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PANCE/EOC > Endocrine #2 > Flashcards

Endocrine #2 Flashcards

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1
Q

Most aggressive type of thyroid cancer

A

-Anaplastic Thyroid Cancer

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2
Q

Symptoms of anaplastic Thyroid cancer

A
  • Rapid growth, compressive symptoms (dyspnea, dysphagia)

- Rock hard thyroid mass

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3
Q

A medullary thyroid carcinoma is associated with

A
  • Calcitonin synthesizing parafollicular cells

- MEN IIa or IIb

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4
Q

Follicular Thyroid Carcinoma has METs that go

A

Distant (lung MC, liver, brain, bone)

Think Follicular goes FAR

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5
Q

Risk Factors for thyroid nodules

A

-Extremes of age, history head and neck radiation

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6
Q

MC type of thyroid nodule

A

Follicular adenoma (colloid)

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7
Q

Symptoms of thyroid nodule

A
  • Most asymptomatic

- Can have compressive symptoms (recurrent laryngeal nerve impingement)

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8
Q

On physical examination, what symptoms are concerning for malignant?

A

-rapid growth, fixed in place, no movement with swallowing

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9
Q

On PE, what is found on a benign thyroid nodule?

A

-Varied, smooth, firm, irregularly sharply outlined, discrete, painless

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10
Q

Diagnostics for thyroid nodule

A
  • Thyroid function testing (initial). If TSH normal or high, FNA indicated
  • Thyroid US: irregular margins, hypoechoic, central vascularity
  • FNA: best test and done if (Nodules > 1.5 cm with normal TSH)
  • Radioactive iodine uptake scan: Cold nodules (biopsied to rule out malignancy)
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11
Q

Do hot or cold nodules have a higher chance of malignancy?

A

Cold

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12
Q

Diagnostics for DM

A
  • Fasting plasma glucose > 126 (at least 8 hours apart on 2 occasions) = GOLD
  • 2 hour glucose tolerance test > 200
  • A1c > 6.5%
  • Random Plasma > 200
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13
Q

When to screen for DM?

A

-All adults > 45 every 3 years OR any adult with BMI > 25 and 1 additional risk factor

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14
Q

MOA for Metformin

A
  • Decreased hepatic glucose production by inhibiting gluconeogenesis
  • No effect on pancreatic beta cells; not associated with hypoglycemia
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15
Q

Adverse reactions to Metformin

A
  • GI complaints (MC)
  • Vitamin B12 deficiency
  • Lactic Acidosis
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16
Q

Contraindications to Metformin

A
  • Severe renal or hepatic impairment
  • Excessive alcohol intake
  • Hold before contrast and resumed within 48 hours
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17
Q

Somogyi Phenomenon

A

-Nocturnal hypoglycemia followed by rebound hyperglycemia

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18
Q

How to prevent Somogyi Phenomenon

A
  • Decrease nighttime NPH dose
  • Move evening NPH dose earlier
  • Give bedtime snack
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19
Q

Dawn Phenomenon

A

-Normal glucose until rise in serum glucose levels between 2 AM - 8 AM

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20
Q

How to manage Dawn Phenomenon

A
  • Bedtime injection of NPH

- Avoid carb snack late at night

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21
Q

How long does NPH normally work?

A

-Covers insulin for about a half day or overnight

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22
Q

When do you give Lispro or Aspart, which are rapid acting insulin agents?

Study These Flashcards
A

At the same time as the meal.

23
Q

Short-acting, or regular insulin, lasts how long?

