Q

What are the 4 end organs that Angiotensin II acts on

A

Blood vessels- vasoconstriction
Adrenals- release aldosterone
Brain- release ADH and increase thirst
Kidney- Increase Na reabsorption

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8
Q

Causes of Cushing’s syndrome

A

Causes of Cushing syndrome include administration of exogenous corticosteroids such as prednisolone, pituitary adenoma, adrenal adenoma or carcinoma, and exogenous production of ACTH (such as oat cell tumor of lung).

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9
Q

Cushing’s dx vs Cushing’s syndrome

A

Both are from excess cortisol. Cushing dx is from a pituitary tumor secreting excess ACTH

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10
Q

Cushing’s syndrome is diagnosed with

A

urinary free cortisol levels - 24hr urine collection

also dexamethasone suppression test

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11
Q

in addition to moon facies, buffalo hump, abd. skin purple striae, other symptoms findings include…

A

Hypertension, impaired glucose tolerance, and osteopenia may be seen.

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12
Q

What is the confirmatory test for CF

A

Sweat test

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13
Q

What is the most common cause of hyperaldosteronism?

Are all hypokalemic?

A

Adrenal adenoma
second is idiopathic
No

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14
Q

treatment for hyperaldosterone from adenoma

A

surgery,

potassium sparring diuretic like amiloride + HCTZ or spironolactone

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15
Q

longest acting injected insulin

A

Degludec (Tresiba) up to 42 hrs

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16
Q

What are the 3 releasing hormones that are released by the hypothalamus

A

CRH (corticotrophin releasing H) TRH (Thydrotrophic)

GHRH (Growth Hormone Releasing H)

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17
Q

What are the 6 Trophic hormones

A

TSH, ACTH, GH, Prolactin and the two gonadotrophins LH and FSH

18
Q

Best test to R/O Addison’s disease

A

ACTH stimulation test

19
Q

Graves’ disease

A

Autoimmune. Unclear trigger. .Antibodies attach to follicular cells. Both hypertrophy and hyperplasia occur.

20
Q

What causes the proptosis in Graves’ dx

A

glycosaminoglycans

21
Q

Best test for Addison’s disease

A

ACTH stimulation test (Cosyntropin)

22
Q

STOP bang questionnaire for sleep apnea

A

snore, tierd, observe you stop breathing during sleep, pressure, BMI, age, neck size, gender

23
Q

What antibiotics are most likely to increase INR

A

TMP/SMX, ciprofloxacin, levofloxacin, metronidazole, fluconazole, azithromycin, and clarithromycin (TABLE 2).

Low-risk agents include clindamycin, cephalexin, and penicillin G.

24
Q

what happens in the esophagus with esophageal achalasia

A

Esophageal manometry to reveal incomplete lower esophageal sphincter relaxation in response to swallowing, high resting lower esophageal sphincter pressure, and the absence of esophageal peristalsis.

25
Q

what is amblyopia

A

Lazy eye. USPSTF recommends screening 3-5yrs age

26
Q

tapazole for hyperthyroidism takes how long to be effective

A

3-6 wks

27
Q

What are the 3 functions of Parathyroid Hormone to increase serum Ca

A
  1. Mobilize Ca from bone (activate ostoclasts) 2.Reabsorbtion Ca in Kidney, and excrete phosphorus
  2. Activate Vit D for increase absorption in sm. intestine
28
Q

Symptoms of hypocalcemia

A

mostly asymptomatic. + Chvostek’s sign (tentany) “cheek” tap + Trousseau sign (tetany) use tourniquet

29
Q

What value is needed for a corrected calcium level

A

albumin. Low albumin, low Ca

30
Q

Causes of elevated PTH

A

most common cause is parathyroid adenoma- primary
Secondary hyperparathyroidism is from hypocalcemia from kidney dx or vitamin D deficiency, other causes of hypocalcemia such as hypomagnesemia

31
Q

Hypercalcemia symptoms

A

Moans, groans, stones, psych overtones – abdominal pain, constipation, decreased appetite, nausea, and vomiting, confusion

32
Q

what T score on Dexa scan indicates osteopenia.

what score indicates osteoporosis?

A

-2.5 to -1

33
Q

What is tertiary hyperparathyroidism

A

When secondary hyperparathyroidism leads to parathyroid hypertrophy and abnormally increased PTH from the hypertrophied gland resulting in hyperCa

34
Q

what is calcitriol

A

Activated vitamin D- It is also known as 1,25-dihydroxycholecalciferol.

35
Q

Describe calcitonin

A

It is secreted by the Thyroid Gland and acts to reduce Ca levels of they get too high

36
Q

Besides their anatomic proximity, how is the thyroid gland endrocrinologically related to parathyroid gland

A

Calcitonin vs PTH in Ca regulation

37
Q

Treatment of Hypercalcemia

A

Saline, lasix, IV Calcitonin, IV bisphosphonate (e.g Mithramycin), dialysis

38
Q

When is surgery recommended for hyperparathyroidism

A

<50yrs old, Ca > 11.5, Osteoporosis, low GFR

39
Q

What should all postmenopausal women take daily

A

1200 mg elemental Ca and Vitamin D

40
Q

What are vitamin D supplement recommendations?

A

400IU infants then 600IU up to 70yrs old then 800IU per day

41
Q

Psyllium is effective for lowering…

Fish oil for lowering….

A

LDL and Total cholesterol
Triglycerides

42
Q

Does omega 3 FA have a role in primary CVD prevention? Secondary?

A

Nope. Nope

Family Medicine Re certification (19 decks)

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