Endocrine (Exam #4) Flashcards
(288 cards)
1
Q
Overweight is…
A
BMI of 25% to 29.9%
2
Q
Obese is…
A
BMI of 30+%
3
Q
What waist circumference in men is associated with increased cardiometabolic risk? In women?
A
- 40+ inches in men
- 35+ inches in women
4
Q
What condition involves chronic disease where increased body fat promotes adipose tissue dysfunction?
A
OBESITY
5
Q
What is a negative energy balance and what is it associated with?
A
Obesity
- Increasing activity and decreasing calories consumed
6
Q
What are the three “best diets” for obese patients?
A
- Mediterranean
- DASH
- Flexitarian
7
Q
Intermittent fasting has been shown to promote weight loss, improve lipids, reduce BP/BS/HbA1c independent of what?
A
Independent of exercise
8
Q
What is an important modifiable risk factor associated with obesity?
A
Physical activity
9
Q
Physical inactivity is linked to what?
A
Reduced life expectancy
10
Q
Who should be screened for obesity?
A
ALL adults
11
Q
What is the recommended treatment for obesity (BMI of 30+)?
A
Intensive, multicomponent behavioral intervention
12
Q
What are the 5 A’s of nutritional counseling? Which is the rate limiting step?
A
- Ask/address
- Advise
- Assess = RLS
- Assist
- Arrange
13
Q
For what group is diet and exercise to prevent weight gain an appropriate treatment?
A
Low risk
- BMI 25-29.9 WITHOUT CVD risks or other comorbidities
14
Q
For what two groups is intensive, multicomponent behavioral intervention, maybe drug therapy an appropriate treatment?
A
Moderate risk
- BMI 25-29.9 WITH 1+ CVD risks or other comorbidities
OR
- BMI 30-34.9
15
Q
For what two groups is intensive, multicomponent behavioral intervention +/- drug therapy/bariatric an appropriate treatment?
A
High risk
- BMI 35-40
Very High risk
- BMI 40+
16
Q
What is ALWAYS the first line treatment for obesity?
A
Comprehensive lifestyle changes
17
Q
Which obesity drug therapy is associated with “unpleasant” GI side effects?
A
Orlistat (Alli)
18
Q
Which obesity drug therapy may decrease absorption of fat-soluble vitamins?
A
Orlistat (Alli)
19
Q
Which obesity drug therapy is daily SQ injection; common choice in Type II DM?
A
Liraglutide (Victoza)
20
Q
Which obesity drug therapy is a selective Serotonin agonist?
A
Lorcaserin (Belviq)
21
Q
Which obesity drug therapy decreases appetite?
A
Lorcaserin (Belviq)
22
Q
Which two obesity drug therapies should NOT be used in patients with HTN, CA, hyperthyroidism?
A
- Phentermine/Topiramate (Qsymia)
- Phentermine
23
Q
Which obesity drug therapy is most widely prescribed?
A
Phentermine
24
Q
Which obesity drug therapy is only approved for short-term use because more AEs/potential for abuse?
A
Phentermine
25
When should bariatric surgery be considered as treatment for obesity (3)?
- BMI 40+
- BMI 35-39.9 + 1 comorbidity
- BMI 30-34.9 + uncontrolled Type II DM
26
How does weight loss occur with bariatric surgery (4)?
- Restriction
- Malabsorption
- Decreased appetite
- Improve metabolism
27
Proper bariatric care includes...
LIFELONG surveillance
28
What is the recommended exercise for adults (2)? What other component is recommended?
- 150-300 min/week of moderate intensity
- 75-150 min/week of vigorous intensity
PLUS muscle strengthening 2+ days/week
29
How does function of the anterior pituitary differ from the posterior pituitary?
BOTH secrete, but anterior pituitary also synthesizes hormones
30
What is the function of Luteinizing Hormone (LH) in females (2)? In males?
- Females = trigger ovulation and corpus luteum
| - Males = T by Leydig cells
31
What is the function of Follicle-Stimulating Hormone (FSH) in females? In males?
- Females = growth of ovarian follicles
| - Males = formation of secondary spermatocytes
32
What is the function of Prolactin in females? In males?
- Females = milk production
| - Males = with LH + T, increase reproductive function
33
What six hormones are synthesized and secreted from the anterior pituitary?
- ACTH
- TSH
- LH
- FSH
- GH
- Prolactin
34
What two hormones are secreted from the posterior pituitary?
- ADH
| - Oxytocin (OT)
35
Which hormone acts via positive feedback? How does this work?
