Endocrine

Question 1

What would you see on a retina in a patient with diabetes

Answer 1

dot-blot hemorrhages (microaneurysms)

flame hemorrhages

cotton- wool spots

neovascularization

Question 2

What is the MoA for metformin?

Answer 2

Metformin stops gluconeogenesis in the liver

Question 3

What is the MoA for sulfonureas

Answer 3

They bind to the K+ channels on the beta cells of the pancreas and cause the increase release of endogenous insulin

Question 4

What is the use of short acting insulin?

Answer 4

Lispro, Aspartate, and Glulisine are used to control postprandial blood glucose spikes.

Question 5

What are the S/S of DKA?

Answer 5

DKA presents with Nausea, Vomiting, fatigue, polyuria

Question 6

What class of drug has the same MoA as the sulfylureas but can be used if someone is allergic to sulfa drugs?

Answer 6

Meglitinides can be used as a substitute for sulfonylureas.

They close the K+ channel on the beta cells of the pancreas and increase endogenous insluin release

Question 7

How do GLP-1 agonists work to decrease blood sugar?

Answer 7

GLP-1 agonists (“-tide”) work to increase the endogenous insulin release and satiety, decrease gastric emptying. and decreased glucagon release

Question 8

How do the gliptins reduce blood sugar?

Answer 8

the gliptins prevent the breakdown of GLP-1, which promotes insulin release, satiety, decreases gastric emptying, and the release of gastrin.

Question 9

What diabetes medication can cause pancreatitis?

Answer 9

GLP-1 agonists (“-tide”) can cause pancreatitis

Question 10

What is the MoA of thiazolidinedones

Answer 10

thiazolidinediones are ligands of the PPAR1 receptor that regulates gene replicaiton within a cell. Thiazolidinediones upregulate adiponectin which increases fatty acid oxidation…

THEY DECREASE TRIGLYCERIDES IN THE BLOOD

Question 11

How does pheochromocytoma generally present?

Answer 11

pheochromocytoma generally presents with episodic

Headache

tachycardia

hypertension

due to the release of nor-epinepherines

Question 12

What is the treatment for pheochromocytomas?

Answer 12

treat pheochromocytomas with phenoxybenzamine

then a beta blocker

*phenoxybenzamine is a non-selective alpha-blocker

**If you treat with a beta-blocker alone you will exacerbate the hypertension

Question 13

What is the presentation for a neurofibroma?

Answer 13

Neurofibromas generally present with

Abdominal Pain

Abdominal mass

Fever

Weight loss

opsoclonus-monoclonus (disorganized eye movements)

ataxia

Question 14

A hard painless goiter is a classic finding of what?

Answer 14

A hard and painless goiter is a classic finding in

Reiter’s Thyroiditis

*Reiter’s Thyroiditis is an autoimmune disorder affecting the thyroid. Its associated with other systemic fibrosing disorders including IgG4-related systemic disease

Question 15

an acutely tender goiter is associated with what?

Answer 15

subacute granulomatous thyroiditis

Question 16

What are the medical treatment of choices for prolactinoma?

Answer 16

Microadenomas of the pituitary gland (usually found in women) are treated with dopamine agonists

bromocriptine

cabergoline (better tolerated but more expensive)

Question 17

Lupus Criteria

Answer 17

DOPAMINE RASH

1. Discord Lupus
2. Oral Ulcers
3. Photosensitivity
4. Arthritis
5. Malar Rash
6. Immunologic (Anti-smith ab)
7. Neurologic symptoms
8. Elevated ESR (not a criteria)
9. Renal disease
10. ANA +
11. Serositus (pleurisy)
12. hemolytic disease

Question 18

What are the classic lab values of an adrenal crisis?

Answer 18

Lab values suggestive of an adrenal crisis:

1. Hyponatreimia d/t a decrease in aldosterone
2. hyperkalemia also d/t a decrease in aldosterone
3. hypoglycemia
4. low cortisol (an am cortisol < 3 is indicitive of adrenal insufficiency

*remember that a patient experiencing an adrenal crisis may initially present with vague symptoms of adrenal insufficiency like fatigue and weakness. There will be an inciting event (like an illness, surgery, trauma) and the patient will develop intractible abdominal pain, vomiting, fever, etc.

Question 19

What are the classic findings in Conn’s Syndrome?

Answer 19

Conn’s syndrome is characterized by:

HTN

muscle weakness

hypokalemia

Conn’s syndrome is a result of an aldosterone producing tumor. Diagnose Conn syndrome with an Aldosterone: renin ratio >20