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FM MED II GENERAL > ENDOCRINE > Flashcards

ENDOCRINE Flashcards

(60 cards)

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1
Q

What regulates Ca homeostasis?

A

Parathyroid hormone

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2
Q

What stimulates the release of PTH?

A

Lox Ca levels

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3
Q

What can often occur after having neck surgery or surgery for thyroid cancer?

A

Hypoparathyroidism

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4
Q

If a pt is having significant muscle spasm, paresthesia, Chvostek sign (tapping on the face that causes facial twitching), or trousseau sign (inflating the BP cuff causes tetany) -dx?

A

Hypoparathyroidism

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5
Q

How do you dx hypoparathyroidism?

A

Decreased PTH, Serum Ca, and increased Phosphorus

EKG – prolonged QT interval

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6
Q

How do you treat hypoparathyroidism?

A

replace Ca and Mg

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7
Q

If you elevated PTH and serum Ca, and low phosphate – dx?

A

HYperparathyroidism

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8
Q

What is the MC cause hyperparathyroidism?

A

Single adenoma

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9
Q

If a pt has renal stones, nausea, constipation, and decreased bone mineral density – dx?

A

Hyperaparthyroidism

“Bones, stones, and groans”

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10
Q

What will you see on EKG with hyperparathyroidism?

A

short QT interval

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11
Q

If PTH is low with elevated Ca – dx?

A

Need to think of other causes (aka malignancy)

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12
Q

How do you treat hyperparathyroidism?

A

Surgery for symptomatic patients

Asymptomatic + serum Ca over 1.0, reduced CrCl, osteoporosis, and under 50 – go to surgery

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13
Q

What would secondary hyperparathyroidism be caused from? Tx?

A

Chronic renal failure and Vit D deficiency

Tx – Replace Vit D or dietary phosphate restriction

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14
Q

What’s more common, hyper or hypothyroidism?

A

Hypothyroidism

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15
Q

Hashimoto’s is associated with what?

A

Hypothyroidism

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16
Q

What is grave’s disease associated with?

A

Hyperthyroidism

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17
Q

If a pt has constipation, weight gain, fatigue, hair loss, and cold intolerance – dx?

A

Hypothyroidism

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18
Q

What would the labs show for hypothyroidism?

A 
TSH = High
T4 = Low
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19
Q

How do we treat hypothyroidism?

A

Levothyroxine (take on an empty stomach and wait 4 hours before taking Ca or Fe)

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20
Q

What are the causes of hyperthyroidism?

A

Grave’s Dz (autoimmune that leads to TSH receptor antibodies)
Subacute Thyroiditis = post-infectious, tender thyroid
Silent thyroiditis = occurs post-partum
Toxic nodular goiter – nodular felt on exam
Pituitary adenoma – nothing in particular in Hx or exam

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21
Q

If a pt has heat intolerance, weight loss, palpitations, hyper defication, and anxiety – dx?

A

Hyperthyroidism

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22
Q

What will the labs look like with hyperthyroidism?

A

TSH – suppressed

T4 – elevated

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23
Q

What if free T4 is also elevated, along with T4, and TSH is suppressed – what should you do?

A

Pituitary adenoma – get an MRI

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24
Q

How do you treat a thyroid storm?

