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PANCE 2024 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What 4 things do you think of when it comes to hyperthyroidism

A

Graves
Medication cause = Amiodarone
Multi nodular goiter
Toxic thyroid adenoma

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2
Q

What does the thyroid look like with Graves’ disease

A

Diffuse non tender enlargement

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3
Q

What does the thyroid look like in multi nodular toxic goiter

A

Bumpy irregular asymmetric with nodules

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4
Q

4 general sxs for hyperthyroidism

A

Dysrhythmia
Moist Pretibial myxedema
Increased DTRs
Proptosis

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5
Q

Lab findings and antibodies in hyperthyroidism

A

Low , NML TSH ; high FT4 or FT3

Thyroid stimulating immunoglobulins

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6
Q

What two things do you think of with high FT4/FT3 labs and low radio iodine uptake

A

Subacute thyroiditis and Amiodarone exposure

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7
Q

Give 4 talking points for hyperthyroid medications

A

First and Best = Radio Iodine ablation ; common in Graves’ disease

Methimazole ; can be used if they dont want ablation

PTU = best in pregnancy

Propanolol best for hyper sympathetic sxs

surgery if large goiters and contraindications

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8
Q

What is the #1 risk factor for a thyroid storm?

A

1 infection

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9
Q

What are three complications to think of in thyroid storm?

A

Heart failure
Hyprecalcemia
Osteoporosis

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10
Q

Which hyperthyroid medication is teratogenic

A

Methimazole

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11
Q

How does exogenous iodine effect thyroid hormone?

A

Inhibits release of thyroid hormone

Used days [7] before thyroidectomy

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12
Q

What do yo have to remember when administering iodine

A

Block the sympathetic pathway first with PTU or Methimazole (1hr before)

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13
Q

What is the benefit of steroids in thyroid storm

A

Can treat adrenal insufficiency and autoimmune process in Graves’ disease

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14
Q

What are the main antibodies in hypothyroidism (Hashimotos)

A

Anti TPO and anti thyroglobulin

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15
Q

What 4 medications can cause hypothyroidism

A

Methimazole
PTU
Lithium
Amiodarone

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16
Q

What are two uncommon sxs of hypothyroidism

A

Slow mentation

Menorrhagia

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17
Q

What’s the effect on DTRs in hypothyroidism

A

Delayed!

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18
Q

What is the extreme/severe version of hypothyroidism

A

Myxedema coma

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19
Q

What is the dose adjustment per levels of thyroid hormone (TSH) ?

Less the 5-10

10

Less than 20

A

Less the 5-10 = 25 to 50

10 = 50 to 75

Less than 20 = 75 to 100

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20
Q

What it the #1 cause of supparative thyroiditis

A

Staph A.

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21
Q

What proceeds subacute thyroiditis normally?

A

URI

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22
Q

What is the tell tale sign of subacute thyroiditis

A

The gland itself is painful ; low grade fever ; pain that radiates to the ears

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23
Q

What are the tell tale signs of bacterial thyroiditis

A

Severely tender thyroid ; sudden onset fever erythema and fluctuation

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24
Q

What studies would you get with subacute thyroiditis or infectious

A

Subacute
> radio iodine uptake = LOW

Infectious
>thyroid U/S
>FNA with gram stain

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25
Q

Do you give antibiotics to subacute thyroiditis?

A

NO

ASA/ NSAIDS
Prednisone
Supportive care

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26
Q

Physical exam findings in thyroid nodules (3)

A

Smooth firm
Well outlined
Painless

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27
Q

For a thyroid nodule that has low TSH what should you do?

A

Radionuclide thyroid scan

HOT = benign

COLD = MALIGNANT

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28
Q

For a thyroid nodule that has normal to high TSH what should you do?

A

Thyroid U/S

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29
Q

What are malignant findings for thyroid on U/S

A

Hypoechoic with irregular margins and micro calcifications

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30
Q

If a thyroid nodule is suspicious for malignancy on U/S what do you do?

A

FNA

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31
Q

If a thyroid nodule is causing dysphagia and proved benign what can you do for management? If what?