Oxytocin (OT)
| - Increase uterine contractions, promote stretching of cervix and uterus in labor
36
What causes the release of ADH? What is the result?
Released with hypertonicity
| - Kidneys reabsorb water and salt → concentrates urine and reduces urine output
37
What is the primary hormone synthesized and secreted from the intermediate pituitary?
Melanocyte-Stimulating Hormone (MSH)
38
What is the most common symptom associated with Sellar Masses? What other symptom is often associated?
```
Bitemporal hemianopsia (visual impairments)
- Also, diplopia
```
39
Why are visual impairments common with Sellar Masses?
Compress optic chiasm
| - Due to suprasellar extension of adenoma
40
Are Pituitary Adenomas more commonly benign or malignant? What are the two subtypes?
Pituitary Adenomas = BENIGN
- Microadenoma (<1 cm)
- Macroadenoma (1+ cm)
41
What are the five cell types associated with Pituitary Adenomas, and what type of hormone does each secrete? With which cell type is hormone secretion NOT changed?
- Gonadotroph = LH and FSH (NO CHANGE IN SECRETION)
- Thyrotroph = high TSH
- Corticotroph = high ACTH
- Lactotroph = high prolactin
- Somatotroph = high GH
42
What are two of the most common causes of HIGH Prolactin?
- Tumor
| - Pregnancy
43
What is the most common type of pituitary tumor?
Prolactinoma
44
In what group do Prolactinomas present with amenorrhea, infertility; prolactin of 30+?
PREmenopausal women
45
In what group do Prolactinomas present with HA, impaired vision; 20+?
POSTmenopausal women
46
How can you differentiate sxs in a PREmenopausal vs POSTmenopausal woman with a Prolactinoma? How do labs differ for each?
PRE = sex related (amenorrhea, infertility)
- Prolactin is 30+
POST = non-sex related (HA, impaired vision
- Prolactin about 20+
47
In men, high prolactin causes a decrease in what hormone, and how does this present symptomatically?
High prolactin → Low T
| - Decreased libido, impotence, infertility
48
What is the treatment for Prolactinoma? What non-pharm treatment can be considered?
Cabergoline
| - Surgery = transsphenoidal resection
49
What is the most common etiology for HIGH GH?
Pituitary macroadenoma of somatotrophs
50
What condition involves in adults; onset in 30’s; excess IGF-1?
Acromegaly
51
In patients with Acromegaly, what three conditions are they at increased risk for?
- DM
- HTN
- CAD
52
What is the gold standard test to evaluate for Acromegaly? What other two tests can be used?
OGTT = gold standard
- Serum IGF-1
- MRI
53
What is the treatment for Acromegaly?
Transsphenoidal resection
54
What is the most common etiology for LOW GH?
Pituitary macroadenoma of somatotrophs
55
What condition involves decreased QOL, lean body mass, BMD; increased CV disease?
Low GH
56
What is the recommended treatment for LOW GH?
GH therapy if hx of GH deficiency as child
57
What hormone is LOW with Male Hypogonadism? What are the two subtypes, and what hormone can be tested to differentiate the two?
LOW T
- Primary (Hypergonadotrophic Hypogonadism): HIGH FSH, LH
- Secondary (Hypogonadotrophic Hypogonadism): LOW FSH, LH
58
What condition presents with ED, hot flashes, gynecomastia, infertility; low energy, low libido, low muscle mass, less body hair?
Male Hypogonadism
59
What treatment is recommended for Male Hypogonadism? When is this contraindicated?
T replacement via IM injections or transdermal
- Pellets SC every 3 months
CI IF PROSTATE CA
60
For treatment of Male Hypogonadism with T replacement, what is the one contraindication?
CI IF PROSTATE CA
61
What are two possible causes of Pan-Hypopituitarism, and which is more common?
- Radiation therapy = more common
| - Sheehan Syndrome (rare)
62
What condition involves postpartum pituitary necrosis, and what is it associated with? What is the initial symptom?
Sheehan Syndrome = possible etiology of Pan-Hypopituitarism
| - Initial sxs: lactation difficulties
63
What condition involves ALL 6 Anterior Pituitary hormones LOW?
Pan-Hypopituitarism
64
What condition involves extensive hormone replacement (Levothyroxine (TSH), Dexamethasone (ACTH), T in males vs. E in females, GH; calcium)?
Pan-Hypopituitarism
65
What hormones results in concentrated urine, reduced urine output?
ADH
66
How can you differentiate Central Diabetes Insipidus from SIADH?
- Central Diabetes Insipidus = LOW ADH
| - SIADH = HIGH ADH
67
What is the most common cause of Central Diabetes Insipidus?
