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NPLEX II TIA > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

in what scenario(s) is DHEA tested?

A

hirsutism
adreal function

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2
Q

what is the dexamethasone suppression test?

A

dx for cushings

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3
Q

in what scenario(s) is estradiol tested?

A

amenorrhea

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4
Q

in what scenario(s) is estriol tested?

A

monitor fetal wellbeing

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5
Q

in what scenario(s) is FSH/LH tested?

A

disorders of puberty, subfertility, and pituitary etiologies

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6
Q

gastrin is elevated in what condition(s)

A

zollinger ellison syndrome
pernicious anemia
pyloric stenosis
atrophic gastritis
chronic renal failure

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7
Q

workup for pheochromocytoma

A

24 hour urine catecholamine test with or without VMA (breakdown of catecholamines) testing

inc plasma catecholamines NOT suppressed by clonidine

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8
Q

mechanisms of hormone action:

A

second messengers: insulin, NTs

nuclear reactors: steroids, thyroid, sex hormones, retinoids, vit D

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9
Q

if serum prolactin is high, what are next dx steps?

A

brain MRI

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10
Q

high prolactin but normal brain MRI at this point; what could be causing the exacerbation of the prolactinoma?

A

estrogen dominance
subclinical hypothyroidism

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11
Q

DI presentation

A

ADH def from post pit
inc thirst (wakes at night), urination
water deprivation does NOT cause ADH release; urinate regardless of water intake
kidneys cant concentrate urine

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12
Q

thyroid hormone precursor

A

tyrosine + iodine

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13
Q

herb for hyperthyroid

A

lycopus
melissa

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14
Q

main concern in graves

A

cardio complications; why BB are also in early graves tx with other meds

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15
Q

what medication can often cause hypothyroidism?

A

lithium; screen pts every 6 mo

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16
Q

if you had a pt presenting with what seemed to be a straightforward graves case, but thyroid labs were normal; what ddx would be your next consideration?

A

pheochromocytoma

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17
Q

dequervains subacute granulomatous thyroiditis

A

self limited (8-10 weeks) painful inflammation of thyroid

AI, viral
W>M, 10-40

hyperthyroid > hypothyroid > euthyroid

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18
Q

reidel’s thyroiditis

A

rock hard/woody thyroid
mimics carcinoma
older women
fibrotic thyroid proliferation (may cause hypothyroidism/dyspnea)

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19
Q

causes of goiter

A

simple: iodine def, too many goitrogens (ca/fluorine in water, bassicae, polluted water)

multinodular: cancer, adenomatous dz

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20
Q

workup goiter

A

US and thyroid labs

watch palpation pressure; in secretory/hot nodule can induce thyroid storm with pressing too hard

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21
Q

thyroid adenomas

A

extremely common
most are benign
pressure sx in throat
post meno women

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22
Q

CS AEs

A

adrenal suppression if dose exceeds adrenal output (TAPER)
avascular necrosis of hip from fat emboli
cushings

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23
Q

hydrocortisone:prenisone ratio

A

4:1

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24
Q

pheochromocytoma presentation

A

adrenal medulla tumor of chromaffin cells that secretes catecholamines

triad: palpitations, pounding HA, episodic sweating
HTN, arrythmias, hyperglycemia, hypermetabolism (very similar to graves presentation)