A

RF ablation if greater than 3cm

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32
Q

What is the monitor time for thyroid nodules

A

6 months by U/S and then yearly

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33
Q

Most common type of thyroid cancer

A

Papillary carcinoma

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34
Q

Talking points for medullary thyroid cancer (2)

A

Arises from parafollicular cells
Produces calcitonin

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35
Q

Talking point for follicular thyroid cancer

A

Higher rates of metastasis

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36
Q

What do you need to know about anaplastic carcinoma

A

Common in elderly MOST AGGRESSIVE

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37
Q

What are secondary findings associated with medullary thyroid cancer

A

Diarrhea

Flushing

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38
Q

What are secondary findings associated with anaplastic thyroid cancer

A

Dysphagia

Laryngeal nerve involvement

Hoarseness

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39
Q

Metastatic papillary and follicular cancers often have an increase in what hormone?

A

Serum thyroglobulin

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40
Q

What is the management for thyroid cancer (papillary and follicular)

A

Total thyroidectomy

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41
Q

What is the #1 cause of primary hyperparathyroidism

A

Parathyroid adenoma

2nd = lithium use or malignancy

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42
Q

2 common reasons for secondary hyperparathyriodism

A

CKD causing low calcitriol ; which causes increased PTH

Vitamin D deficiency

At worst think ESRD and Renal transplant

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43
Q

Dont forget what sxs with hyperparathyriodism and why

A

Stones Moans Groans and Psych Overtones

Think: Hypercalcemia

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44
Q

3 management things to remember in severe Hypercalcemia

A

IVF
Furosemide
Bisphosphonates and Calcitonin

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45
Q

If someone has hyperparathyriodism secondary to CKD you will likely replace what deficiency?

A

Calcitriol

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46
Q

Severe Hypercalcemia can be treated with

A

Cinacalcet

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47
Q

What deficiency can cause hypoparathyroidism

A

Magnesium deficiency

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48
Q

What should you think of with hypoparathyroidism or low calcium

A

Chovsteks

Trousseau’s sign

Increased DTRs

Low PTH Low Ca INCREASED PHOSPHATE

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49
Q

3 etiologies of adrenal insufficiency

A

Infection [TB, Fungal, HIV]

Destruction [Autoimmune]

Deficiency [Autoimmune]

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50
Q

Difference between primary and secondary adrenal insufficiency

A

Primary = low cortisol, Low DHEA, Low Aldosterone ; because the adrenal gland is not able to read the ACTH; so an increaed ACTH which results because of high CRH [adrenal gland tumor/infection]

Secondary = low cortisol, Low DHEA, Normal Aldosterone ; because the pituitary gland is sending a low ACTH signal and a high CRH signal results to try to fight the low ACTH [pituitary tumor]

Tertiary is a problem of the hypothalamus

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51
Q

How do we treat adrenal insufficiency

A

Primary = hydrocortisone / prednisone + fludrocortisone [corrects the low aldosterone]

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52
Q

What is ACTH independent Cushings?

A

Overproduction or overconsumption of steriods

[independent of your own ACTH]

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53
Q

What is ACTH dependent Cushings?

A

Cushings Disease !

Due to : pituitary tumor or ectopic ACTH production

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54
Q

What are the main 3 tests we want to do for Cushings

A

Dexamethasone suppression test

24 hour urinary free cortisol

ACTH level testing

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55
Q

What is a positive dexamethasone suppression test? Also talk about ACTH and disease vs. syndrome

A

Above 1.4 mL allows you to know that the cortisol can not be suppressed by dexamethasone.

ACTH will be low in Cushings Syndrome
ACTH will be high in Cushings Disease

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56
Q

A positive 24 hr urinary free cortisol will have what ?