Idiopathic
68
What condition involves dilute urine and polyuria?
Central Diabetes Insipidus
69
What condition involves LOW urine osmolality and HIGH serum osmolality?
Central Diabetes Insipidus
70
What condition involves concentrated urine and decreased UO? What other finding may be seen?
SIADH
| - Also, hyponatremia
71
What is the recommended treatment for SIADH?
Fluid restriction
72
What condition involves HIGH urine osmolality and LOW serum osmolality?
SIADH
73
What two groups of hormones are produced by the adrenal gland?
- Steroids (aldosterone, cortisol, androgens/DHEA)
| - Catecholamines (NE, Epi)
74
What are three results of high ADH?
- Increase BP
- Increase Na+ reabsorption
- Increased K+ excretion
75
What condition involves etiology of bilateral idiopathic adrenal hyperplasia vs. unilateral aldosterone-secreting tumor?
Primary Hyperaldosteronism (Conn’s Syndrome)
76
What are the two primary symptoms associated with Primary Hyperaldosteronism (Conn’s Syndrome)?
- HTN
| - Hypokalemia
77
What three lab findings will be seen with Primary Hyperaldosteronism (Conn’s Syndrome)?
- High Aldosterone
- Low Renin
- Hypokalemia
78
What is the recommended treatment for bilateral idiopathic Primary Hyperaldosteronism (Conn’s Syndrome)?
Spironolactone
79
What is the recommended treatment for unilateral tumor Primary Hyperaldosteronism (Conn’s Syndrome)?
Surgery
80
What are three results of high cortisol?
- Increase blood glucose
- Anti-inflammatory
- Lower Ca
81
What hormone is released in a circadian rhythm?
Cortisol
| - HIGHEST at 8 AM
82
What are the two subtypes of Cushing's Syndrome, and how can you differentiate the two based on labs? Which is more common?
ACTH-Dependent = HIGH ACTH
- More common
ACTH-Independent = LOW ACTH
83
What are two possible causes of ACTH-Dependent (high ACTH) Cushing's Syndrome?
- Cushing’s disease = pituitary hypersecretion of ACTH
| - Non-pituitary origin (SCLC)
84
What is the most common possible cause of ACTH-Independent Cushing's Syndrome?
Excessive synthetic steroids
85
What condition presents with amenorrhea, striae, hyperpigmentation, central obesity (moon face, buffalo hump), HTN?
Cushing's Syndrome
86
What is the gold standard test for evaluating Cushing's Syndrome? What other test might be used?
24-hour urine collection = gold standard
| - Low-Dose Dexamethasone Suppression Test
87
What can the Low-Dose Dexamethasone Suppression Test be used to determine? What is a positive test for Cushing's?
Cushing’s Syndrome vs. non-Cushing’s
- If cortisol 5+ mcg/dL = Cushing’s
- Normal is normal/low cortisol
88
What can the High-Dose Dexamethasone Suppression Test be used to determine?
Cushing’s Syndrome vs. Cushing’s Disease
89
For treatment of Cushing's Syndrome, what is recommenced if the etiology is...
- Synthetic steroids?
- Pituitary adenoma?
- Adrenal tumor?
- Adrenal hyperplasia/inoperable tumor/CA?
- Synthetic steroids: taper steroids
- Pituitary adenoma: surgery (transsphenoidal resection)
- Adrenal tumor: surgery (adrenalectomy)
- Adrenal hyperplasia/inoperable tumor/CA: medication = Ketoconazole vs. Mitotane
90
What is the recommended treatment for an adrenal hyperplasia/inoperable tumor/CA with Cushing's Syndrome?
Ketoconazole
91
What condition involves entire adrenal dysfunction = ALL HORMONES LOW (low aldosterone, low cortisol, low androgens)? What hormone level will be HIGH?
Primary Adrenocortical Insufficiency (Addison’s Disease)
| - HIGH ACTH
92
What is the most common cause of Primary Adrenocortical Insufficiency (Addison’s Disease)?
Autoimmune destruction of adrenal cortex
93
What three symptoms are often seen with Primary Adrenocortical Insufficiency (Addison’s Disease)?
- Hypotension
- Salt craving
- Hyperpigmentation
94
What condition involves hypotension, salt craving, hyperpigmentation?
Primary Adrenocortical Insufficiency (Addison’s Disease)
95
How can you differentiate Primary Adrenocortical Insufficiency from Secondary or Tertiary (2)?
- Primary = HIGH ACTH, LOW Aldosterone
| - Secondary/Tertiary = LOW ACTH, normal Aldosterone
96
What condition involves etiology of abrupt cessation of synthetic steroids?
