Endocrine

Question 1

Hallmarks of Type I DM

Answer 1

1. Acute Onset
2. Ketones (in blood and urine)
3. Human Leukocyte antigens (HLA-DR3 or HLA-DR4)
4. Destruction of pancreatic islet cells by antibodies (autoimmune process)

Question 2

Type I DM S/S

Answer 2

1. Poly-sisters
2. Nocturnal enuresis
3. Loss of SQ Fta
4. Diminished DTRs

Question 3

Diagnostics for Type I DM

Answer 3

1. Elevated HbA1C–> can be elevated but may not be if acute onset
2. BS > 126 on 2 separate occations
3. Elevated Bun/Creatinine
4. Random BS > 200 with poly-sisters, and wt loss
5. Impaired glucose tolerance (IGT): > 100 and

Question 4

Type I DM Management

Answer 4

1. Diet
2. Insulin (in peds 0.5u/kg/day, give 2/3 in am and 1/3 remaning in pm)
3. Ask about family hx: age onset, obesity?, insulin required?

Question 5

Somogyi Effect

Answer 5

1. Nocturnal hypoglycemia is responded to by surge of opposing hormones and in AM hyperglycemic
2. Decrease or stop HS insulin

Question 6

Dawn Phenomenon

Answer 6

1. Blood sugar progressively increase over night so hyperglycemic by AM. (due to increasing tissue desensitization to insulin)
2. Add or increase HS insulin

Question 7

Metabolic syndrome

Answer 7

1. Waist Circumference: Men >= 40in, & women >=35 in
2. BP >= 130/85
3. Trigs >= 150
4. FBG >= 100
5. HDL: Men > 40, & Women > 50

Question 8

1. DM Type 2 - incidence

2. DM incidence

Answer 8

1. Most common type of DM in US. (> 90% of DM cases in US)
2. 29 Million in US have DM
3. 27% of all people with DM are undiagnosed.

Question 9

Type 2 DM diagnostics

Answer 9

Same as type I but NO ketones

Question 10

Type 2 DM med management

Answer 10

1. Metformin

2. Sulfonylurea (glipizide, glyburide, glimepiride)

Question 11

Types of DM Meds

Answer 11

1. Sulfonylureas: stimulate the pancreas
   ex: glipizide, glyburide, glimepiride
2. Alpha-glucosidase inhibitors less glucose absorbed by the gut
   ex: acarbose/miglitol
3. Thaizolidinediones: decreases gluconeogenesis
4. nonsulfonylurea insulin release stimulators: mimics effects of rapid acting insulin

Question 12

DKA (Diabetic Ketoacidosis)

Answer 12

1. Intracellular dehydration due to increased bld sugar levels.
2. associated w/ type 1.
3. Acidosis (pH 250
4. Ketonuria (and in bld)

Question 13

Hyperosmolic Hyperglycemic Non-Ketosis (HHNK)

Answer 13

1. No ketone production
2. Not acidotic
3. normal ion gap
4. SUPer elevated BS. >1000
5. Mortality rate 30- 50%

Question 14

Hyperthyroidism (A) vs Hypothyroidism (B)

Causes/Etology

Answer 14

A) - More common in women (8:1).
- Graves disease most common presentation (in kids too)
B) - Primary disease of thyroid gland
- Hashimoto’s thyroiditis common presentation (disease cause of hypothy.
* babies are “best in the world”
- Iodine deficiency/damage to gland

Question 15

Hyperthyroidism (A) vs Hypothyroidism (B)
S/S
*hypothyroidism in pregnancy

Answer 15

A) Gas peddle stuck: exophthalmos, heat intolerance, hyper DTRs
B) Break stuck: brittle nails, hair loss. Slowed DTRs, bradycardia, hypoactive bowel sounds
*may affect fetus in 1st trimester

Question 16

Hyperthyroidism (A) vs Hypothyroidism (B)

Diagnositics

Answer 16

A) Elevated serum T3 & T4. Serum ANA (Test for lupus) also usually elevated w/ s/s/ of lupus.
B) Elevated TSH, Low/low normal T4 (T3 not reliable). Hyponatremia & hypoglycemia

Question 17

Hyperthyroidism (A) vs Hypothyroidism (B)

management

Answer 17

A) decrease thyroid –> refer. Can use Methimazole and radioactive idodine, thyroid removal
B) Levothyroxine. increase by 25mcg q 1-2 weeks until symptoms stable, > 60yrs–> decrease dose.

Question 18

Cushing’s Syndrome

1. Def
2. S/S
3. Diagnostics
4. management

Answer 18

1. Too much steroids: ACTH hypersecretion by pituitary tumors or steroid meds
2. S/S: moon face w/ buffalo hump, poor wound healing, labile mood, hirsutism, HTN, amenorrhea, purple striage
3. Hyper: glycermia, natremia, elevated plasma cortisol in AM, serum ACTH (elevated)
4. depends on cause…removal adrenal tumors,
   manage electrolyte balance

Question 19

Addison’s Disease

1. def
2. s/s
3. diag
4. mgt

Answer 19

1. too little steroids ( deficient in cortisol, androgens and aldosterone) due to autoimmune destruction or cancer or pituitary failure (no feedback loop)
2. hyper-pigmintaiton of buccal mucosa, difuse tanning/freckles.
3. hypo: glycemia, natremia, kalemia. plasma cortisol

Question 20

Peds: Short Stature

1. def:
2. causes

Answer 20

1. Def: ht falling 2 standard diviations below mean. failure to grow more than 4 cm in 1 yr.
2. Normal variants –> familial genetic variant, constitutional delay (bone age consistant w/ ht age)
   proportional short –> IUGR, Maternal/fetal infection, failure to thrive
   nonproportional –> dwarfism, rickets

Question 21

Hashimoto’s thyroiditis

Answer 21

hypothyroidism

Question 22

Grave’s disease

Answer 22

Hyperpthyroidism

Question 23

brittle nails, hair loss

Answer 23

Hyperthyroidism

Question 24

exophtalmos

Answer 24

hyperthyroidism

Question 25

heat intolerance

Answer 25

hypertyroidism

Question 26

moon face and buffalo hump

Answer 26

Cushing's syndrome

Question 27

Addison's Disease

Answer 27

deficient in steroids

Question 28

excess steroids

Answer 28

Cushing's syndrome