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Flashcards in Endo Deck (152):
1

Most common cause of primary hyperCa?

Primary hyperpara (outpatient)

Malignancy (inpatient)

2

1st step in hyperCa?

Parathyroid hormone level

3

Androgen insensitivity syndrome classic.

Male genotype with female characteristics (breast, sparse armpit and pubic hair)
No uterus
No periods
Infertility

4

Incomplete androgen insensitivity?

Partial fusion of vaginal lips
Enlarged clitoris
Blind ending vagina

5

Aspartame sugar is metabolized to?

Aspartic acid
Phenylalanine

6

Aspartame sweetener in contraindicated in which patients?

Phenylketonuria

7

Euthyroid sick syndrome labs?

Low T3
Normal T4 + TSH

8

What should be done before starting metfoemin?

Creatinine clearance > 70

9

Drug causes hyperCa?

Lithium

10

Diuretic used to Rx hyperCa?

Furosemide

11

Testosterone supplant SE?

Erythrocytosis

12

HyperCa in hyperpara vs renal failure vs milk alkali vs sarcoidosis.

Hyperpara: normal PTH + high Ca.


Renal: high PTH + High Ca

Milk alkali: overdose of Ca supplement + low PTH

Sarcoidosis: low PTH

13

Complications of acromegaly?

arthritis
Amenorrhea
HTN
Cardiomegaly
Carpel tunnel syndrome
DM
Renal failure
Colonic polyps

14

Most common cause of death in acromegaly?

Cardio

15

Most common cause of 1ry hyperpara? Rx

Adenoma

16

Normal Anion Gap?

10-14

17

How to calculate Baseline anion gap?

0.25 x (44-albumin)

18

Pathophysiology of Cushing's

High corticosteroids

19

Types of Cushing's

ACTH dependent
ACTH independent

20

Dx of Cushing's

DXM suppression test

21

Pager disease pathophysiology?

Increase bone remodeling (resorption, formation and mineralization)

22

Association between pages and multiple myeloma?

None

23

Rx of paget disease

Bisphosphonate

24

Effect of H-blocker / PPl on Ca absorption?

Decrease Ca carbonate

25

Patient on long term PPi / H-blocker what Ca formula should be started?

Ca citrate.

26

Anti-psychotic causing DM?

Risperidone
Clozapine
Olanzapine
Quetiapine

27

Most common cause of high K in healthy?

Lysis of RBC during phlebotomy.

28

What level of High K causes cardiac changes?

> 6 miles/L

29

Rx of hyperthyroidism in pregnancy?

PTU > MMI

30

Most important feature in
1. Insulin
2. Sulfonylurea
3. Glitazone

1. Most effective
2. Least expensive
3. No risk of hypoglycemia

31

Sulfonylurea SE?

Hypoglycemia

32

Metformin SE?

Lactic acidosis
GI upset

33

Metformin effect on weight?

Reduction

34

Rx of hyperK?

1. Ca gluconate to stabilize cardiac cells.
2. Sodium bicarbonate
3. Glucose with insulin
4. Albuterol

35

HypoPO4 classic?

Acute low PO4 in malnourished patients with refeeding syndrome at 2-3 day of improved nutrition

36

Sx hypoPO4?

Weakness
Confusion
Arrhythmia
Low PB
HypoK

37

Pathophysiology of refeeding syndrome?

Refeeding increases insulin > uptake of phosphate > sever low PO4

38

Rx of uncontrolled DM in friable elderly?

Insulin
1. Diet is not recommended in elderly friable.

39

Contraindication to pioglitazone?

Heart Failure

40

Monitor LFT with statin. High LFT.

Only stop statin if LFTs are 3x increased.
No need for dose adjustment in <3x increase.

41

Effect of tight blood sugar control in post-op?

Improve morbidity and mortality.

42

Rx of post-op hyperglycemia

Insulin infusion

43

Causes of dyslipidemia?