Secondary Adrenocortical Insufficiency
97
How can you differentiate Secondary Adrenocortical Insufficiency from Tertiary? What two hormone levels are the same in these conditions?
- Secondary: high CRH
- Tertiary: LOW CRH (problem from the very top)
BOTH: LOW ACTH, normal Aldosterone
98
What two diagnostic tests can be used to evaluate Adrenocortical Insufficiency?
- Serum AM cortisol
| - ACTH stimulation test via Cosyntropin
99
For what diagnostic test is Cosyntropin used, and how can it be used to diagnose Primary Adrenocortical Insufficiency (Addison’s Disease)?
ACTH stimulation test (Cosyntropin = synthetic ACTH)
| - Tests ability of adrenal gland to respond to ACTH; cortisol does NOT increase = Addison’s
100
What are the three recommended treatments for Adrenocortical Insufficiency?
- Mineralocorticoid (Fludrocortisone)
- Short-acting steroids (Hydrocortisone) vs. long-lasting steroids (Dexamethasone or Prednisone)
- Oral DHEA in women
101
What condition involves a catecholamine-secreting tumors from adrenal medulla? Is this often benign or malignant?
Pheochromocytoma
| - Often BENIGN
102
What condition involves the classic triad of episodic HA, tachycardia, sweating?
Pheochromocytoma
103
What is the classic triad associated with Pheochromocytoma?
- Episodic HA
- Tachycardia
- Sweating
104
Besides the class triad, what other two symptoms/findings are suspicious for Pheochromocytoma?
- Refractory HTN
| - FH of Pheochromocytoma
105
What is the gold-standard test for Pheochromocytoma?
24-hour urine collection for catecholamines & metanephrines
106
Besides 24-hour urine, what other test can be used to evaluate for Pheochromocytoma? What is a positive finding?
Clonidine Suppression Test
| - If catecholamines still HIGH after Clonidine administration = Pheochromocytoma
107
What radiologic test can be used to evaluate for Pheochromocytoma?
CT without contrast
108
What is the recommended treatment for Pheochromocytoma (2)?
SURGERY
| - “Chemical sympathectomy” until surgery (alpha-blockers, beta-blockers)
109
What condition involves adrenal mass 1+ cm in diameter; high prevalence but often non-problematic?
Adrenal Incidentaloma
110
What two conditions should be ruled out with Adrenal Incidentaloma?
What if HTN is also present?
- Pheochromocytoma
- Cushing's Syndrome
HTN also, R/O Primary Hyperaldosteronism (Conn’s Syndrome)
111
What diagnostic test should NEVER be performed for Adrenal Incidentaloma if known CA elsewhere?
NO biopsy
112
What is the leading cause of ESRD?
DM
113
What type of DM is prone to other autoimmune disorders?
Type I DM
114
What type of DM involves o genetic predisposition → immunologic trigger?
Type I DM
115
What condition involves the 3 P’s (polyuria, polydipsia, polyphagia)?
Type I DM
116
Which type of DM is family history more associated with?
Type II DM
117
What condition involves peripheral insulin resistance → impaired glucose tolerance (IGT) → overt then beta cell failure = pancreatic “burn out”?
Type II DM
118
What type of DM is often asymptomatic?
Type II DM
119
What condition involves acanthosis nigricans?
Type II DM
120
What two non-endocrine conditions should be considered with Type II DM?
- Chronic skin infections
| - Vulvovaginitis
121
What is the recommended screening for DM (2)?
- ALL patients age 45+ years
OR
- Overweight/obese (BMI of 25+) WITH 1+ DM risk factors
122
What are the nine risk factors associated with DM?
- 1st-degree relative with DM
- High risk ethnicity (AA, Latino, NA, Asian, PI)
- CVD hx
- HTN
- Dyslipidemia
- PCOS/GDM hx
- Physical inactivity
- Severe obesity or acanthosis nigricans
- Medications (glucocorticoids, HIV meds, antipsychotics)
123
What is a normal fasting blood glucose level?
<100
124
What is a DM fasting blood glucose level?
126+
125
What is a normal OGTT level?
<140
126
What is a DM OGTT level?
200+
127
What is a normal HbA1c level?
<5.7%
128
What is a DM HbA1c level?
6.5+%
129
What are the two diagnostic criteria associated with DM?
- Classic sxs + random glucose of 200+
OR
- NO classic sxs + TWO abnormal tests (from same sample or two different tests)
130
Those with pre-DM are at increased risk for what two diseases?
