Endo step Up Flashcards
1
Q
when is insuline released
A
response to glucose intake
secreted by pancreatic beta islet cell
2
Q
effects of insulin
A
induce glucose and aa uptake by muscle, adipose and liver
glucose to glycogen fatty acids and pyruvate
inhibits lipolysis
3
Q
where and when is glucagon released
A
by alpha islet cells in response to decreased glucose and protein intake
promotes breakdown of glycogen and fatty acids
4
Q
What HLA is assoc with DM I
A
HLA DR3 DR4 and DQ
5
Q
signs of DM I
A
polyuria polydipsia, polyphagia, weight loss
rapid onset
6
Q
labs of DMI I
A
hyperglycemia, glycosuria, serum and urine ketones, increase HbA1c
7
Q
what happens if DM I patient gives too much insulin
A
hypoglycemia
8
Q
what illnesses are associated with onset beta cell destruction
A
rubella
coxsackie virus and mumps
9
Q
risk factors DM II
A
FMH obesity metabolic syndrome, lack of exercise, gestational DM
10
Q
Dx criteria DM
A
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
Q
what are the rapid acting insulin
A
lispro, asoart and glulisine
12
Q
what are the long acting insulins
A
NPH, glargine and detemir
13
Q
diabetic ketoacidosis is complication of what
A
DM I only
14
Q
complication dM II
A
hyperosmolar hyperglycemic nonketotic syndrome retinopathy nephropathy neuropathy atherosclerosis
15
Q
what leads to DKA
A
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
Q
signs DKA
A
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
Q
how does metformin work
A
decrease hepatic gluconeogenesis
increase insulin sensitivity
18
Q
side effects metformin
A
GI
dec B12 absorption
CI in those with hepatic or renal insufficiency
19
Q
what are the sulfonylurea drug names
A
glyburide glimepriride, glipizide
20
Q
how do sulfonlyureas work
A
stimulate insulin release from beta cells, reduce serum glucagon, increase binding insulin to tissue R
21
Q
adverse effects of sulfonylureas
A
hypoglycemia. CI in those with hepatic or renal insufficiency
22
Q
Mechanism of thiazolidinediones
A
decrease gluconeogenesis
increase insulin sensitivity
23
Q
thiazolidinediones are CI in what patients
A
CHF
24
Q
what are the gliptins
A
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
