Endocrine Flashcards
(163 cards)
1
Q
What are the HLA haplotypes associated with DM I?
A
HLA-DR3 and DR4
2
Q
What are the antibodies that can be present in DM I? (4)
A
Anti-islet cell
Anti- glutamic acid decarboxylase
Anti-insulin
Anti Zn transpor
3
Q
What is the test to screen for renal dysfunction in DM pts?
A
albumin-to-creatinine ratio
4
Q
How often is HbA1c obtained for DM I patients?
A
Q 3 months
5
Q
what happens to total K stores with DKA or HONK?
A
Decreased
6
Q
What type of fluids should be used for initial fluid resuscitation with DKA? At what point is D5 added?
A
NS (really, not LR)
D5 added at 250 mg /dl
7
Q
What is the MOA of metformin?
A
Inhibits hepatic gluconeogenesis and increases peripheral sensitivity to insulin
8
Q
What is the major contraindication to metformin use?
A
Renal insufficiency
9
Q
What is the MOA of sulfonylureas?
A
Increases endogenous insulin secretion
10
Q
What type of drug is glipizide?
A
Sulfonylurea
11
Q
What type of drug is glyburide?
A
Sulfonylurea
12
Q
What type of drug is glimepiride?
A
Sulfonylurea
13
Q
What is the MOA thiazolidinediones?
A
Increases insulin sensitivity by PPRA activation
14
Q
What is the major contraindication of thiazolidinones?
A
CHF
15
Q
What is the MOA of DPP-4 inhibitors?
A
Inhibit degradation of GLP-1
The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP), which inhibit glucagon release,
16
Q
What is the major advantage to DPP-4 inhibitors?
A
Weight neutral
17
Q
what is the common suffix to all DPP-4 inhibitors?
A
-Gliptins
18
Q
What is the MOA of GLP-1 agonists?
A
binds to glucagon-like peptide 1 receptors, slowing gastric emptying and increases insulin secretion by pancreatic Beta cells
19
Q
What is the common suffix to GLP-1 agonists?
A
tides
20
Q
What is the advantage of GLP-1 agonists?
A
Lower risk of hypoglycemic episodes
21
Q
What is the common suffix to SGLT2 inhibitors?
A
Flozin
22
Q
True or false: DM automatically puts one at the highest risk category for acute coronary events
A
True
23
Q
What is the goal BP of patients with DM? What is the agent of choice? Why?
A
Less than 140/90
ACEI and ARBS due to renal preservation effects
24
Q
What are the annual physical exam that should be performed for DM? (5)
A
BP Lipids Microalbuminuria Retinopathy Foot neuropathy
25
All DM pts older than 19 should receive what vaccine that other groups do not need?
Pneumovax
26
True or false: anti-islet cell and anti-GAD antibodies are found in DM II
False
27
What are the fast acting insulins?
Lispro
Aspart
Glulisine
(no LAG)
28
What is the intermediate acting insulin?
NPH
29
What are the two long acting insulins?
Detemir
| Glargine
30
Which has more profound mental status changes: DKA or HHS?
HHS
31
What are the respirations like with DKA?
Kussmaul breathing
32
What are the glucose levels in HHK?
Over 600 mg/dl
33
True or false: there is a normal anion gap in HHK
True
34
When is bicarb used for treating DKA?
only if pH is less than 6.9
35
What are the screening recommendations for DM?
Test A1c q 3 years starting at age 45
36
When does retinopathy occur in DM?
when present for 3-5 years
37
What is the treatment for diabetic retinopathy?
Laser photocoagulation prevents further neovascularization, but does not reverse damage
38
What are the symptoms of diabetic nephropathy?
Glomerular hyperfiltration, followed by microalbuminuria
39
When in the course of DM does nephropathy occur?
over 10 years
40
What are the classic histological findings of diabetic nephropathy?
Kimmelstiel-Wilson nodules
41
What is the preventative treatment for diabetic nephropathy?
ACIEs
42
What, besides gabapentin and lyrica, can be used to treat diabetic neuropathy?
TCAs
| NSAIDs
43
What is the treatment for gastroparesis 2/2 DM?
metoclopramide
44
What level of fasting glucose is prediabetes (impaired fasting glucose)?
between 100-126
45
What are the criteria for metabolic syndrome?