- DM
| - CVD
131
What three conditions is pre-DM associated with?
- Obesity
- HTN
- Dyslipidemia
132
What medication can be used as DM prophylaxis?
Metformin
133
In those with pre-DM, how often should testing for DM be performed?
ANNUALLY
134
In what stage of DM can hyperglycemia be reversed?
Pre-DM ONLY
135
For macrovascular complications of DM, what are the two types?
- ASCVD
| - HF
136
What is an independent risk factor for ASCVD?
DM itself
137
For microvascular complications of DM, what are the four types?
- Diabetic Nephropathy
- Diabetic Retinopathy
- Diabetic Neuropathy (peripheral)
- Diabetic Neuropathy (autonomic)
138
What condition involves albuminuria +/- reduced GFR in absence of sxs or other primary causes of kidney dx?
Diabetic Nephropathy
139
What is the screening test utilized for Diabetic Nephropathy? When should this begin (2, I vs. II)?
UACR
- Type I after 5+ years
OR
- Type II at time of diagnosis
140
What is the screening test utilized for Diabetic Retinopathy? When should this begin (2, I vs. II)?
Dilated/comprehensive eye exam
- Type I after 5+ years
OR
- Type II at time of diagnosis
141
What is the recommended treatment for Diabetic Nephropathy?
ACE-I or ARBs
142
What is the leading cause of new blindness in DM?
Diabetic Retinopathy
143
What are the two subtypes of Diabetic Retinopathy, and what can be seen with each?
- Non-proliferative: hemorrhages, yellow lipid exudates, cotton wool spots
- Proliferative: neovascularization
144
After initial screening of Diabetic Retinopathy, what is the recommended follow up if NO evidence of retinopathy? What if ANY level of retinopathy present?
- NO evidence for 1+ annual eye exams = every 1-2 years
| - ANY level of retinopathy = annually or more frequent
145
What condition involves “stocking-glove” sensory loss (distal symmetric)?
Diabetic Neuropathy (peripheral)
146
What condition involves LOPS (loss of protective sensation) → diabetic foot ulcers?
Diabetic Neuropathy (peripheral)
147
What condition often involves hypoglycemia unawareness; gastroparesis?
Diabetic Neuropathy (autonomic)
148
What is a major cause of morbidity and mortality if DM?
Foot ulcers/Amputations
149
How often should a Comprehensive Foot Exam be performed in DM patients? When should this begin (2, I vs. II)?
At least annually
- Type I after 5+ years
OR
- Type II at time of diagnosis
150
When evaluating neuro during Comprehensive Foot Exam in DM patients, what two components must be performed?
- Monofilament testing
| - Pinprick/temp./vibratory/ankle reflexes
151
What diagnostic test can be used to evaluate vascular function during the Comprehensive Foot Exam in a DM patient?
ABI
152
What are three examples of RAPID-acting insulin?
- Insulin glulisine
- Insulin lispro
- Insulin aspart
153
Insulin glulisine, Insulin lispro, Insulin aspart are examples of what type of insulin?
RAPID-acting insulin
154
If dyslipidemia + DM + ASCVD present, what is the recommended treatment? If only 40+ with DM, what is the recommended treatment
- HIGH-intensity statin if DM + ASCVD
| - MODERATE-intensity statin if 40+ with DM
155
What are three examples of SHORT-acting insulin?
Insulin regular
- Humulin R
- Novolin R
156
What are three examples of INTERMEDIATE-acting insulin?
Insulin NPH
- Humulin N
- Novolin N
157
Insulin regular (Humulin R and Novolin R) are examples of what type of insulin?
SHORT-acting insulin
158
Insulin NPH (Humulin N and Novolin N) are examples of what type of insulin?
INTERMEDIATE-acting insulin
159
Insulin glargine, Insulin determir, Insulin degludec are examples of what type of insulin?
LONG-acting insulin
160
What are three examples of LONG-acting insulin?
- Insulin glargine
- Insulin determir
- Insulin degludec
161
What type of insulin is considered “mealtime” or “correction”?
RAPID-acting insulin
162
What type of insulin is considered “background”?
LONG-acting insulin
163
What type of Insulin is used in insulin pumps?
RAPID-acting insulin
164
What type of insulin is good for patients stable on insulin with relatively same diet?
Insulin Premixed
165
What is the risk associated with Insulin Premixed?
HYPOGLYCEMIA
166
What two types of Insulin are basal?
- INTERMEDIATE-acting insulin
| - LONG-acting insulin
167
What two types of Insulin are bolus?
