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Flashcards in Endo step Up Deck (128):
1

when is insuline released

response to glucose intake
secreted by pancreatic beta islet cell

2

effects of insulin

induce glucose and aa uptake by muscle, adipose and liver
glucose to glycogen fatty acids and pyruvate
inhibits lipolysis

3

where and when is glucagon released

by alpha islet cells in response to decreased glucose and protein intake
promotes breakdown of glycogen and fatty acids

4

What HLA is assoc with DM I

HLA DR3 DR4 and DQ

5

signs of DM I

polyuria polydipsia, polyphagia, weight loss
rapid onset

6

labs of DMI I

hyperglycemia, glycosuria, serum and urine ketones, increase HbA1c

7

what happens if DM I patient gives too much insulin

hypoglycemia

8

what illnesses are associated with onset beta cell destruction

rubella
coxsackie virus and mumps

9

risk factors DM II

FMH obesity metabolic syndrome, lack of exercise, gestational DM

10

Dx criteria DM

random plasma glucose >200 with Sx
fasting glucose >126 on 2 separate occasions
plasma glucose >200 2 hrs after 75 g oral glucose load
HbA1c>6.5%

11

what are the rapid acting insulin

lispro, asoart and glulisine

12

what are the long acting insulins

NPH, glargine and detemir

13

diabetic ketoacidosis is complication of what

DM I only

14

complication dM II

hyperosmolar hyperglycemic nonketotic syndrome
retinopathy
nephropathy
neuropathy
atherosclerosis

15

what leads to DKA

low insulin
glucagon excess leading to dehydration of TG that eventually turn to ketoacids
so not taking insuline or have infection,stress, MI or high alcohol use

16

signs DKA

weakness, polyuria, polydipsia, abdominal pain, vomiting, dry mucous membranes, decreased skin turgor, fruity odor on breath, hyperventilation, kussmaul breathing, mental status changes from dehydration

17

how does metformin work

decrease hepatic gluconeogenesis
increase insulin sensitivity

18

side effects metformin

GI
dec B12 absorption
CI in those with hepatic or renal insufficiency

19

what are the sulfonylurea drug names

glyburide glimepriride, glipizide

20

how do sulfonlyureas work

stimulate insulin release from beta cells, reduce serum glucagon, increase binding insulin to tissue R

21

adverse effects of sulfonylureas

hypoglycemia. CI in those with hepatic or renal insufficiency

22

Mechanism of thiazolidinediones

decrease gluconeogenesis
increase insulin sensitivity

23

thiazolidinediones are CI in what patients

CHF

24

what are the gliptins

DDP-IV inhibitors that inhibit degradation of incretin. cause decreased glucagon and increased insulin
delay gastric emptying so can cause diarrhea or constipation

25

what are the gliflozins

SGLT-2 inhibitors that inhibit renal reabsorption of glucose, lowering BP
can cause fungal infections or recurrent UTI

26

how does acarbose work

alpha glucosidase inhibitor that decrease GI absorption of starch
cause flatulance

27

what drugs stimulate insulin release

meglitinides
can cause hypoglycemia
and sulfonylureas

28

what drug promotes satiety in DM

pramlintide, delays gastric emptying

29

labs in DKA

high glucose like 300-800, decreased Na
normal or inc K (total body K decreased) so pseudohyperkalemia
dec phosphate
high anion gap acidosis
serum and urine ketones

30

Tx DKA

IV saline, insulin, KCl

31

labs in hyperosmolar hyperglycemic state

glucose >800 and commonly above 1000

32

what are signs of DM retinopathy

AV nicking, hemorrhages, edema and infarcts

33

type of nephropathy in DM

glomerulosclerosis, mesangial expansion and BM degeneration

34

signs of DM nephropathy

proteinuria, renal insufficiency later turns into nephrotic

35

labs in DM nephropathy

hypoalbuminemia, increased Cr, increased BUN, UA showing proteinuria and microalbuminuria, EM show thickening and kimmelstiel wilson nodules

36

Autonomic neuropathy in DM

postural hypotension, impotence and incontenence and gastroparesis

37

why are DM at highger risk silent MI

altered pain sensation from neuropathy

38

greatest cause of death in DM patients

cardiac
macrovascular disease

39

signs of hypoglycemia

fainting, weakness, diaphoresis, palpitations (from epinephrine release)
headache, confusion, mental changes, decreased consciousness

40

causes of hypoglycemia

reactive- post eating
iatrogenic (too much insulin)
insulinoma (beta islet cell tumor)
fasting (under production glucose)
alcohol induced
pituitary/adrenal insufficiency- decreased cortisol leads to insuffiecient hepatic gluconeogenesis