A

High levels of cortisol in the AM = positive test

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57
Q

What is another name for hyperaldosteronism

A

Conn Disease

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58
Q

3 clinical features of conn disease

A

Headache
Metabolic alkalosis
Weakness

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59
Q

What it is the concern with acute increased SIADH

A

Cerebral edema

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60
Q

What are lab findings in SIADH (3)

A

Low serum sodium
Low serum osmolality

Increased urine osmolality

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61
Q

What are the lab findings of diabetes insipidous

A

Incr serum sodium
Incr serum osmolality

Dec urine osmolality

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62
Q

4 interventions for SIADH

A

Water restriction to 500-1500 mL per day
Correct sodium [no more than 10 mEq in 24 hrs // 18 mEq in 48 hrs]
Vasopressin = VAPTANS
Loop diuretic

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63
Q

3 main complications of SIADH

A

Seizures
Osmotic Demylenation Syndrome [SHRINKING OF THE BRAIN]
Coma/death

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64
Q

Diabetes Insipidous think what?

A

Low or Resistance to ADH

Large amounts of Dilute Urine

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65
Q

Explain Central vs. Nephrogenic DI

A

Central = Idio; Trauma; Surgery; Malignancy // ADH is not PRODUCED at the pituitary

Nephrogenic = Genetics[KIDS] Medications[Lithium] , CKD // ADH is not RECOGNIZED at the renal tubule

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66
Q

Lab studies for diagnosis of DI

A

Low osmolality // Low specific gravity urine
High serum osmolality
High NA+
Water deprivation test positive

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67
Q

What is the water depreciation test in DI

A

Still pee large amounts of DILUTE urine
-Showing that there is no increased in ADH production to decrease urine production and osmolality

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68
Q

What imaging should i get if I suspect central DI

A

Brain MRI

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69
Q

What happens when DI patient is given desmopressin? Central vs. Nephro

A

Central = increase in urine osmolality

Nephro = minimal or no increase in urine osmolality

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70
Q

Management for central DI

A

Desmopressin = INTRANASAL

Thiazide , Carbamazepine , Chlorpropamide

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71
Q

Management for nephro DI?

A

Low solute diet
Thiazide diuretic
NSAIDS

If continuing lithium use => Amiloride

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72
Q

How are pituitary Adenomas classified

A

Secretory and Non Secretory

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73
Q

What are the 4 types of secretary pituitary adenomas

A

Prolactinoma

Somatotropinoma

Corticotroph adenoma

Thyrotropinoma

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74
Q

3 sxs significant in macro Adenoma of the PT gland > 1cm

A

Bitemporal heminopsia
Headache
Diplopia

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75
Q

3 talking points for somatotropinoma

A

Adults = acromegaly
Kids = gigantism
Often HYPERglycemic

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76
Q

Corticotropinoma sxs (3)

A

Weight gain
Hypertension
Proximal muscle weakness

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77
Q

What are labs for somatotropinoma

A

Increased IGF-1 ; abnormal glucose tol testing PO

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78
Q

Imaging of choice for pituitary adenoma

A

MRI with contrast

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79
Q

Imaging of choice for pituitary adenoma

A

MRI with Contrast

80
Q

What guides management in pituitary Adenoma resection

A

Symptomatic or not?

81
Q

How do we treat prolactinoma

A

Not resection

Dopamine agonist =Cabergoline and Bromocrpitine

82
Q

Treatment of somatropinoma

A

First give octreotide, an analog of somatostatin

Then surgery or for residual disease

83
Q

Diabetes type 1 is

A

Autoimmune destruction of pancreatic B cells = decrease in insulin production

84
Q

When is the peak incidence of DM1

A

Age 4-6 and 10-14 years old

85
Q

What is the reason for Kussmauls breathing in DKA

A

Respiratory response to metabolic acidosis

86
Q

Diagnosis of DM [4 examples]

A

Fasting plasma glucose over 126 on 2 occasions

Random glucose higher 200

2hr OGTT over 200

HbA1c over 6.5 %

87
Q

3 lab indications of DKA

A

High anion gap
Sodium bicarbonate over 18!
Ketonuria

88
Q

Management of DKA

A

First reverse causes [infection]

IVF NML saline 0.9% until glucose = 250 ; then change to a 5% dextrose containing solution

Use KCL if necassary to correct Hypokalemia

Correct other electrolytes

89
Q

How do we check for kidney disease in DM patients

A

Urine albumin : CREATINE ratio

Annually

90
Q

When should you screen for diabetic neuropathy in type 1

A

3-5 years after diagnosis

91
Q

Type 2 DM summary

A

Insulin resistance in tissues // decreased insulin release

92
Q

What dietary patterns lead to risk for T2DM

A

Red meat
Processed meat
Sugar and sweetened beverages

93
Q

What is pH normally in HHS

A

Over 7.3 [not acidotic-not dka]