Central obesity
Impaired glucose
HTN
Dyslipidemia
46
What level of triglycerides may indicate metabolic syndrome?
Over 150 mg/dL
47
What level of HDL in men and women respectively, may indicate metabolic syndrome?
Less than 40 in men
| Less than 50 in women
48
TSH is the best measure of thyroid function unless what?
There is a h/o brain injury
49
What is the preferred screening test for thyroid hormone levels (NOT thyroid disease)?
Free T4
| TSH is best screen for thyroid disease
50
What is the most common cause of hyperthyroidism in the US?
grave's disease
51
Exophthalmos, pretibial myxedema, and thyroid bruits are specific to what primary thyroid disease?
Grave's disease
52
What causes increased thyroid binding globulin?
Pregnancy
Estrogen
Infection
53
What is the pathophysiology behind fetal thyrotoxicosis?
IgG TSH stimulating antibodies can cross the placenta
54
What are labs like with subclinical hypothyroidism?
Increased TSH, but normal T3 and T4
55
What are the labs like with euthyroid sick syndrome?
Normal TSH
Normal to decreased T4
Decreased T3
56
What lab finding is relatively specific for euthyroid sick syndrome?
Increase in reverse T3
57
What is the cause of euthyroid sick syndrome?
Thought to be due to caloric deprivation and increased cytokines. May have transient ↑ in TSH during recovery period.
58
What drug can be given to hyperthyroid pts to decrease symptoms?
Beta blockers
59
What are the two drugs that can inhibit thyroid hormone production?
Methimazole
| PTU
60
What is the treatment for severe ophthalmopathy 2/2 hyperthyroidism?
Steroids
61
What is the treatment for thyroid storm? (4)
Antithyroid drugs
Iodine
IV esmolol
Steroids
62
What are the s/sx of thyroid storm?
Fever
Delirium
A-fib
63
What is the major side effect of PTU?
Agranulocytosis
64
What is the major side effect of methimazole?
Agranulocytosis
65
Which is safe to use in pregnancy: PTU or methimazole?
PTU
66
Which prevents the peripheral conversion of T4 to T4: PTU or methimazole?
PTU
67
What happens to ophthalmopathy with radioactive iodine thyroid ablation?
Initially worsens
68
What is the most common cause of hypothyroidism in the US?
Hashimoto's thyroiditis
69
What are the antibodies seen in Hashimoto's thyroiditis?
Anti-thyroglobulin
| Anti Thyroid peroxidase
70
What is the most common cause of congenital hypothyroidism?
Thyroid dysgenesis
71
How does congenital hypothyroidism present?
Failure to thrive
Umbilical hernias
Prolonged jaundice
72
What happens to LDL with hypothyroidism?
Increases
73
Why are thyroid disorders associated with menstrual irregularities?
TSH and LH/FSH share the same alpha subunit
74
When should subclinical hypothyroidism be treated?
If TSH more than 10mU/L
75
Patients with Hashimoto's disease are at an increased risk of developing which hematological malignancy?
Lymphoma
76
What are the s/sx of myxedema coma?
Decreased LOC
Hypothermia
Hypotension
Hypoventilation
77
What is the treatment for myxedema coma?
IV levothyroxine and IV cortisone if renal insufficiency has not been excluded
78
What are the s/sx of subacute thyroiditis?
Tender thyroid
malaise
URI s/sx
79
What is the treatment for subacute thyroiditis?
If severe, NSAIDS or corticosteroids
80
True or false: most thyroid nodules are benign
True
81
Which are more likely to be malignant: hot or cold thyroid nodules?
Cold--hyperfunctioning nodules are not malignant
82
What are the top four most common thyroid neoplasms?
Papillary
Follicular
Medullary
Anaplastic
83
What lab value should be checked if medullary thyroid CA is suspected?
Calcitonin
84
What are the histological characteristics of papillary thyroid cancer?
```
Pupil nuclei ("orphan annie eyes")
Psammoma bodies
```
85
How does papillary thyroid cancer spread?
lymphatics
86
How does follicular thyroid cancer spread?
hematologically
87
what is the prognosis for papillary and follicular thyroid cancer?
Very good--more than 90% life 10+ years
88
What is the prognosis for medullary thyroid cancer?
80% survive 10 years
89
What is the prognosis for anaplastic thyroid cancer?