41

what stiulates and inhibits TRH

cold stimulates
stress inhibits

42

TSH comes from where

ant pituitary

43

which thyroid hormone is more potent

T3

44

what increase TBG levels

pregnancy and OCP
free T4 stays same

45

what decrease TBG levels

nephrotic syndrome and androgen use
normal free T4

46

signs of thyroid storm

severe diaphoresis, vomiting, diarrhea, tachy, fever and mental changes

47

what happens in graves

autoimmune TSI Ab bind to TSH R and stimulate hormone production

48

what is toxic multinodular goiter or toxic adenoma

single or multiple
produce excess thyroid hormones
increased uptake at nodules on scan

49

What is subacute thyroiditis

de quervain
enlarged thyroid maybe from virus
painful goiter
neck pain, fever, increased ESR
decreased uptake!!!!

50

Tx subacute thyroiditis

NSAIDs, beta blockers

51

silent thyroiditis

temporary may follow pregnancy
low uptake on scan
Bx will show inflammation
beta blockers for sx.
self limited

52

factitious hyperthyroid

taking hormones for thyroid

53

how does IV sodium iodine help hyperthyroid

block thyroid hormone release

54

how does hydrocortisone help hyperthyroid

inhibits conversion T4 to T3

55

Hashimoto

Autoimmune antithyroid peroxidase anti-TPO and antithyroglobulin Ab
also have lymphocytic infiltrates

56

thyroid scan of hashimoto

decreased uptake "cold"

57

chronic use of what can cause hypothyroidism

chronic lithium and chronic iodide

58

which type thyroid nodules have higher risk malignancy

cold nodule and solid on US

59

signs of thyroid carcinoma

nontender mass in neck. dysphagia hoarseness and maybe lymphadenopathy

60

Tx thyroid carcinoma

surgery, radioablation and postop replacement of hormones
malignant need resection and radioiodine ablation
chemo for mets

61

decreased TSH and hypothyroid

pituitary or hypothalamic

62

complications thyroid surgery

hypoCa from loss PTH
hoarseness from recurrent laryngeal nerve

63

most common thyroid carcinoma

papillary
has follicular variant
follicular has worse prognosis

64

which thyroid CA produces calcitonin

medullary in parafollicular cells
!! MEN 2A and 2B

65

most aggressive thyroid CA

anaplastic

66

PTH is screted in response to what and what does it do

low Ca
reabsorb bone and increase Ca
induce kidneys to conver Vit D
decrease phosphate reabsorption (lose phosphate)
increase Ca reabsorption

67

active Vit D does what

increase intestinal reabsorption Ca

68

calcitonin does what

inhibits bone reabsorption

69

hypercalcemia

bones stones abdominal groans and psychiatric overtones

70

labs in primary hyper PTH

increase Ca, decreased phosphate, increased urine Ca, increased PTH

71

decreased Ca. but high PTH

hyperparathyroidism secondary to malnutrition, malabsorption, renal disease or Ca wasting drugs

72

Tx hypercalcemia

IV fluids and bisphosphonates

73

most common cause hypoPTH

surgery

74

signs hypoPTH

hypo Ca
tingling in lips and fingers, dry skin, weakness, abdominal pain, tetany, dyspnea, tachycardia, seizures, movement disorders, cataracts, dental hypoplasia, Trousseau sign, Chvostek sign
increased phosphate, decreased PTH

75

Tx hypoPTH

Ca and Vit D

76

pseudohypo PTH

tissue does not respond to elevated PTH
Albright hereditary osteodystrophy

77

Sx of pseudohypo PTH

hypoCa symptoms, short stature, seizure, poor mental development

78

labs in pseudohypo PTH

decreased Ca, increased phosphate and increased PTH!!

79

Tx pseudohypo PTH

Ca and Vit D

80

ant pituitary secretes

ACTH, TSH, GH, FSH and LH

81

post pituitary secretes

ADH and oxytocin

82

what drugs can cause hyperprolactinemia

phenthizines, risperidone, haloperidol, methyldopa, verapamil

83

Tx prolactinoma

dopamine agonists like cabergoline and bromocriptine and pergolide

84

most common pituitary tumor

prolactinoma

85

acromegaly

excess secretion GH from anterior pituitary

86

effect of glucose on GH

should decrease it

87

Tx for acromegaly

surgical resection adenoma, dopamine agonists or octreotide to lessen effects

88

complications acromegaly

cardiac failure, DM, spinal cord compression, vision loss

89

child with advanced growth

check GH for gigantism

90

why do those with acromegaly have higher risk DM

also have increased insulin R

91

decreased LH FSH causes what

no estrogen
no testosterone in men impotence and testicular atrophy
decreased libido, infertility, decreased pubic hair, amenorrhea and genital atrophy in women

92

how to check for hypopituitary

no menstruation after medroxyprogesterone
no GH after give insulin
dec TSH
dec prolactin
cortisol does not increase after insulin from no ACTH

93

Sx low ACTH MSH

adrenal insufficiency causing fatigue, weight loss, dec appetite, poor response to stress, decreased skin pigment!!!!