94
Q

Serum osmolality and bicarbonate in HHS

A

SO = over 320

Bicarbonate = over 15

95
Q

Screening for T2DM

A

Any age with BMI over 25 and one risk factor

Or at age 35-70 yrs old ; and if normal every 3 years after that

96
Q

4 risk factors to remember in T2DM

A

HTN greater 140/90

HDL less than 35 Triglycerides over 250

History of PCOS

Physical inactivity

97
Q

Anterior lobe description of the hypothalamus

A

Hormones first made here

Sent through portal veins

To increase anterior pituitary hormone production

—> target organs

98
Q

Posterior lobe description of hypothalamus

A

Hormones made here then sent via :

Neurons —> posterior pituitary

Hormones —> target organs

99
Q

Somatotrophs secrete what hormone

A

GH —> liver adipose

IGF hormone increased =

Growth of muscle bone

100
Q

Lactotrophs secrete what

A

PRL —> targets mammary glands

—> milk production

101
Q

corticotroph secretes what hormone

A

ACTH —> targets adrenal cortex

Adrenal release of cortisol —> aldosterone —> androgens

= increase in glucose and fluid volume

102
Q

Thyrtroph release what hormone

A

TSH —> thyroid —> thyroxine and triiodothyronine

=regulation of metabolism

103
Q

Gonadotroph releases what hormone

A

FSH / LH —> gonads

Gonads release —> estrogen and progesterone and testosterone

=egg sperm production // ovulation

104
Q

ADH comes from where and causes what

A

Kidneys

= increase water absorption

105
Q

Oxytocin is produced in what organs and does what

A

Uterus ; mammary ; male reproductive tract

= contraction for delivery lactations ; sperm release

106
Q

Micro vs. Macro adenoma of pituitary

A

Less than 10 = micro

Over 10 = macro

107
Q

What CN is impacted by pituitary adenoma

A

CN2 @ the optic chiasm

= Bitemporal; hemeniopsia

And opthalmoplegia = CN 346

108
Q

Best imaging study for pituitary adenoma

A

MRI with contrast

109
Q

MC cause of hypopituitarism

A

Pituitary adenoma

110
Q

ACTH deficiency think

A

Addisons

111
Q

Klinefelters =

A

LH and FSH receptor mutations

112
Q

Turners =

A

Ovarian (primary) hypergonadotropic

113
Q

2 exogenous causes of secondary hypogonadism

A

Spirnolactone

Steriods

114
Q

When should you test estrogen or testosterone

A

8 am - Morning

115
Q

Central vs. Peripheral gonadism

A

Central = hypo = low normal FSH/LH

Peripheral = hyper = high FSH and LH

116
Q

Even if T is low you should not give testosterone to what population

A

Prostate cancer pts

Monitor hematocrit

117
Q

How do you treat infertility in hypogonadism

A

Gonadotropin

118
Q

Prolactinoma diagnosis

A

MRI with gadolinium

119
Q

Prolactinoma levels of prolactin and TXM

A

Over 200 NG/mL

TXM = dopamine agonist —> cabergoline or bromocriptine

120
Q

4 other causes of hyeprprolactinoma

A

Atypical antipsychotics

Pregnancy

Stalk compression

Hypothyroidism

121
Q

Prolactin deficiency =

A

Sheehans syndrome —> delivery

= lack of lactation at delivery and drop in blood pressure —> post partum hemorrhage

122
Q

Best screening test for GH excess =

A

IGF -1 will be HIGH

123
Q

GH excess treatment

A

Trnassphneoidal surgery

Dop agonist = cabergoline

Somatostatin = octreotide

GH receptor antagonist

124
Q

TXM GH deficiency

A

Recombinant human GH

Correct metabolic issues

Treat to nml IGF-1 level

125
Q

Being on GH can make you at risk for

A

Psuedotumor cerebrii

126
Q

TXM SIADH

A

Fluid restriction

Furosemide

Treat the cause

127
Q

Central vs. Nephrogenic DI

A

Central = decreased pituitary secretion of ADH
-etiology : HEAD TRAUMA

Nephro = decreased response to ADH in kidneys
-etiology: drug induced

128
Q

Drugs that can cause Nephro DI

A

Lithium

Colchicine

Amphotericin B

Gentamicin

129
Q

Condition that can cause nephrogenic DI

A

Hypercalcemia

130
Q

Does nephrogenic DI respond to desmopresin ?