DM
Hypothyroid
Obstructive liver disease
CKD

44

Rx of hypoNa from SIADH?

3% saline at 100 ml/Hr Q2-4 hr.

45

When to Rx SIADH with fluid restriction?

If no neuro sx

46

Hyperosmolar hyperglycemic state HHS classic?

Plasma glucose > 33
Blood osmolality 320
Blood PH > 7.3
HCO3 > 15
Dehydration
Altered consciousness
+/- Ketonuria

47

Predisposing cause of HHS?

T2DM with infection
Alcohol
CVS
Renal

48

Rx of HHS?

1. R/o MI by ECG
2. Correct Na calculated and 9-10L NaCl should replaced.
3. Stop metformin
4. 2L should be given in 1st hour.

49

Pre-DM fasting glucose level?

6.1 - 6.9

50

Dx DM?

1. Sx + Random 11.1
2. Sx + FPG 7
3. 2hr GTT 11.1
4. HgbA1c > 6.6

51

Addison's Disease?

Low PB
Hyper pigmentation
Low Na + high K
Weakness + fatigue
GI symptoms

52

Dx of addison's?

Cosyntropin (ACTH analogue)

53

Feature of exenatide?

No risk of hypoglycemia
Given in combination.
No studies on children.

54

Hypoglycemia not related to insulin triad?

whippes triad:
1. Neuro sx of low glucose
2. Low plasma glucose
3. Relief of Sx with glucose

55

Cushing's triad?

Head injury
1. Low HR
2. Low RR
3. HTN

56

Samter's triad?

Nasal polyp
Asthma
Aspirin sensitivity

57

Virchows triad?

Stasis
Hyper coagulable state
Vessel injury

58

Beck's triad?

Muffled heart sound
Distended neck veins
Hypotension

In cardiac tamponade

59

Niacin in statin patient?

Increases risk of rhabdomyolysis

60

Vitamin produced endogenously?

Vit D + K

61

Dx DI?

1. Water deprivation fails to concentrate urine.

2. Exogenous ADH (vasopressin) to differentiate central from nephrogenic

62

Primary Polynesia Dx?

Concentrate urine with water deprivation test.

63

Sub clinical thyroid?

Abnormal TSH
Normal T4

64

Subclinical thyroid dz association

1. High TSH: high LDL

2. Low TSH: A-FIB , low bone density , cardiac disease.

65

Investigation of hypertrichosis + regular periods.

Free testosterone

66

Drugs contraindicated in pheochromocytoma?

1. Diuretics => worsen pressure diuresis and volume depletion.

67

Causes of SIADH?

1. Drugs esp Vincrstine
2. CNS
3. Lung esp. SCLC

68

Known endocrinological SE of lithium?

Hypothyroid

69

What dose of steroids suppresses ACTH?

Late evening dose.

70

Acceptable range of glucose in critically ill patients?

7.7 - 10

71

Vit D deficiency Sx?

Bone metabolism abnormality

72

Vit C deficiency?

Scurvy => bleeding gums

73

Thiamine deficiency?

High out put HF
Dermatitis
Neuropathy

74

Niacin deficiency?

Diarrhea
Dermatitis
Dementia

75

Dx pheochromocytoma?

Urine catecholamine products

76

Sx of low PO4?

Rhabdomyolysis at <0.3

77

Lab findings in pheochromocytoma

High glucose

High Ca

Erythrocytosis

78

Importance of 7-day half life of thyroxin?

If you miss the does for 1 week pts remain asymptomatic.

79

High Vit D labs?

High Vit D
High Ca
High PO4

80

Rx subacute thyroiditis

NSAIDs
High dose steroids

81

Good glycemic control doesn't affect which diabetic complication?

CVS

82

Endocrinological disease ass with vitiligo?

Graves' disease
Hashimoto's

83

Mechanism of action of DPP-4?

Dipeptidyl peptidase-4 inhibitor > inhibits Glucagon like peptide > increase glucagon > insulin release

84

Advantage of PPD-4

No weight gain
No hypoglycemia (glucose level dependent)

85

Mechanism action of sulfonylurea?

