Endo Flashcards Preview

boards > Endo > Flashcards

Flashcards in Endo Deck (83)
Loading flashcards...
1
Q

Screening tests for DM-what do you do if one of two tests is abnormal

A

repeat the Abnormal one

2
Q

random glucose cut off for diagnosing DM

A

> 200 WITH sx

3
Q

how do you restore hypoglycemia awareness

A

lower insulin dose/raise glucoses for several weeks

4
Q

statin dose for >40, ASCVD <7.5, DM

A

moderate

5
Q

follow up for someone with a history of gestational DM

A

yearly screening for DM

6
Q

eye exams for someone with T2DM and pregnancy

A

trimesterly eye exams

7
Q

common cause of non-diabetic post prandial hypoglycemia

A

gastric bypass/gastrectomy (glucose rapidly absorbed->rapid insulin secretion)

8
Q

drugs to screen for if suspect surrepticious hypoglycemic use

A

sulfonylureas and meglinitides

9
Q

MEN1 presentation

A

hyperparathyroid
pituitary neoplasm
pancreatic NETs including gastrinomas or insulinomas

10
Q

tx for postprandial hypoglycemia after gsatric bypass

A

small meals with mix of protein/fat/fiber

11
Q

Sheehan syndrome presentation

A

associated with hemorrhage/hypotension
causes possibly vascular collapse
more often amenorrhea, lack of lactation, fatigue

12
Q

how do you test for growth hormone deficiency

A

loss of muscle mass

low IGF-1 and diminished insulin tolerance test

13
Q

what happens to prolactin in hypopituitarism

A

may go up

14
Q

what is pituitary apoplexy

A

bleeding into or poor blood supply of pituitary (i.e from tumor or sheehan syndrome)

15
Q

how do you dose levothyroxine for central hypothyroid

A

T4 (NOT TSH)-also rule out and tx hypoadrenal first

16
Q

non-tumor causes of large pituitary

A

pregnancy or primary hypothyroidism

17
Q

diagnosis for acromegaly

A

incr. IGF
AND
OGTT will fail to suppress GH

18
Q

If presentation of headache, bitemporal hemianopsia maybe other sx, first test?

A

imaging! (not hormone tests)

19
Q

which patients get screening for pituitary adenoma

A

1 component of MEN1 (i.e. hyperparathyroid) + family member with MEN1

20
Q

other test in hyperprolactin (other than pregnancy)

A

TSH (hypothyroid can cause hyperprolactin)

21
Q

tx for symptomatic hyperprolactinoma

A

dopamine agonist i.e. cabergoline or less preferred bromocriptine

22
Q

which pituitary adenomas get surgery

A

ACTH/GH/LH secreting, mass effect, or prolactinomas not responding to cabergoline

23
Q

test once you’ve confirmed nephrogenic DI

A

kidney ultrasound (vs. mri brain if central)

24
Q

tx for Li induced DI if you can’t stop Li

A

amiloride

25
Q

Tx for non-drug induced nephrogenic DI

A

thiazide diuretic and salt restriction

26
Q

presentation of postpartum thyroiditis

A

painless autoimmune thyroiditis within a few months postpartum

27
Q

labs in thyrotoxicosis (other than thyroid)

A

mild hyper Ca, elevated alk phos, low HDl/total chol

28
Q

next test in low tsh, nl t4

A

t3 (?t3 toxicosis)

29
Q

test if you suspect surreptitious thyroid hormone

A

thyroglobulin (will be suppressed (high in hyperthyroid/thyroiditis)

30
Q

side effects of radioactive iodine therapy

A

sialadenitis and painful radiation thyroiditis

31
Q

outcomes after antithyroid meds for graves

A

30-50% will get a drug free remission afte ra year

32
Q

why is propylthiouracil worse than methimazole

A

more liver failure (better in pregnancy)

same rashes/agranulocytosis

33
Q

when do you avoid radioactive iodine for hyperthyroid

A

pregnancy/breast feeding and graves opthalmopathy

34
Q

tx for thyroidstorm

A

propylthiouracil (!), iodine, steroids, beta blockers

35
Q

likely dx in patient with fever or sore throat on methimazole/propylthiouracil

A

be on the look out for agranulocytosis

36
Q

in general, when do you treat subclinical hypothyroid

A

TSH >10

37
Q

tx of myxedema coma

A

levothyroxine + hydrocort until you rule out hypoadrenal

38
Q

which thyroid nodules need FNA

A

ANY >1 cm + NL TSH

or <1 cm with risk factors/suspicious ultrasound

39
Q

steroid amt likely to cause clinically significant endogenous suppression

A

> = 10-20 for 3 weeks+

40
Q

1st line tests for hypercortisol (3)

A

low dose dex suppression
24 hr urine cort
EVENING salivary cort

41
Q

Next text if:
hypercortisol confirmed
Elevated or nl TSH
No pituitary tumor on imaging

A

High dose dexamethasone suppression test
If it does NOT suppress cortisol: ectopic acth tumor-look for SCLC, bronchial carcinoid, pheo, medullary thyroid
If it DOES suppress cortisol: pituitary source, do intrapetrosal sinus sampling for acth to confirm