10% survive more than 3 years
90
What should be done if a FNA of a thyroid mass reveals benign neoplasm?
Follow with physical exam/US to assess for continued growth
91
What should be done if a FNA of a thyroid mass reveals malignant neoplasm?
Surgical resection with hemi or total thyroidectomy
92
What should be done if a FNA of a thyroid mass reveals indeterminate neoplasm?
Watchful waiting vs hemithyroidectomy (10–30% chance of malignancy). If resected, await final pathology to guide further treatment.
93
What is the first step in working up a thyroid nodule?
Determine if functioning by taking TSH
- If low, then not malignant
- If normal or high, workup malignancy
94
What is osteomalacia?
a mineralization defect often due to severe vitamin D deficiency that presents with bone pain, decreased calcium/phosphorus, and 2° hyperparathyroidism.
95
Which ethnicities are at an increased risk of osteoporosis?
Caucasians
| Asians
96
What are the three major risk factors for osteoporosis?
Smoking
Age
Corticosteroid use
97
When are DEXA scans recommended for men and women?
Women 65+
| Men 70+
98
How many standard deviations are diagnostic for osteopenia?
between 1 and 2.5
99
What will labs reveal in osteoporosis?
Nothing
100
Global demineralization is only apparent on x-ray after what percentage of bone loss?
30%
101
True or false: bisphosphonates are recommended for treating osteopenia?
False--only for osteoporosis
102
What is the MOA and use of denosumab?
Monoclonal ab to RANK-L, to decreased osteoclast function
103
What is the MOA and use of teriparatide?
analogue of parathyroid hormone, PTH
104
What is the basic pathophysiology behind Paget's disease?
Increased rate of bone turnover
105
What is the classic description of Paget's disease on histology?
Mosaic lamellar bone pattern
106
What is the usualy presentation of Paget's disease?
Asymptomatic, but s/sx include bone/joint pain
107
Does Paget's disease affect all bones, or just one?
either
108
↑ serum alkaline phosphatase with normal gamma-glutamyl transpeptidase (GGT) points to what etiology?
Bone
109
Bone pain + hearing loss = ?
Paget's disease
110
What are the lab values like with Paget's disease?
Abnormalities include ↑ serum alkaline phosphatase with normal calcium and phosphate levels.
111
What is the treatment for asymptomatic Paget's disease?
Follow--nothing
112
What is the treatment for symptomatic Paget's disease?
Bisphosphonates, Vit D, and Ca
113
What are the radiographic findings of Paget's disease?
Lytic and sclerotic bone lesions
114
What are the two major complications of Paget's disease?
high output cardiac failure
| Osteosarcoma
115
What is the most common cause of hyperparathyroidism?
Single hyperfunctioning adenoma
116
What is the cause of secondary hyperPTH?
Renal insufficiency (due to ↓ production of 1-25 dihydroxyvitamin D)
117
What is the cause of tertiary hyperparathyroidism?
Seen in dialysis patients with long-standing 2° hyperparathyroidism that leads to hyperplasia of the parathyroid glands. When one or more of the glands become autonomous, 3° hyperparathyroidism results.
118
What is the pathophysiology behind pseudohypoparathyroidism?
PTH resistance
| Elevated PTH levels but ineffective at target organs. Hypocalcemia and hyperphosphatemia.
119
What are the labs like with primary hyperparathyroidism?
Elevated Ca
| low phosphate
120
What are the s/sx of hypercalcemia?
```
Stones
Bones
Moans
Groans
Psychiatric overtones
```
121
What is the treatment for hypercalcemia 2/2 hyperparathyroidism?
IVFs
Loop diuretics
Bisphosphonates if malignancy
122
What is the treatment for primary hyperparathyroidism?
Parathyroidectomy
123
```
What happens to
-PTH
-Ca
-PO4
with primary hyperparathyroidism?
```
- PTH increased
- Ca increased
- PO4 decreased
124
```
What happens to
-PTH
-Ca
-PO4
with secondary hyperparathyroidism?
```
- PTH Increased
- Ca nl/decreased
- PO4 increased
125
```
What happens to
-PTH
-Ca
-PO4
with tertiary hyperparathyroidism?
```
- PTH Increased
- Ca increased
- PO4 increased
126
```
What happens to
-PTH
-Ca
-PO4
with ectopic PTHrP?
