Endocrine Flashcards
(105 cards)
1
Q
Pt has insominia, sweating, heat intolerance, and palpitations, tachycardia, wt loss?
A
hyperthyroidism
2
Q
What are the cx of hyperthyroidism and how can they be differentiated?
A
Graves dz - autoimmune dz; has goiter + bruit and exophthalmopathy
3
Q
How to tx hyperthyroidism?
A
1) BB
2) methimazole/PTU
3) radioiodine 131
4) surgery
4
Q
What is gold standard for Grave dz?
A
radioactive iodine uptake scan
5
Q
What is the active form: T3 or T4?
A
T3
T4 converts to T4
6
Q
TSH, T3/T4 elevated or decreased in Grave dz?
A
TSH is LOW
T3/T4 is HIGH
7
Q
What else to think about if pt has high T3/T4?
A
pregnancy
8
Q
If pt is pregnant and has hyperthyroidism - how to tx?
A
PTU
9
Q
Pt has fever, tachycardia, confusion, N/V/D?
A
thyroid storm
10
Q
How to tx thyroid storm?
A
1) IV fluids
2) cooling blankets
3) glucose + Beta blockers + PTU
11
Q
Pt has low RR, bradycardia and is in coma?
A
myxedema coma - d/t hypothyroidism (LONG UNTX)
12
Q
Pt has trouble concentrating, bradycardia, dull expression, hyporeflexia, menstural disturbances?
A
hypothyroidism
13
Q
How to tx hypothyroidism?
A
levothyroxine
14
Q
Autoimmune dz of hypo/hyperthyroidism?
A
hypo: hashimoto
hyper: grave
15
Q
TSH, T3/T4 levels in hypothyroidism?
A
HIGH TSH
LOW T3/T4
16
Q
Pt has hx of flu last week and now has a painful thyroid gland? What to expect on labs?
A
subacute thyroiditis
low TSH and high T3/T4
17
Q
Pt has hx of carpal tunnel sx and now has dry skin and brittle hair?
A
hypothyroidism
18
Q
How to tx thyroiditis?
A
ASA, steroids
19
Q
Pt has goiter + low T3/T4?
A
chronic lymphocytic thyroiditis - hashimoto (hypothyroidism)
20
Q
How to tx chronic lymphocytic thyroiditis (hashimoto)?
A
levothyroxine
21
Q
Pt has nodule on thyroid - what PE should you do to r/in further work up? What is the next step?
A
nodule is bigger than 1cm have pt swallow and if it doesn’t move and it’s hard –> FNA nodule
also do a thyroid scan - hot is normal BUT 5% are malginant; cold is cancer
22
Q
What are the types of thyroid cancer and what is the prognosis?
A
papillary - good
follicular - not good
medullary - bad
23
Q
How to tx thyroid cancer?
A
exicision
radioiodine tx
+/-chemo
24
Q
What are the types of MEN 2 syndrome?
A
MEN 2A- parathyroid hyperplasia
MEN 2B- NO parathyroid hyperplasia
25
What are the 2 types of DI?
- central: posterior pit is broken --> ADH is low
| - nephrogenic: kidneys are broken --> ADH is normal/high
26
Hallmark for DI?
polyuria -urine is colorless
polydipsia
hypernatremia - b/c so much water is excreted
27
What is dx for DI? What would you expect for central vs. nephro? What lab can you do at the office?
water deprivation test
-central: serum ADH does not increase when plasma osm increase
-nephro: serume ADH does not increase when urine osm increase
UA and glucose finger
-UA will have LOW specific gravity b/c urine is dilute
28
How to tx central vs nephro DI?
central: desmopressin
nephro: stop meds of Lithium, steroids; no Na and use thiazide diuretics
29
Pt annual exam shows hyponatremia but NO pitting edema, what should be suspected? In this pt, what is the tx?
SIADH
too much ADH is produced - water is being withheld
restrict water
30
Pt is vomiting w/ diarrhea and labs show hyponatermia-how to tx? And what may this pt have (complication)?
hypertonic saline to correct hyponatremia but not too quickly to avoid osmotic demylination
swelling of the brain - visual changes
31
Pt has positive chvostecks sign and trousseaus sign (what are they), what EKG would you expect? What is this?
chvostek: tapping on facial nerve and spasms occur
trousseaus: BP cuff is tight and carpal spasms occur
ekg: QT prolongation
hypoparathyroidism
32
How to dx hypoparathyroidism?
high phosphate
| low PTH
33
How to tx hypoparathyroidism?