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25
neuroblastoma presentation
childhood (<5) tumor of adrenal medulla chromaffin cells occur sporadically, born with + usually will be present in utero large abdominal mass, can be fatal
26
addisons presentation
hypoadrenalism (AI, TB, fungal) **adrenal medulla unaffected** weakness, fatigue, wt loss, diarrhea/vomiting, hyperpigmentation from inc ACTH (mimics MSH) low Na, cl, cortisol high K
27
causes of cushings (hyperadrenalism)
**long term steroids** pituitary adenoma ectopic ACTH/neoplasm thyroid carcinoma adrenal cortex tumor
28
conn's syndrome presentation
solitary **aldosterone secreting adenoma in adrenal cortex > hyperaldosteronism** low plasma renin and K high Na and aldosterone tachycardic, hypertensive
29
thymic hyperplasia etiology
**myasthenia gravis** SLE, Graves, RA
30
digeorge syndrome
aplasia/hypoplasia of thymus and parathyroid lack of cell mediated immunity, hypoparathyroidism dev defects in heart and great vessels
31
zollinger ellison syndrome presentation
tumor in pancreas secretes **gastrin** > peptic **ulcers**, gastric hypersecretion, malabsorption, diarrhea 60% are malignant
32
alpha cells of pancrease secrete
glucagon (opp insulin)
33
beta cells of pancrease secrete
insulin
34
delta cells of pancrease secrete
somatostain
35
PP cells of pancrease secrete
pancreatic polypeptide
36
insulinoma presentation
beta islet cell tumor of pancreas > hypoglycemia (confusion, LOC, stupor), temp relieved by eating insulin will be high fasting and non fasting, inc c peptide need pancreas/abdominal imaging CT/US MEN1 syndrome
37
DM1
AI to beta islet cells > dec function insulin dependent wt loss, wasting, hypotension, hypothermia
38
HbA1c levels
5.7-6.5 prediabetic/impaired glucose metabolism >6.5 diabetes <7 DM management
39
5.7 HbA1c is about an avg blood glucose of
126
40
what do incretins do?
inc insulin secretion
41
what insulin is long acting?
glargine
42
what insulin is short acting?
lispro
43
DKA presentation
ONLY DM1 lack of insulin > acidosis > burns fat > bodywide dump of ketones lack of tx MI, CHF infxn or emotional disturbance (cortisol release) digestive complaints > acetone breath odor, low BP, high HR > **urinary ketone!!!**
44
DKA tx
test for ketones/sugar ER!! can not do anything outpatient, they will die.
45
reactive dysglycemia/hypoglycemia
excess insulin tx in T1DM, sulfonylurea, T2DM excessive insulin hypoglycemic 1-5 hours after eating
46
calcitonin production and functions
produced in parafollicular cells of thyroid lowers blood Ca (via kidney), preserves bone Ca in bone: inhibit resorption, inc Ca resorption by osteoclasts in kidney/cortex: inc ca/na/k excretion, dec mg excretion
47
PTH purpose
raise low blood calcium (dec ca excretion via vit D)
48
PTH vs calcitonin
calcitonin: blood ca DEC, bone ca INC (via kidney) PTH: blood ca INC, bone ca DEC (via kidney via vit D)
49
lysis (loss) of bone triggered by
thyroid function, gravity, bone stress, hypocalcemia > stim osteoclasts osteoclasts leave behind alk phos
50
blastic (building) of bone is triggered by
alk phos triggers osteoblasts
51
abnormal serum ca what are your next steps
ionized calcium > if abnormal: 24 hr urinary ca >> if abnormal work up parathyroid, vit d metabolites, consider lytic bone lesions
52
high PTH = x calcium
high
53
bisphosphonates MOA, uses, SEs
inhibit osteoclast activity (osteoporosis prev AND tx) -ronates (alendronate) orally/by injection SE: esophagitis, osteonecrosis of jaw
54
what SERM is used in osteoporosis prev/tx more commonly SEs
raloxifene SE: faux menopause
55
MEN I
kidnety stones, stomach ulcers, sx of hyperparathyroidism and insulinoma
56
MEN II
medullary thyroid cancer (secretes calcitonin), hyperparathyroidism, pheochromocytoma (pounidng Ha, palpitations, sweats, inc BP)
57
panhypopituitarism workup
triple bolus test (rapid IV infusion insulin, GnRH, TRH)
58
how to differentiate between central and nephrogenic DI?
exogenous ACH (desmopressin) in central, will inc water reabsorption in kidneys
59
tx nephrogenic DI
HCTZ
60
tx SiADH
furosemide
61
gigantism/acromegaly tx
bromocriptine
62
tx cushing
radiation
63
primary hyperthyroidism / graves tx
propylthiouracil BB for sx
64
hyperparathyroidism presentation
hypercalcemia > bones, stones, groans, psychiatric overtones
65
causes of acute adrenal insufficiency
abrupt steroid withdrawwl waterhouse friderichsen syndrome (septicemia from neisseria>hemorrhage), anticoags
66
addison disease tx
corticoid replacement therapy
67

NPLEX II TIA (21 decks)

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