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Endocrine Flashcards

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1
Q

Thyroid nodules - work up?

A

GET and US, uptake. - Changes of benign are much higher than CA

But if irregular or cold nodule -> biopsy.

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2
Q

Thyroid

Follicular adenoma

v
Follicluar CA

A

Adenoma - capsule w/o invasioan. FNA CANT distinguish

AdenoCA - Invades capsule - hematogenous spread (RCC, HCC, ChorioCA, Follicular A)

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3
Q

Thyroid CA

Papillary
Medullary
Anaplastic

A

Papilalry - 80% of CA - Orphan annie , nuclear groove, Responds to radiation, excellent prognosis

Medullary - Parafollicular C cells - INC calcitonin (HypoCalcemia)-> amyloid stroma . MEN , ->

Anaplastic - highly malgiant - elderly

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4
Q

hyperparathyroism lab findings -

- - lab findings and urinary findings  
Primary HyperPara (aka?)

Familial hypoCalciuric, HypoCalcemia

A

HyperCa, INC urinary cAMP, INC ALK PHOSPH (from osteobalsts because they activate ostoeclasts)

Primary - Osteitis Fibrosa cystica - INC PTH, INC Ca, Ca/Cr >0.02 (hyperCa keeps spilling Calcemia in urine)

Familial - INC PTH, INC Ca, Ca/Cr

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5
Q

Pseduohypoparathyroidism

\

A

PTH resistance.

DINC PTH, but DEC Ca.

AD - short stature, 4/5 digiti problem.

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6
Q

Primary hyperparathyroidism - recommended tx? In whom?

A

Tx surgery if younger than 50. Even if asx.

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7
Q

Findings in malignancy related PTHrP release?

A

INC Ca,

Normal 25 oh

DEC 1,25OH!

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8
Q

Adrenal insufficiency causes?

dx?

A

TB (bilat calcifications), Autoimmune, Lung CA, fungal, CMV

Dx - Cosyntropin (ACTH analogue)

Fails to INC Ca

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9
Q

Addisons lab findings, acid base findings? Clinical findings

A

HypoNa, HyperK.

Non anion gap METABOLIC ACIDOSIS

Hyperpigmentation

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10
Q

Primary Aldo/Conns - what lab findings to check?

What can accentuate findings?

Tx

A

Aldo/renin > 20 . HTN, HypoK. (especially brought out with diuretic use !

Single adrenal - surgery
Double trouble - spirnololactone, eplerenone

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11
Q

DHEAS produced by?

A

Adrenals only

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12
Q

HyperNatremia tx (in dry pt)

A

Severe - NS

Once euvolemic - 1/2NS +D5

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13
Q

Presentation, lab findings

Central DI

Nephrogenic DI

A

Central - HyperNa, DIlute urine, impaired thirst.
water depreveation does NOT INC urine osm. Tx - DDAVP.

Nephrogenic- May be euNa due to intact thirst. May be HyperNa, No responset o DDAVP. Tx -NORMAL SALINE. Once euvolemic, can switch to D5 / (1/2 ns?)

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14
Q

SIADH

A

Free water restriction, Salt Tab, Hypertonic Saline.

Demeclocycline, vaptans.

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15
Q

Glycemic control in DM2 - waht does it do for the pt?

A

DEC microvascular complications - retinopathy, nephropathy

Does not change macro - MI, stroke, death

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16
Q

Ulcers tx algorithm

A

Offload, -> debride -> wound dressing - >abx -> revasc - > amputate

Dont need to use Abx until deep ulcer w/ cellulitis

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17
Q

Best way to test for DM neuropathy?

A

Monofilament test -

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18
Q

Retinopathy - findings - tx?

A

cotton wool, microaneurysm, ehmorrhage,s exudate, edema - tx argon laser

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19
Q

DKA tx -

Study These Flashcards
A

Regular insulin + K + NS - Change to D5, 1/2NS when glucsse is 200-250.

20
Q

Insulinoma - clinical and lab findigns

Glucagonoma

Study These Flashcards
A

Insulinoma - Hyperglycemia w/ AMS - resovles w/ glucose. INC insulin AND c peptide

Glucagonoma - DM in skinny - controleld w/ oral meds and diet. Necrolytic migrans erythem a

21
Q

Somatostatinoma presentation

Study These Flashcards
A

Achlorhydria, Cholelithiasis, steatorrhea (block CCK)

22
Q

HyperT causes - x4

Graves
Multinodular Goiter
factitious

(DeQuervains Granulomatous Thyroiditis)

Study These Flashcards
A

Graves - IgG to TSH. RadioI tx is preferred, but can worsen opthalmopathy. Highest risk of hypoT due to global shut down. Afib -> propanlol

Multinodular goiter - Can be from Iodine deficient. Euthyroid. If it becomes TSH independent -> toxic goiter.