A

NO

*but central does

131
Q

Too much desmopressin can equal

A

Hyponatremia

132
Q

3 systemic effects of GC release from adrenal cortex

A

Increase plasma glucose levels

Mx vascular integrity

Decrease inflammation

133
Q

Adrenal medulla produces

A

Catecholamines

134
Q

Cortex of adrenal gland

-Glomerulosa

-Fasciculata

-Reticularis

A

G = mineralcorticoid

F = GC

R - androgens

135
Q

4 causes of pseudo Cushings

A

Alcoholism, Pregnancy , Anorexia , Depression

136
Q

Cortisol and
ACTH are high when

A

In the morning

137
Q

Overnight dexamethosaone suppression = low cortisol think

A

Suppressed by exogenous steriods

138
Q

Nelson syndrome

A

Post pituitary r2

Recurrent severe enlargement of adenoma

139
Q

Secondary adrenal insufficiency MC cause

A

Cessation of steroids

140
Q

In secondary adrenal insufficiency aldosterone is

A

Intact

141
Q

Skin in secondary adrenal insufficiency

A

Alabaster skin

142
Q

Test for adrenal insufficiency

A

Consyntropin test

High = primary

Low = secondary

143
Q

Androgen deficiency in adrenal insufficiency is treated by

A

DHEA

144
Q

Adrenal crisis mgmt

A

Hydrocortisone high dose IV

Fluid // electrolyte correction

Broad spectrum ABX if dont know cause

145
Q

Unilateral or bilateral adrenal hyperplasia txm

A

Spirinolactone

146
Q

Muscle weakness ; paresthesia ; tetany ; headache ; polys

+

Refractory HTN

Think

A

Hypokalemia form primary aldosteronism

147
Q

Pheo = rule of

A

10s

10% of everything

148
Q

Beta blocker use in pheo

A

Used only after alpha to avoid worsening of HTN

149
Q

Elevated serotonin tumor think

A

Carcinoid tumor ;

W/ ABD pain l wt loss ; glossitis

150
Q

MEN inheritance

A

Autosomal dominant

151
Q

MEN 2 think what 3

A

Pheo

Parathyroid

Medullary thyroid carcinoma

152
Q

T4 and T3 need what in order to be released from the thyroid

A

Iodine + Thyroglobulin + Enzyme TPO

153
Q

MC autoimmune hyperthyroidism in the US

A

Graves

154
Q

Iodine deficiency think

A

Multi nodular goiter or Adenoma

155
Q

Main medication that induces hyperthyroidism vs hypo

A

Hyper = Amiodarone

Hypo = Lithium

156
Q

Arrythmia assoc with hyperthyroidism

A

A fib or SVT

157
Q

Eye effects in Graves’ disease [4]

A

Infiltration opthlamopathy

Upper lid lag on downward gaze

Each eye can be affected differently

Worse with smoking

158
Q

Thyroiditis is often

A

TRIPHASIC

Phases lasting up to a few months

159
Q

Graves ab

A

Thyrotropin receptor antibodies

160
Q

Subacute and infectious thyroiditis often has an elevated what

A

ESR

161
Q

RAI uptake for the following :

Graves

Toxic multinodular goiter

Toxic adenoma

Subacute thyroiditis

Exogenous

A

G = diffuse symmetric uptake

T M G = patchy

TA = focal uptake

ST = low uptake

E = No uptake

162
Q

Thyrotoxicosis acute mgmt

A

Beta blocker —> BMAE or propanolol [acute]

NSAIDs or Steriods —> thyroiditis [acute]

Mx = ATD
Methimazole = preferred
PTU = 1st trimester of pregnancy

163
Q

RAI requires thyroid fxn to be what?