Increase insulin release

86

Disadvantage of solfonylurea?

Hypoglycemia (increase insulin independent of glucose level)

87

Importance of pancreatic B and a cells.

a => Glucagon.

b => insulin

88

Mechanism of action of anti-hyperglycemics

1. DPP-4: increase insulin (b) + decrease glucagon (a)

2. Sulfonylurea: increase insulin (b)

3. Repaglinide: insulin (b)

4. a-Glucosidase inhibitor: inhibits absorption

5. Pioglitazone: improves glucose uptake by tissues.

89

Serious SE of PTU?

Agranulocytosis

90

Effect of nicotinic acid?

Lowers cholesterol, LDL, TG, LDL/HDL ratio

91

SE of nicotinic acid

High glucose (x DM)
Hepatotoxic
Muscle pain

92

Most common cause of hypoglycemia in well control DM?

1. Chance in diet
2. Change dose
3. Renal disease

93

Sojgren Syndrome classic?

Dry mouth and eye.
1. Ocular Sx
2. Oral Sx
3. Ocular signs
4. Focal sialadenitis
5. Salivary gland involvement
6. Anti- Ro/La

94

Sjogren association.

Autoimmune disorders
Salivary gland Ca
B cell lymphoma

95

Rx sjogren?

Pilocarpine for xerostomia

Cyclosporine 0.05% eye

96

Rx worsen ophthalmopathy in graves ?

Radioactive iodine

97

What Rx increase risk of rhabdomyolysis with statin?

Rx inhibit CYP 3A4 => Ca blockers (verapamil)

98

Non-K sparing?

1. Loop diuretics: furosemide, bumetanide

2. Thiazide diuretics:
Chlorothiazide

99

Drug to be stopped before CT contrast?

Metformin

100

Criteria Dx DM?

1. Hgb A1C > 6.5
2. Fasting glucose > 7
3. 2h post prandial > 11.1
4. Random glucose > 11.1 + symptoms

101

ACEI SE?

High K

102

HyperK with ACEI?

1. Temporarily stop
2. Repeat test

103

Effect of DHEA on muscle?

Doesn't improve strength or performance

104

MEN syndromes

MEN I > 3P (pancreas, pituitary, parathyroid)

MEN IIa > parathyroid, medullary thyroid, pheochromocytoma

MEN IIb > medullary thyroid, pheochromocytoma, neuromas.

105

Most sensitive and specific test for pheochromocytoma

Metanephrin levels

106

Screen for hyperaldosteronism

Aldosterone/Renin ration
> 20:1 (aldosterone > 15)

107

Who should be screened for hyperaldosteronism?

HTN + low K

108

Insulin formulas

1. Regular insulin
Acts > 30-60 min
Peaks > 2-3 hr

2. Lispro, asparte
Act > 15 min
Peaks > 1hr

109

Stimulants for aldosterone

1. K levels (high > release | low > inhibits)

2. RAAS

110

What should be done before measuring aldosterone:renin ratio?

Normalize K levels

111

Conn's syndrome findings?

HTN
High Na
low K

112

Maximum dose of rosuvastatin?

40 mg/d

113

Pathophysiology of phenylketonuria

Defect in phenylalanine hydroxylase (PAH):
Phenylalanine converted to phenylpyruvate instead of tyrosine > musty odor

114

What's tetrahydrobiopterin

Co-factor for phenylalanine hydroxylase

115

Rx of phenylketonuria

- diet
- replenishing tetrahydrobiopterin

116

Hyperpara vs familial hypocalceuric hypercalcemic?

Hyperpara > high urine Ca

FHH > low urine Ca

117

Drugs increase risk of High K?

ACEI
BB
NSAIDs
K-sparing

118

Vit D form measured in suspected deficiency ?

