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Endo Flashcards

1
Q

Most common cause of primary hyperCa?

A

Primary hyperpara (outpatient)

Malignancy (inpatient)

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2
Q

1st step in hyperCa?

A

Parathyroid hormone level

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3
Q

Androgen insensitivity syndrome classic.

A

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

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4
Q

Incomplete androgen insensitivity?

A

Partial fusion of vaginal lips
Enlarged clitoris
Blind ending vagina

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5
Q

Aspartame sugar is metabolized to?

A

Aspartic acid

Phenylalanine

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6
Q

Aspartame sweetener in contraindicated in which patients?

A

Phenylketonuria

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7
Q

Euthyroid sick syndrome labs?

A

Low T3

Normal T4 + TSH

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8
Q

What should be done before starting metfoemin?

A

Creatinine clearance > 70

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9
Q

Drug causes hyperCa?

A

Lithium

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10
Q

Diuretic used to Rx hyperCa?

A

Furosemide

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11
Q

Testosterone supplant SE?

A

Erythrocytosis

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12
Q

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

A

Hyperpara: normal PTH + high Ca.

Renal: high PTH + High Ca

Milk alkali: overdose of Ca supplement + low PTH

Sarcoidosis: low PTH

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13
Q

Complications of acromegaly?

A 
arthritis 
Amenorrhea 
HTN
Cardiomegaly 
Carpel tunnel syndrome
DM
Renal failure 
Colonic polyps
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14
Q

Most common cause of death in acromegaly?

A

Cardio

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15
Q

Most common cause of 1ry hyperpara? Rx

A

Adenoma

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16
Q

Normal Anion Gap?

A

10-14

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17
Q

How to calculate Baseline anion gap?

A

0.25 x (44-albumin)

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18
Q

Pathophysiology of Cushing’s

A

High corticosteroids

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19
Q

Types of Cushing’s

A

ACTH dependent

ACTH independent

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20
Q

Dx of Cushing’s

A

DXM suppression test

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21
Q

Pager disease pathophysiology?

A

Increase bone remodeling (resorption, formation and mineralization)

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22
Q

Association between pages and multiple myeloma?

A

None

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23
Q

Rx of paget disease

A

Bisphosphonate

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24
Q

Effect of H-blocker / PPl on Ca absorption?

A

Decrease Ca carbonate

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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

CanQB (16 decks)

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