A

PTU or methimazole

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25
How do you treat an adenoma?
surgical resection
26
How do you treat someone who is preggo with hyperthyroidism?
PTU in 1st tri, methimazole in 2nd and 3rd
27
What’s the definitive treatment for hyperthyroidism?
Radioactive iodine * Methimazole can lead to leukopenia/agranulocytosis * PTU can cause hepatotoxicity
28
A pt presents with a fixed hard mass in the throat, cervical lymphadenopathy, and vocal cord paralysis -dx?
Thyroid cancer
29
How do you move forward with a thyroid nodule?
Always draw a TSH If normal, do an U/S
30
What If a pt has a thyroid nodule and the TSH is low, what do you do?
Do a radionucleotide iodine uptake scan Non-functioning (cold) à BIOPSY Hyper-functioning (warm) à serial ultrasounds
31
When should we always biopsy a thyroid nodule?
Solid nodule greater than 1 cm Cystic nodule greater than 2cm
32
What are the 2 types of adrenal insufficiency?
Cushing Syndrome Cushing Disease
33
What is Cushing syndrome?
Increased cortisol levels from any source
34
What is Cushing disease?
Increased cortisol levels from a pituitary adenoma
35
How does a pt present with Cushing?
Central obesity, proximal weakness, striae, moon face, buffalo hump, HTN, DM.
36
How can we diagnose cushing?
Need 2 positives showing elevated cortisol levels 24 hour urine free cortisol, low dose dexamethasone (1mg), or late night salivary test THEN measure ACTH (normal pituitary function = low ACTH)
37
So, when testing for Cushing what do you do when the ACTH comes back as low?
Low ACTH = ATCH independent à CT the adrenals | If it’s not the adrenals, then it’s exogenous use (prednisone)
38
So, when testing for Cushing what do you do when the ACTH comes back as high?
High ACTH = ACTH dependent à pituitary adenoma or tumor in lungs High dose dexamethasone (8mg) – if cortisol is suppressed = pituitary adenoma à get an MRI of pituitary If no suppression = tumor à get MRI or CT chest
39
In general, how do we treat Cushing?
Pituitary adenoma or adrenal tumors are treated with surgery
40
What are some of the risk factors to Type 2 diabetes?
Over the age of 45, BMI greater than 25, DM in a 1st degree relative, sedentary lifestyle, gestational DM, Hx of delivering a child 9lbs or heavier, dyslipidemia, PCOS
41
When do we screen for diabetes?
Aged 40-70 with BMI greater than 25, every 3 years
42
What would indicate diabetes?
Fasting glucose greater than 126 or One glucose greater than 200 or HA1c greater than 6.5 or Positive 2-hr oral glucose tolerance test
43
Give an example and time frame for a rapid acting insulin:
Rapid Acting – lispro, aspart, glulisine (onset 5-15 min; peak 1 hr; lasts 4 hours)
44
Give an example and time frame for a fast acting insulin:
Fast Acting – Regular (onset 30-60mins, peaks 2 hours, last 6 hours)
45
Give an example and time frame for a Intermediate acting insulin:
Intermediate – NPH – onset 2 hours, peak 6 hours, lasts 14 hours
46
Give an example and time frame for a Long-acting insulin:
Long-acting – glargine (onset 1-2 hours, no peak, lasts 24 hours)
47
Where do we start when someone is pre-diabetic or has a slightly positive A1c?
Weight loss, proper nutrition, and exercise
48
What is first line medication for diabetes?
Metformin
49
What can we add if Metformin is not enough?
Sulfonylureas
50
If oral’s aren’t working to control diabetes, then what?
Basal insulin, can add an rapid acting as well
51
If an A1c is greater than 9%, what do we do?
They must start insulin
52
What should a diabetic have done yearly?
Eye exam, urine for microalbumin, LDL (statin), BP less than 140/90 (ACE or ARB first line), ASA if 10 year risk is greater than 10% or greater than 30 years of age
53
What are some of the risk factors to hypercholesterolemia?
HTN, Smoking, DM, obesity, age over 45 (males; 65 for females), and Family Hx
54
How and when do we screen for hypercholesterolemia?
HDL, LDL, total cholesterol, and trigs High risk males over 25 and females over 35 Non-high risk males over 35 and females over 45
55
How do we treat hypercholesterolemia?
Diet, exercise, weight loss, and no tobacco products LDL is greater than 190 = high statin DM ages 40-75 with LDL between 70-180 = moderate statin CVD or DM w/ LDL between 70-189 and a 10year risk of atherosclerotic dz >7.5% = moderate to high statin
56
Why would we treat hypertriglyceridemia?
To reduce CV risk If levels are greater than 1,000 pts at risk of pancreatitis
57
What’s the difference between acromegaly and gigantism?
``` Acromegaly = adults Gigantism = kids (before fusion of growth plates) ```
58
How do we diagnose acromegaly and gigantism?
Increased Insulin-growth factor If high, draw growth hormone after giving oral glucose load Normally, glucose should completely suppress growth hormone, If HIGH = + test à get an MRI
59
A pt with low urine osmolality and high serum osmolality – what should you think of?
Diabetes insipidus
60
What is occurring in diabetes insipidus?
ADH is not made or does not work

FM MED II GENERAL (6 decks)

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