- SHORT-acting insulin
| - RAPID-acting insulin
168
When treating with insulin, what two types of insulin are recommended to start with?
How do you decide dose (2)?
Begin with basal insulin (INTERMEDIATE or LONG) at night
1. Calculate TDD based on weight
OR
2. Start with 10 units then titrate
169
½ of TDD should always be what?
BASAL insulin
170
When treating with insulin, if fasting glucose normal but A1c HIGH, what should be considered (2)?
- Need to add mealtime/bolus insulin OR
| - Overbasalization (need to add mealtime/bolus insulin)
171
If overbasalization present, what should NOT be done?
Do NOT increase basal dosing
172
What are the two treatments for hypoglycemia?
- Glucose (oral vs. IV)
| - Glucagon
173
What is the first line treatment for Type II DM?
Metformin
174
What DM drug class involves the “-glitazone” name hint?
Thiazolidinediones (TZDs)
175
What DM drug class involves the “-gliptin” name hint?
DDP-4 Inhibitors
176
What DM drug class involves the “-tide” name hint?
GLP-1 Agonists
177
What DM drug class involves the “-gliflozin” name hint?
SGLT-2 Inhibitors
178
What is the name hint for Thiazolidinediones (TZDs)?
“-glitazone”
179
What is the name hint for DDP-4 Inhibitors?
“-gliptin”
180
What is the name hint for GLP-1 Agonists?
“-tide”
181
What is the name hint for SGLT-2 Inhibitors?
“-gliflozin”
182
What DM medication involves AEs of GI side effects; deplete Vitamin B12 levels?
Metformin
183
What DM medication involves AEs of HOLD pre-surgery or with contrast dye for CT
Metformin
184
What DM medication involves CIs of CKD, liver disease, HF?
Metformin
185
What DM medication involves CI of lactic acidosis?
Metformin
186
What DM medication involves CIs of CHF; active bladder CA
Thiazolidinediones (TZDs)
187
What DM medication involves MOA of insulin and glucagon back to physiologic levels?
DDP-4 Inhibitors
188
Which DDP-4 Inhibitor can be used in patients with DM and renal disease?
Linagliptin
189
Which class of DM medications has been known to reduce MACE?
GLP-1 Agonists
190
Which class of DM medications has been known to induce weight loss?
SGLT-2 Inhibitors
191
What DM medication involves CI of thyroid CA risk (MTC, or FH of MTC)?
GLP-1 Agonists
192
What DM medication involves CI of hypoglycemia?
Sulfonylureas (SUs)
193
What DM medication involves CI if GFR <30; DKA risk?
SGLT-2 Inhibitors
194
What DM medication involves LE amputation risk?
SGLT-2 Inhibitors
195
Which SGLT-2 Inhibitor is associated with LE amputation risk?
Canagliflozin
196
What involves morning hyperglycemia due to undetected nocturnal hypoglycemia?
Somogyi Effect
197
What involves morning hyperglycemia due to elevated AM hormone levels?
Dawn Phenomenon
198
What is Somogyi Effect?
Morning hyperglycemia due to undetected nocturnal hypoglycemia
199
What three components are seen with DKA?
- Hyperglycemia
- Ketonemia
- Acidemia
200
What condition is precipitated by the 4 S’s and what are they?
DKA
- Sepsis (infection)
- Skipping insulin dose
- Sickness
- Stress (surgery)
201
What condition presents with Kussmaul respirations (rapid breathing)?
DKA
202
What test is used to diagnose DKA? What other two lab findings should be seen?
ABG diagnoses DKA
- Hyperglycemia (250+)
- High ketones
203
What is the recommended treatment for DKA (2)?
Hospitalize and...
- SLOWLY restore volume deficits
- IV insulin
204
What condition is more common in older Type II DM patients?
Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)
205
What often precipitates Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS) (2)?
- Illness
| - Infection
206
What condition presents with profound hyperglycemia (600+); NO acidosis, NO/low ketones?
Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)
207
What two symptoms present with Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS)?
- Dehydration
| - AMS
208
What is the recommended treatment for Non-Ketonic Hyperglycemic Hyperosmolar Syndrome (NKHS/HHS) (2)?
Hospitalize and...
- SLOWLY restore volume deficits
- IV insulin
209
What is the best initial test of thyroid function? What is the follow up test if abnormal?
TSH then Free T4
210
What is the functional study to evaluate low TSH (Hyperthyroidism)?
RAIU (Radioactive Iodine Uptake)
211
What is the most common etiology of Hypothyroidism?
Hashimoto’s Thyroiditis
212
What condition involves weight gain, fatigue, constipation, cold intolerance, dry skin, hair loss/brittle nails?