IV Ca glyconate
34
What is hallmark for hyperparathyroidism?
stones -kidney stones
bones- bone aches
groans -muscle, gout, constipation
psychiatric overtones - depression, anxiety
35
Pt has polyuria, polydipsia - ddx?
DM
| DI
36
EKG for hyperparathyroidism?
SHORT QT
37
What is primary vs secondary hyperparathryoidism? Tx?
primary: adenoma in brain - tx: bisphosphates, surgery
secondary: renal failure, or some other underlying dz-tx: surgery, Ca acetate
38
Pt has brown tumors of the jaw- what else would you expect on DEXA?
osteopenia d/t hyperparathyroidism (primary)
39
What are the sx for cushing sx?
round face
purprle straie
buffalo hump
40
What is the most common cx of cushing sx?
iatrogenic - steroid use
41
How to dx cushing sx?
24hr urine cortisol test
| overnight dexamethasone suppression test
42
Which one has the hyperpigmentation: cushing sx or dz? Why?
cushing dz b/c of increased ACTH
43
Difference between cushing sx and cushing dz
Cushing dz is prob with the pit gland and needs MRI
| cushing sx OUTSIDE and secondary -> chest, abdomen CT
44
Pt has HA, lots of sweating, palpitation, tachycardia, sense of impending doom? Next step and what to expect as results?
pheochromocytoma
| urine screen - metanephrine which is a breakdown product of catecholamines
45
How to tx phenochromocytoma?
beta and alpha blocker
46
How to differentiate MEN IIA and IIB?
both have: medullary thyroid carcinoma + pheochromocytoma
MENIIA- parathyroid carcinoma
MENIIB- mucosal neuroma (nasopharynx, oropharynx) + marfanoid body habitus (long and lanky)
47
Pt is hypertensive + hypokalemia + NO EDEMA; NOT on diuretic?
hyperaldosteronism
48
How to dx hyperalodsteronism?
saline infusion test
- plasma renin activity is LOW-primary
- plasma renin activity is HIGH - secondary
49
How to tx primary hyperaldosteronism?
surgery
50
How to tx hyperplasia hyperaldosteronism?
sprinolactone
51
Pt has wt loss, PIGMENTATION, anorexia, abdominal pain, hypoglycemia?
primary adrenal insufficiency
52
Cx for primary and secondary adrenal insufficiency?
primary: TB
secondary: abrupt stop of steroids
53
How to dx Addison?
ACTH/corticotropin stimulation test
54
What is adrenal crisis and how to tx?
NO cortisol and aldosterone
| tx: HD cortisol, IV saline, mineralcorticoids
55
In Addison is ACTH, renin, and aldosterone high or low?
ACTH is high
renin is high
aldosterone is low
56
How to tx Addison?
steroids and mineralocorticoid
57
Pt has high PTH, high serum Ca but low urine ca?
familiar hypocalcuric hypercalcemia
58
What is the cornerstone management of thyroid cancer?
supratherapeutic doses of thyroid hormone
59
What are the three congenital adrenal hyperplasia outcomes d/t deficiency? What do the babies look like?
most common - 21hydroxylase
11 hydroxylase
17hydroxylase
all have ambiguous genitalia
60
How to dx congenital adrenal hyperplasia?
high 17 hydroxyprogesterone
61
How to tx congenital adrenal hyperplasia?
cortisol and mineralocoricoid
62
What is the PTH feedback?
25hydroxy vita D --> 1,25 dihydroxy vitD --> this increases gut absorption of Ca --> increase absorption of Ca tells PTh to decrease 1,25 dihydroxy vitD conversion in the kidney
63
How to tx hypercalcemia?
tx w/ volume and sodium
64
Bisphosphates can cause what?
ostenecrosis of the jaw
65
Cortisol should be the highest in am or pm? What should be suspected if abnormal?
high in AM
66
Pt is thin, with ketosis and had recent sudden dx of DMI - would you expect HLA association and are kids are risk for DM?
YES
| kids are most likely not at risk
67
How does a DMII typically present and what genetic counseling should they get?
obese
| can be passed off to future offsprings
68
How to determine if pt has Somogyi effect vs dawn phenomenon?
pt checks glucose level at 3a -> if elevated: dawn phenomenon and increase insulin; if low: Somogyi and reduce evening insulin
69
What is happening in DMI vs DMII pts -pathophys?