A

Euthyroid

164
Q

Tachy delirious high fever N/V/D

Complication = from ?

A

= thyroid storm

From —> thyrotoxicosis

165
Q

What is cretinism

A

Decreased mental and growth in infants and children

-hypothyroidism-

166
Q

Congenital hypothyroidism presentation

A

Jaundice

Lethargy

Hoarse cry

Growth f.

Constipation

Hypotonia

167
Q

Most increased cardio risk with what type of thyroid disease

A

Hypothyroidism

168
Q

When are newborns screened for thyroid disease

A

First 2-5 days of birth

169
Q

Hashimotos autoimmune ab

A

Anti-TPO and thyroglobulin ab

170
Q

Hashimotos goiter described as

A

Diffusely heterogenous

171
Q

Who gets a smaller vs. higher dose of Levothyroxine

A

Smaller = over age 60 or CAD

Higher = pregnancy

172
Q

Hypothyroidism with cortisol insufficiency ; which do you treat first

A

Cortisol deficiency —> increased metabolic rate and set off and adrenal crisis

173
Q

Myxedema crisis mgmt

A

IV thyroxine
Steriods
ICU admit

174
Q

Workup for thyroid nodule

A

Exam finding —> get a TSH

TSH hot = benign

U/S if worrisome solid irregular calcified
Get TIRADS score

FNA —> for cytology and molecular testing

Monitored by : Bethesda system

175
Q

Medullary thyroid cancer

A

Elevated calcitonin MEN flushing diarrhea

176
Q

How does PTH affect

Renal tubule

Small intestine

Bone

A

Renal tubule —> increase Ca2+ absorption ; decrease phosphate absorption

Small intestine —> increase synthesis of vitamin D ; increase intestinal ca 2+ absorption

Bone —> formation and resorption for net effect

177
Q

4 exogenous causes of hyperparathryroidism

A

Increase in PTH protein [cancer]

heme cancers

Sarcoidosis

Lithium thiazide diuretics

178
Q

High PTH and high CA 2+ think

A

Bones
Stones
Groans
Moans

179
Q

Arrhythmia assoc with hyperparathyroidism

A

Brady arrhythmia

180
Q

Type 1 DM [4]

A

Complete destruction of pancreatic beta cells

Hyperglycemia

Acute onset sxs

DKA

181
Q

Type 2 DM [4]

A

Peripheral insulin resistance

Decreased insulin response

Insidious ; Asian l Native American I AA I Latino

HHS

182
Q

Bicarbonate in DKA vs. HHS

A

DKA = low

HHS = high

183
Q

HHS onset

A

Days to weeks

184
Q

Microvascular complications of DM

A

Retinopathy

Neuropathy

Nephropathy

185
Q

Macovascular complications of DM

A

Coronary heart disease
Peripheral heart disease
Cerebrovascular diseae

“Chronic”

186
Q

4 things to check in addition when suspect type 1

A

Positive ab
Low c peptide
Low insulin
Screen for thyroid and celiac disease

187
Q

BMI over what gets DM testing

A

Over 25 or 23 in Asians

188
Q

What type of diabetes gets annual diabetes tests

A

Annually for pre diabetics

189
Q

NML DM testing should be retested when ; starting after age ___

A

3 year interval

After age 35

190
Q

General goal for A1C in diabetics

A

A1C under 7%

Preprandial = 80-130

Postprandial = less than 180

191
Q

Disadvantages to insulin

A

Weight gain

Hypoglycemia

192
Q

Metformin can lead to what deficiency

A

B12

193
Q

DPP4 has what two side effects

A

Pancreatitis
CHF

194
Q

TZD meds side effects

A

Increases weight
CHF
Bladder Cancer
Bone fx

195
Q

SU side effects

A

Hypoglycemia
Weight gain

196
Q

What can help stabilize blood sugar after carbohydrate correction

A

Fat/Protein

197
Q

Glucose less than 70 with AMS think about giving

A

Glucagon

PANCE 2024 (15 decks)

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