Study These Flashcards
A

-Given 30-60 minutes prior to meal

24
Q

Symptoms of DKA

Study These Flashcards
A
  • Fruity (acetone) breath
  • Kussmaul respirations (deep, continuous respirations)
  • Tachycardia, tachypnea, hypotension, decreased skin turgor
25
What diagnostic shows DKA
- Plasma glucose > 250 - Positive ketones in the urine - High anion gap metabolic acidosis
26
Treatment for DKA
- SIPS - -Saline, Insulin (regular), Potassium Repletion, Search for underlying cause - --Isotonic 0.9% (Normal saline) - --Correction of DKA will invariably cause hypokalemia
27
_____ are more important than glucose levels in determining the severity of DKA
-Bicarbonate levels
28
Treatment for diabetic neuropathy
- Optimal glucose control | - Pregabalin and Duloxetine, Amitriptyline, or Gabapentin
29
Treatment for Gastroparesis from Diabetes
- Dietary modifications are initial management | - Prokinetics: Metoclopramide or Erythromycin
30
Diabetes mellitus is the MCC of
End stage renal disease
31
What is syndrome of inappropriate ADH (SIADH)
-Excess of ADH from pituitary gland or ectopic source leading to free water retention and hyponatremia due to kidney's inability to dilute the urine
32
Symptoms of SIADH
-Neurologic symptoms of hyponatremia and cerebral edema (confusion, lethargy, seizure, coma)
33
Diagnostics for SIADH
- Hyponatremia - Decreased serum osmolarity - Increased urine osmolarity (>20) - Increased ADH levels
34
Treatment for SIADH
- Water restriction | - IV hypertonic saline + Furosemide (if severe)
35
Diabetes Insipidus leads to production of
large amounts of dilute urine
36
Symptoms of Diabetes Insipidus
- Polyuria (20 L daily) - Polydipsia - Neurologic symptoms of hypernatremia (confusion, lethargy)
37
Labs for DI
- Increased serum osmolarity - Decreased urine osmolarity - Decreased specific gravity - Increased urine volume
38
diagnostics for DI
- Fluid deprivation test: DI continues to produce large amounts of dilute urine - Desmopressin Stim Test: Distinguishes the types - ---Central: reduction in urine output - ---Nephrogenic: continued production of large amounts of urine
39
Treatment for Central DI
Desmopressin (DDAVP)
40
Treatment for Nephrogenic DI
Hydrochlorothiazide, Indomethacin, Amiloride
41
Symptoms of Hypercalcemia
- Stones (Nephrolithiasis) - Bones (bone pain and fractures) - Abdominal groans (ileus, constipation) - Psychic Moans (Depression, anxiety, cognitive dysfunction)
42
Diagnostics for hypercalcemia
- Intact PTH | - ECG: shortened QT interval
43
MCC of hypercalcemia
-Hyperparathyroidism
44
Symptoms of Hypocalcemia
- Increased muscular contractions: muscle cramps, bronchospasm, tetany, Chvostek Sign (facial spasm with tapping of facial nerve), Trousseau's Sign (inflation of BP cuff above systolic causes carpal spasm) - Increased DTR
45
What does an ECG for hypocalcemia show?
-ECG: prolonged QT interval classic
46
Treatment for hypocalcemia
- Oral Calcium + VItamin D | - IV calcium gluconate for severe
47
Triad of Symptoms for Primary hyperparathyroidism
-Hypercalcemia + Increased intact PTH + Decreased Phosphate
48
What is the treatment for primary hyperparathyroidism
Parathyroidectomy
49
Symptoms of a Prolactinoma
- Hypogonadism - Amenorrhea - Infertility - Galactorrhea - Headache, Visual Changes - Bitemporal Hemianopsia
50
Diagnostic for prolactinoma
-Increased prolactin, decreased FSH, and LH
51
Treatment and Prolactin
-Dopamine agonists (Cabergoline or Bromocriptine) first-line treatment
52
What is the key component of Metabolic Syndrome
-Insulin resistance
53
Diagnostic Criteria of Metabolic Syndrome
- Decreased HDL: < 40 in men, < 50 in women - High blood pressure - High fasting TG levels: > 150 - High fasting blood sugar: > 100 - Abdominal obesity
54
What are some weight loss medications
- Phentermine - Lorcaserin - Orlistat

PANCE/EOC (63 decks)

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