DMI- autoimmune disorder that kills all B cells in pancreas; when you find out pt has DMI - most of B cells are gone
DMII: fat decreases glucose uptake -> insulin resistance occurs; even though B cells are there, they become desensitized to glucose -> less insulin is released
70
What age are DMI pts usually dx?
71
How to dx DM?
1) random plasma >200
2) fasting glucose >126 x2
3) 2hr post prandial or 75g OGTT >200
4) ha1c: >6.5
72
Pt is 18yo + has recurrent yeast infxn + wt loss + fatigue + recent cold? What to other sx to expect?
DM
polyuria, polydipsia, numbness if severe
+/-DKA sx
73
What is the tx goal of ha1c?
6.5
74
What haps if mom has DMII?
premature labor
| baby will be hypoglycemic
75
Complication of mom having gestational diabetes?
can develop DMII w/in 20yrs
76
What are the macrovascular complications of DM?
CAD
peripheral vascular ddz
cerebrovascular dz
77
What are the microvascular complications of DM?
retinopathy
neuropathy
nephropathy
78
What is BP goal for DM?
140/90
79
How to tx HTN in DM
ACE/ARB
B blockers
thiazide
80
When to use high dose statin?
DM + CVD + 10yr ASCVD risk >7.5%
81
What can lead to ESRD in addition of DM?
htn
82
How to tx nephropathy complication from DM?
ACE/ARB
83
How to dx nephropathy in DM?
2 tests w/in 3-6mo
- spot urine microalbumin
- 24 collection for total protein: 30-300
84
What are the 3 stages of retinopathy in DM? What do you see in each?
1) nonproliferative - macular edema, hard exudates, microanuerysms
2) proliferative - cotton wool patches, new vessels are forming
3) proliferative- retinal hemorrhaging, retinal detachment
85
How to tx retinopathy DM?
photocoagulation
BP control
ASA -but NOT in hemorrhages
86
What other eye probs can DM pts have?
catarcts
glaucoma
retinopathy
87
Pt has DM - what should be checked at every visit to prevent complications re: neuropathy? How to check and what to advise pt?
feet
check w/ monofilament
tell pt to check feet everyday, make sure to check for any injuries (b/c they might not feel it), avoid dryness and cracking
88
DM: What can occur if pt has injury to foot and doesnt realize?
ulcers --> amputation
89
What other organs can get affected re: DM complications?
GI - constipation
impotence
CVA - stroke
bladder issues
90
What to expect from DM pts w/ neuropathy?
stocking glove sx
91
Pt had a pneumonia last week and now presents with N/V, mental status changes, and dehydration? What type of breathing would you expect and smell?
DKA
kussmauls respiration
fruity
92
What are key lab findings for DKA?
glucose >450
urine: ketones -maybe absent if severe
acidosis
high B hydroxybutyrate
93
How to tx DKA?
1) IV fluids - isotonic
2) insulin
3) K
94
What to check before giving insulin in DKA? What are complications for DKA?
always check urine for kidney fxn
| if fluids are given too quickly - cerebral edema can occur
95
What are other cx of DKA?
missed insulin
infxn
trama
96
Pt is very dehydrated with altered mental status - what is next step to r/o and r/in?
check for glucose: >600 (compared to DKA >450) --> hyperosmolar hyperglycemic state
97
What is the main difference between DKA and hyperosmolar hyperglycemic state?
hyperosmolar hypeglycemic state has: NO ketosis NO acidosis (pH: 7.3)
98
How to tx hyperosmolar hyperglycemic state?
1) fluids!
| 2) insulin is low dose
99
What are the phases of DMII?
1) high insulin, low glucose
2) high insulin, norm glucose
3) norm insulin, high glucose
4) low insulin (pancreas has given out), high glucose
100
Which is seen in DMI and DMII - DKA and hyperosmolar hyperglycemic state?
DMI-DKA
| DMII- hyperosmolar hyperglycemic
101
Pt has HA, tachycardia, confusion, and sweating who works in ER? What to expect from labs?
hypoglycemia
| glucose
102
When may sx of hypoglycemia not show?
elderly
use of Beta blockers
repeated episodes
103
How to tx hypoglycemia?
oral glucose
glucagon injxn
IV glucose
104
Pt is homeless, brought in with seizures - what to expect for labs and how to tx?
hypoglycemia:
105
What is metabolic syndrome?
```
bp 130/85
fasting blood sugar >100
waist circum: male 40, female 35
low hdl: male 40, female 50
triglyceride 150
```