42
Q

tests after identifying ANY adrenal incidentaloma

A

1 mg overnight dex suppression test and urine metanephrines

aldo/renin ratio if hypertension or hypokalemia

43
Q

which adrenal incidentalomas get surgery

A

> 6 cm or functioning

44
Q

follow up for non-surgical adrenal incidentalomas

A

repeat imaging AND functional testing in 6-12 months

45
Q

steroid that doesn’t interfere with serum cortisol assay for adrenal insufficiency testing

A

dexamethasone

46
Q

pheochromocytoma disease associations

A

MEN2, vonHippel-Lindau, NF type 2

47
Q

when do you do 24 hr urine vs. plasma metanephrines in suspected pheo

A

low pretest probability-24 hr urine (i.e. adrenal incidentaloma)
high prest probability-plasma (i.e. familial syndrome)

48
Q

tx of intraoperative hypertensive crisis in pheo

A

nitroprusside or phentolamine

vs phenoxybenzamine which is given preop

49
Q

which meds need to be stopped for plasma aldorenin ratio

A

just eplerenone/spironolactone

50
Q

Dx and etiologies (4) of secondary amenorrhea with low estradiol, nl FSH/LH

A

hypogonadotrophic hypogonadism

  • hypothyroid
  • hyperPL
  • hypothalamic (stress weight loss exercise)
  • pituitary (tumor, sheehan)
51
Q

Dx and etiologies (3) of secondary amenorrhea with low estradiol and elevated FSH/LH

A

hypergonadotrophic hypogonadism

  • premature ovarian failure (autoimmune)
  • chemo
  • pelvic radiation
52
Q

Conclusions you can draw from progesterone challenge for secondary amenorrhea

A

+ bleed-intact ovaries/estrogen

no bleed-ovarian failure

53
Q

cut off where you MUST image for hyperPL

A

> 100 with nl TSH

54
Q

how do you prevent osteoporosis in secondary amenorrhea

A

give estrogen/progesterone replacement until return or until 50 yo

55
Q

next tests after two low am testosterones in a male

A

LH, FSH, PL

56
Q

Dx and etiologies (5) of male hypogonadism with low T, high LH/FSH

A

testicular failure

  • Klinefelter
  • atrophy secondary to mumps
  • autoimmune
  • chemo/rad
  • hemochromatosis
57
Q

Dx and etiologies (4) of male hypogonadism with low T, low or nl LH/FSH

A

secondary hypogonadism

  • sleep apnea
  • hyperprolactin
  • pituitary/hypothalamus problem (hemochromatosis, tumor)
  • opiates, anabolic steroids, glucocorticoids
58
Q

tests to find etiology of male secondary hypogonadism

A

PL
iron studies (for hemochromatosis)
MRI
(maybe sleep study, maybe utox)

59
Q

monitoring required during male testosterone therapy

A

Hct and PSA

60
Q

Important test in a patient with hyperCa, nl PTH

A

urine calcium excretion for familial hypocalciuric hypercalcemia

61
Q

3 hypercalcemia etiologies with low or normal phos (rest are high)

A

primary hyperparathyroid
malignancy (Other than MM)
local osteolytic lesions

62
Q

MEN1 components

A

Hyperparathyroid (most common presentation)
Pituitary tumors
Pancreatic neuroendocrine

63
Q

test to measure in ALL hyperparathyroid patients

A

check vitamin D (50% are low, can screw with serum/urine Ca)

64
Q

who gets hyperparathyroidectomy

A

any complications (stones, symptoms…)

  • Ca >1 above ULN
  • decr. GFR
  • T score <2.5 on dexa
  • young (<50)
65
Q

what is hungry bone syndrome

A

precipitous Ca fall after parathyroidectomy

66
Q

special hyperCa tx in MM or sarcoid

A

remember to start steroids

67
Q

what is a better way to phrase pseudohypoparathyroidism

A

PTH resistance

68
Q

vitamin D choice in liver disease

A

25 OH cholecalciferol

69
Q

vitamin D choice outside of liver or kidney disease

A

cholecalciferol or ergocalciferol

70
Q

vitamin D choice in kidney disease

A

1,25 dihydroxy vitamin D (calcitriol)

71
Q

next step after you find hypoaldosteronism to look for source

A

plasma vein sampling if adenoma present because non-functioning is so common
tx hyperplasia with spironolactone/eplerenone

72
Q

T score cut off for osteoporosis

A
73
Q

T score cut off for osteopenia

A

-1- -2.4

74
Q

Frax score that is an indication for tx

A

risk of major fracture >20% or hip >3%

75
Q

raloxifene adverse effect

A

VTE

76
Q

teriparatide adverse effect

A

(osteoporosis drug)-osteosarcoma

77
Q

which osteoporosis med cannot be used for hip fracture reduction

A

raloxifene (given if you cant tolerate oral bisphosphonates)

78
Q

osteomalacia etiology and presentation

A

low vitamin D usually (or Ca/Phos deficiency)

  • fatigue, bone pain, muscle weakness (prox), low Ca/phos, high alk phos
  • can confirm wiht bone ibopsy
79
Q

sceening test for vitamin D deficiency

A

25 OHvitamin D

80
Q

Paget disease presentation (4)

A

bone pain/fractures
cranial/spinal nerve compression
high output cardiac failure
angioid retinal streaks

81
Q

Paget disease labs

A

elevated alk phos

82
Q

Paget disease diagnostic imaging test and findings

A

bone scan and xrays of affected area

-xrays show focal osteolysis cotton wool, cortical thickening

83
Q

Tx of paget disease

A

bisphosphanates