94

how to determine cause of cortisol excess

low DXM test
low cortisol is usually found
if there is no decrease in cortisol then cushings
high dose DXM test-- determine cause of cortisol excess

95

what causes cushings

excess corticosteroid- most common
pituitary adenoma
paraneoplastic from ACTH production
adrenal tumor

96

signs cushing

weakness, depression, menstural irregularities, polydipsia, polyuria, increased libido, impotence, HTN, acne, increased hair growth, central obesity - buffalo hump and moon facies
purple striae on abdomen and cataracts

97

labs in cushings

hyperglycemia, glycosuria and decreased K

98

complications cushings

increased risk CV or DVTs
increased infection
increased avascular necrosis of hip
hypopituitarism or adrenal insufficiency post surgery

99

conn syndrome

primary hyperaldosteronism from adenoma

100

secondary hyperaldosteronism

activation RAAS from perceived LBP from kidneys (renal a stenosis, heart failure cirrhosis, nephrotic syndrome)

101

signs of hyperaldosteronism

HA, weakness, paresthesias, recalcitrant HTN, tetany

102

labs hyperaldosteronism

DECREASED K
metabolic alkalosis
increased Na
decreased renin in conns
increased 24 urine aldosterone
high ratio plasma aldosterone to plasma renin

103

Addison

primary adrenal insufficiency
autoimmune destruction adrenal cortices

104

secondary corticoadrenal insufficiency

insufficient ACTH production by pituitary

105

tertiary corticoadrenal insufficiency

deficient CRH release from hypothalamus
usually from chronic corticosteroid

106

signs of adrenal insufficiency

weakness, fatigue, anorexia, weight loss, nausea and vomiting
myalgia arthralgias
decreased libido, memory impairment and depression
hypotension
increased skin pigmentation!!!(only addison)

107

labs adrenal insufficiency

decreased Na
increased K from low aldosterone
decreased cortisol
increased ACTH if addisons

108

ACTH in secondary and tertiary adrenal insufficiency

decreased

109

give ACTH and if cortisol increases

secondary or tertiary insufficiency

110

what is addisonian crisis

severe weakness, fever, mental status changes, vascular collapse

111

what is congenital adrenal hyperplasia

defect in synthesis cortisol causing low cortisol
increased ACTH, adrenal hyperplasia and androgen excess from shunting

112

17 a hydroxylase deficiency

get cortisol androgen and estrogen deficiency so see amenorrhea, ambiguous genitalia in men
HTN
decreased K, increased Na

113

21 alpha hydroxylase deficiency

insufficient cortisol and aldosterone,
most common form!!!!
shifts to androgen
ambiguous genitalia in female, virilization
mactogenitosomiand precocious puberty in men
dehydration and hypotension in more severe cases

114

labs in 21 alpha hydroxylase def

decreased Na and increase K

115

what causes ambiguous genitialia in women, precocious puberty in men and HTN

11 beta hydroxylase deficieny from excess deoxycorticosterone

116

Tx 17 a hydroxylase def

cortisol replacement to suppress ACTH

117

Tx 21 a hydroxylase def

cortisol for ACTH suppresion.
fludorcortisone for mineralocorticoids

118

Tx 11 b hydroxylase def

cortisol replacement and anti-HTN

119

mutation in RET

most MEN 2A 2B

120

Tx pheo

alpha and beta blockers before and durign surgical resection
give alpha before beta!!!!!!!!!!!! to avoid HTN crisis

121

MEN1

Parathyroid hyperplasia
Pituitary
Pancreas

possible zollinger ellison

122

Men2A

Medullary thyroid hyperplasia
Parathyroid hyperplasia
Pheo

123

MEN2B

Medullary thyroid
Mucosal neuroma
Pheo

can have marfinoid body habitus

124

Cretinism

congenital hypothyroid froms evere iodide deficiency or hereditary

125

signs cretinism

poor feeding, lethargy, large fontanelles, thick tongue, constipation, umbilical hernia, poor growth, hypotonicity, dry skin, hypothermia and jaundice

126

labs in cretinism

decreased T4 increased TSH

127

Tx cretinism

levothyroxine shortly after birth

128

prolonged jaundice

first sign cretinism