Factitious - INC T3,4 w/ DEC TSH. Also LOW THYROGLOBULIN

Granulomatous Dequervains - hypo and hyper. After viral. Tender. SELF LIMITED.

23
Q

Hypo T - histo? Concerns?

Hashi

Reidels Fibrosing

Study These Flashcards
A

Hashin - Anti T peroidase, Tg, MICROSOMAL. - Germinal Center and Hurthle cells - INC risk of B cell lmyphma

Reidel - Young female, hard. Chronic Inflam. ? Anaplastic if older.

24
Q

Thyeroi myopathy - presentation and differnetiation from polymyositis and steroid induced

Study These Flashcards
A

hypo and hyper , INC CK, slow or fast reflexes

This is how you can differentiate from steroidf and polym oysitis. REFLEXES

25
Sick Euthyroid. Lab findings?
Normal function. But T3,4 is lower. Due to DEC peripheral conversion.
26
Acromegaly - Dx? Concerns?
Dx - IGF1 test - If INC, then do a glucose tolerance test - > MRI CV death
27
Mech and tox Sulfonylurea Metformin Glitazone/TZD DPP4 (sitagliptain) GLP-1 - exenatide
Sulfonyurea - INC endogenosu release - hypoG. Tolbutamide and chlorpropamide and have disulfiram like reactio. Glyburidie, glipizide, glimepiride less os Metformin - DEC gluconeogensis -> lactic acidosis. Dont give in Renal pt Glitazone - INC insulin sensitivity - Hepatotox (LFT), may INC HF Sitagliptain DDP4 - nothign GLP1 - exenatide (weight loss, but PANCREATITIS (gulp... weight loss but pancreatitis)(
28
Thyroid strom - presentation? triggers?
Lid lag, HTN, arrhythmias, Febrile, AMS Can be triggered by - Surgery, Trauma, Infection, Iodine, Child birth DONT confuse w/ malig HTN
29
SIADH - urine osm and urine Na?
has HIGH URINE SODIUM with High Urin osmolality!
30
Thyroid affect on reflexes
Hypo – slow, HyperT – fast
31
Initial gout attac – tx?
Lifestyle : Alcohol cessation + weight loss >>> low protein/diet changes.
32
In panhypopit - what to replace first?
Replace cortisone before thyroxine
33
Tx of subacute thyroiditis?
Aspirin
34
Pt w/ thyroid nodule | Workup algorithm?
TSH -> Free T4 --> Biopsy if >1cm`
35
Acute tx of hyperCa?
Hydrate Calcitonin! (FAST ACTION - inhibits osteoclasts - much faster than bisphosphnates, which take days to work)
36
How does low albumin affect Ca?
Lowers total level of Calcium. But the free level of calcium is normal, hence no symptoms.
37
When do you see Chvostek sign?
Hypocalcemia - after accidnetly taking out all parathyroids, you get DEC Ca.
38
EKG findings in HypoCa HyperCa
HypoCa - prolongs QTc, which si why you get torsades. HyperCa - shortens QTc
39
Best initial test for ohypercortisolism?
24 hr urine coritosl. If not available, then 1mg overnight dexamethasone suppression test.
40
Evaluating adrenal incidentaloma? alrogirth?
Metanephrines Renin/aldo levels 1mg overnight dexamethasone suppression.
41
Pheo- Best initial test, best confirmatory test? If positive findings, what scans?
Initial - Free metanephrines in plsama Confirmatory - 24 urine metanephrines Imaging w/ Ct/MRI AFTER!!! BIOCHEM Or MIBG scanning - if outside of adrenal gland
42
All diabetics should receive which health implemetnations/drugs?
``` Aspirin ACEi/ARB (bp >140) Statin until LDL 100 or less Pneumococcal vaccine Yearly eye exam, Yearly screen for MICROALBNINURIA (also reason to start ACEi/ARB regardless of BP) Foot exam for neuroapthy, ulcers ```
43
Oral estrogens affect on levothyroxine –
Oral estrogens INC TBG, thus need to INC levo to saturate TBG sites.
44
Test for Addisons vs Cushings?
Addisosn cosyntropin/basal early morning cortisol. Cushings – 24 hr free cortisol and low dose dex suppression test.
45
HTN and hypoK what to do first?
Aldo/renin . It is the initial screen for primar yhyperaldo. Adrenal suppression confirms.
46
Hyperthyroid with globally DEC radioiodine. Not taking exogenous. What is this?
THYROIDITIS. Primary Hyperthyroid (INC T4, DEC TSH) with DEC radioactive iodine uptake – other causes subacute granulomatous thyroiditis, iodine induced thyrotoxicosis.

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