25-OH Vit D

119

Use of red yeast rice (Monascus Purpureus)

Herbal supplement (China)
For dyslipidemia

120

Mechanism of red yeast rice?

Active ingredients (monacolin K) > HMG-coA inhibitory effect

Lower cholesterol, LDL, TG

121

Monitoring red yeast rice?

LFTs

122

Role of MMT / PTU in sub acute thyroiditis?

No role
It prevents synthesis of new hormones and in sub acute thyroiditis it's excessive release from stores not new formed

123

Rx of sever hypoglycemia (+ neuro Sx)

Admit
IV 50% Dextrose 50-100 ml bolus

Cont infusion D5NS

124

Characteristic of hypoK from hypoMg?

Refractory to replacement until Mg is replaced

125

Does pregnancy or lactation change daily allowance of Vit D?

No still 600 IU

126

Maximum Vit D recommended for which age group?

> 70

127

Cause of HyperCa on malignancy?

PTHrP

128

Mechanism of action of thiazolidinedione

Lower glucose
By decreasing insulin resistance via binding to nuclear peroxisome proliferator-activated response

129

Hyperaldosteronism findings in urine

Low Na in urine
Normal - high K (40 mEq)

130

Ca levels in hyperCa

Total Ca > 3 (12 mg)
Ionized > 1.5 (6 mg)

131

Rx hyperCa

1. IV fluids
2. Loop diuretics (furosemide)
3. PO4 orally.
4. Calcitonin, prednisone

132

Why isn't bisphosphonate the 1st line in sever hyperCa?

Takes 2 days to work

133

MEN-I tumors

Parathyroid > hyperCa
Pancreatic > Zollinger-Ellison syndrome
Pituitary

134

Drugs cause hyperthyroidism?

Interferon
IL-2
Amiodrone and

135

Indication of Rx in dyslipidemia?

+2 risk factors like:
1. FHx of heart disease
2. High LDL
3. Cholesterol

136

Advantage of low carb diet?

1. Don't change BP, LDL levels.

2. More weight loss than low-fat diet.

3. Reduces TG

4. Reduce insulin resistance

137

Assessment of antithyroid Rx?

Measure free T4

138

Components of caloric expenditure?

Basal metabolic rate for metabolic homeostasis 60-70%

Thermogenesis (for digestion) 5-10%


Physical activity 25-35%

139

Would celiac disease cause high TG?

No

140

Criteria for metabolic syndrome?

3 out of 5
1. Central obesity
2. TG > 1.70
3. HDL < 1.29 F or < 0.03 M
4. Fasting glucose > 6.1
5. BP > 130/85

141

Goal of lipid Rx in dyslipidemia?

NB: of blood glucose > 7 Rx DM first.
If < 7 Rx dyslipidemia
1. Decrease LDL via statin
Then decrease non-HDL cholesterol (total cholesterol - HDL = non-HDL lipids)

142

Causes of 2ry HTN?

CHAPS
Cushing's
High aldosterone (Conns)
Aorta cortication
Pheochromocytoma
Stenosis of renal artery

143

Must do before radioiodine Rx? Why?

1. R/o pregnancy
2. Stop anti-thyroid meds 3 days before Rx.

> anti thyroids prevent radioiodine uptake by thyroid!

3. Stop K iodide > competes with radioiodine

144

Function of BNP?

1. Inhibits RAAS
2. Inhibits endothelin secretion
3. Inhibits sympathetic activity

145

BNP role in Dx cardiac Dz?

< 100 HF unlikely
100-400 not clear
> 400 HF likely

146

Best way to monitor blood glucose at home?

Finger tip
3x day

147

Sulfonylurea med

Glyburide
Gliclazide
Glimepride

148

Thiazolidinedion med

Pioglitazone
Rosiglitazone

149

DPP-4 inhibitors

Sitagliptan
Saxagliptan
Linagliptan

150

GLP-1 analogue

Exenatide
Liraglutide

151

Total cholesterol

150-200 or <5.15

152

Normal LDL

<130 or <3.36