Hypothyroidism
213
What condition involves slow movement/speech, dry/coarse skin, thinned hair, edema?
Hypothyroidism
214
What condition involves bradycardia, weight gain, weakness, delayed DTRs?
Hypothyroidism
215
What condition involves high TSH, low T4/T3?
Primary Hypothyroidism (Hashimoto’s Thyroiditis)
216
What condition involves high TSH, normal T4/T3?
Subclinical Hypothyroidism
217
What condition involves normal or low TSH and T4/T3?
Central Hypothyroidism
218
What is the recommended treatment for Hypothyroidism?
Levothyroxine (synthetic T4)
219
What four things should be considered with use of Levothyroxine (synthetic T4)?
- Weight-based
- If older or cardiac concerns, lower initial dose
- Take on empty stomach 1-hour pre-breakfast
- Caution with other meds
220
What condition involves +TPO Ab and +TgAb?
Hashimoto’s Thyroiditis
221
If Subclinical Hypothyroidism is suspected, what is the recommended follow up testing?
Repeat TSH and T4 after 1-3 months
222
What is the severe form of hypothyroidism = life-threatening?
Myxedema Coma
223
What condition presents with TOXIC; HIGH TSH, LOW T4/T3?
Myxedema Coma
| - Severe Hypothyroidism
224
What is the treatment for Myxedema Coma?
IV T4 +/- T3
225
What are three etiologies of Hyperthyroidism?
- Graves’ Disease
- Toxic Adenoma
- Toxic Multinodular Goiter (MNG
226
What condition presents with weight loss with high appetite, heat intolerance, diaphoresis, tremor, tachycardia/palpitations, anxiety, hyperdefecation?
Hyperthyroidism
227
What condition presents with hyperactivity, rapid speech, warm/moist skin, stare and lid lag, exophthalmos, proptosis?
Hyperthyroidism
228
What condition presents with hyperactive BS, tachycardia, muscle wasting, tremors, hyperreflexia?
Hyperthyroidism
229
What condition involves low TSH, high T4/T3?
Graves’ Disease
230
What condition involves low TSH, normal T4/T3?
Subclinical Hyperthyroidism
231
What condition involves low TSH, high T3, normal T4?
T3 Toxicosis (early Graves’)
232
Diffuse elevated uptake on RAIU indicates?
Graves’ Disease
233
Diffuse decreased/absent uptake on RAIU indicates?
Thyroiditis/exogenous hormone
234
Focal irregular uptake on RAIU indicates (2)?
Toxic Adenoma vs. MNG
235
If focal elevated uptake on RAIU, what does this indicate?
Hyperfunctioning “hot” nodules = likely benign
236
If focal decreased uptake on RAIU, what does this indicate?
Hypofunctioning “cold” nodules = likely malignant
237
What is the first line treatment for Hyperthyroidism (2)?
- BB (sxs control)
| - Thionamides (Methimazole or PTU if pregnant)
238
What is the first line DEFINITIVE treatment for Hyperthyroidism?
Radioiodine ablation (I-131)
239
What is the MOST common cause of Hyperthyroidism?
Graves’ Disease
240
When should a thyroidectomy be considered for Hyperthyroidism?
Obstructive sxs present
241
What condition involves +TRAb?
Graves’ Disease
242
How can you differentiate Toxic Adenoma from Toxic MNG?
- Toxic Adenoma = focal hyperplasia of follicular cells
| - Toxic MNG = thyroid nodules
243
What condition is a severe form of thyrotoxicosis = life-threatening?
Thyroid Storm
244
What condition presents with TOXIC; LOW TSH, HIGH T4/T3?
Thyroid Storm
245
What is the treatment for Thyroid Storm (2)?
ICU admission
- BB
- Thionamide (Methimazole or PTU
246
What condition involves painful OR painless thyroid inflammation → dysfunction?
Thyroiditis (subacute)
247
With Thyroiditis (subacute), what is the progression seen (4 steps)?
1. Hyperthyroid
2. Euthyroid
3. Hypothyroid
4. Euthyroid
248
What is the diagnosis and treatment of Thyroiditis (subacute)?
- Dx: clinical
| - Tx: ASA/NSAIDs for pain, monitor TSH
249
What two questions should be asked when working up Thyroid Nodules?
- Cancer?
| - Causing dysfunction?
250
What are the two primary tests used to evaluate Thyroid Nodules?
- TSH
| - Thyroid US
251
What five findings are indicative of a MALIGNANT Thyroid Nodule?