```
- PTH decreased
- Ca increased
- PO4 nl to decreased
127
What is the treatment for hypercalcemia in patients with renal insufficiency?
Oral phosphate binders
128
What are the labs that should be ordered if suspected hypopituitarism?
8 am cortisol
Free T4
Testosterone/estradiol
IGF-1
129
What is the hormone that is secreted from the hypothalamus to the pituitary, and causes prolactin release?
Dopamine
130
What is the treatment for Cushing's syndrome?
Surgical resection of the source
131
What is Cushing's *disease*?
overproduction of ACTH from pituitary adenoma
132
What is the most common cause of acromegaly?
benign pituitary GH-secreting adenoma
133
What happens with the low and high dose dexamethasone test with cushing's *disease*?
In Cushing disease, cortisol secretion remains elevated with the low-dose (1 mg) dexamethasone test but is suppressed with the high-dose (8 mg) dexamethasone test.
134
What are some s/sx of acromegaly?
```
Skull enlargement (frontal bossing)
Wide-spaced teeth
Coarse facial features
Macroglossia
Skin tags
```
135
What is a normal test for the dexamethasone suppression test, and what does it indicated?
Lower ACTH means no cushing's
136
What is the use of the high dose dexamethasone suppression test?
If ACTH suppressed, then pituitary adenoma
| If not, then ectopic production
137
What is the most common cause of death of acromegaly?
Heart failure 2/2 cardiomyopathy
138
What is the treatment for acromegaly?
Resection of the pituitary tumor
| Octreotide or lanreotide
139
What is the MOA and use of pegvisomant?
Gh receptor antagonist, used in the treatment of acromegaly
140
What is the screening lab test for acromegaly?
IGF-1 levels (*NOT* GH levels)
141
What must always be r/o first in cases of hyperprolactinemia?
Pregnancy
142
What is the mechanism through which prolactinomas cause a decrease in libido, and amenorrhea?
Elevated prolactin inhibits GnRH secretion and consequently lowers LH and FSH secretion,
143
What is the serum prolactin level in a prolactinoma?
Over 200 ng/mL
144
What is the pharmacotherapy for a prolactinoma?
Dopamine agonists (cabergoline)
145
When is surgery indicated as the treatment for a prolactinoma?
Refractory to medical management or with compressive effects
146
What are two classic drugs that can cause nephrogenic DI?
Li
| Demeclocycline
147
Dehydroepiandrosterone is only produced by what organ?
Adrenal gland
148
What causes the hyperpigmentation associated with Addison's disease?
Increased ACTH increases POMC intermediate
149
What is the test of choice for diagnosing addison's disease? What is the backup?
- ACTH levels
| - Synthetic ACTH stimulation (cosyntropin test)
150
What amount of steroids, and for what durations, may cause secondary/tertiary adrenal insufficiency?
More than 20g for more than 3 weeks
151
What is the treatment difference for primary vs secondary adrenal insufficiency?
Primary = Glucocorticoid and mineralocorticoid replacement
Secondary = Glucocorticoid replacement alone
152
What are the 4 S's of adrenal crisis management?
Salt (0.9% NS)
Steroids (IV hydrocortisone)
Support
Search for cause
153
What type of cells comprise a pheochromocytoma?
Chromaffin cells
154
What are the s/sx of conn syndrome and/or hyperaldosteronism?
HTN
HA
Polyuria
Weakness
155
What electrolyte is deficient with hyperaldosteronism? What acid/base disorder?
Hypokalemic alkalosis
156
What is the test to diagnose hyperaldosteronism?
Increased aldosterone-to-plasma renin activity ratio
157
What is the pharmacotherapy of choice for hyperaldosteronism?
Eplerenone (aldosterone receptor antagonist)
158
Review 21 hydroxylase flow.
Review
159
What is the treatment for 21 hydroxylase deficiency?
Immediate IVFs
| Salt repletion
160
What are the components of MEN1?
Pituitary
Parathyroid hyperplasia
Pancreatic islet cell tumors
161
What is the underlying genetic mutation in MEN2?
RET protooncogene
162
What are the components of MEN2A?
Parathyroid hyperplasia
Medullary thyroid
Pheochromocytoma
163
What are the components of MEN2B?
Mucosal neuromas
Medullary thyroid
Pheochromocytoma
Marfanoid