- Hypoechoic (darker)
- Larger (1+ cm)
- Taller (more than wide)
- Irregular
- Extrathyroid extension + associated cervical nodes
252
What three findings are indicative of a BENIGN Thyroid Nodule?
- Colloid
- Cystic
- Smaller (<1 cm)
253
If a MALIGNANT Thyroid Nodule is suspected, what is the next test?
FNA
254
What is the most common type of Thyroid CA?
Papillary
255
What is the most aggressive type of Thyroid CA? What population is this most often seen?
Anaplastic
| - Elderly
256
What is the definitive test for Thyroid CA?
Fine-Needle Aspiration (FNA) biopsy
257
What is the treatment for Thyroid CA? What two other treatments may be included, as well?
Thyroid lobectomy OR Total thyroidectomy
- Iodine ablation
- T4 hormone replacement (to avoid hypothyroidism)
258
High PTH means what for calcium?
HIGH calcium
259
Low PTH means what for calcium?
LOW calcium
260
What is the most common etiology of Hypoparathyroidism?
Acquired via post-thyroidectomy
261
What condition presents with irritability, depression; prolonged QT interval?
Hypoparathyroidism
262
What condition presents with +Chvostek sign; +Trousseau sign?
Hypoparathyroidism
263
What condition presents with LOW PTH, LOW calcium, HIGH phosphate?
Hypoparathyroidism
264
For treatment of Hypoparathyroidism, what is recommended if mild case (2)? Severe case?
- Mild: Vitamin D (Calcitriol) + oral calcium carbonate
| - Severe: IV calcium gluconate
265
If hyperphosphatemia is present with Hypoparathyroidism, what is the recommended treatment?
Phosphate binders
266
What is the etiology of Primary Hyperparathyroidism?
Parathyroid adenoma
267
What is the etiology of Secondary Hyperparathyroidism (2)?
CKD or Vitamin D deficiency
| - High calcium or high phosphate → high PTH
268
What condition involves “bones, moans, stones, groans”?
Hyperparathyroidism
269
What condition involves fragile bones/bone pain, kidney stones, abdominal pain, psychosis, depression, delirium?
Hyperparathyroidism
270
What condition involves HIGH PTH, HIGH calcium, LOW phosphate?
Primary Hyperparathyroidism
271
What condition involves HIGH PTH, LOW calcium, HIGH phosphate?
Secondary Hyperparathyroidism
272
What is the definitive treatment for Hyperparathyroidism? What other two treatments can be considered?
Parathyroidectomy
| - Also restrict Ca intake and bisphosphates
273
What radiographic imaging should be obtained for Primary Hyperparathyroidism?
DEXA Scan
274
What thyroid test monitors for thyroid CA recurrence?
Thyroglobulin (TG)
275
What is responsible for iodine oxidation in thyroid hormone synthesis?
TPO Ab
276
What activates TSH receptor → thyroid synthesis/secretion and thyroid gland growth = goiter?
TSI
277
What does a Sestimibi Scan test for, and what is a + finding?
Primary Hyperparathyroidism
- + if localization
- Can support diagnosis and help with preoperative mapping
278
When evaluating adrenal gland, a 24-hour UFC can provide false + in these four patient groups, and should therefore be avoided...
- DM
- Obesity
- Depression
- Alcoholism
279
What is a + finding on Dexamethasone Suppression Test?
High OR normal serum cortisol/ACTH
| - Normal is low cortisol/ACTH
280
What is a + finding on Clonidine Suppression Test?
Elevation of normetanephrine after 3 hours AND <40% decrease from baseline
281
In DM patients, what lab should be checked at EVERY visit?
HbA1c
282
If a patient has DM + ASCVD, what three medications should be considered?
- Metformin
- SGLT-2 Inhibitors
- GLP-1 Agonists
283
If a patient has DM + CHF, what medication should be considered?
SGLT-2 Inhibitors
284
If a patient has DM + CKD, what two medications should be considered?
- SGLT-2 Inhibitors
| - GLP-1 Agonists
285
In what two DM populations should Metformin be avoided?
- CHF
| - CKD
286
If HbA1c 10+%, what medication can be added for Type II DM (type and dose)?
Insulin (basal)
| - 10 units at bedtime
287
What are four IMMEDIATE benefits of exercise?
IMMEDIATE:
- Decrease anxiety/BP
- Improve sleep
- Improve cognitive function/brain health
- Improve insulin sensitivity
288
What are four LONG-TERM benefits of exercise?
LONG-TERM:
- Cardiorespiratory fitness
- Muscle strength
- Decreased depression
- Sustained reduction in BP
