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STEP 3 > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

Diagnosis of diabetes is made by?

A

One of the following:

  1. Two fasting glucose ≥ 126
  2. One random glucose ≥ 200 with symptoms(polyuria, polydipsia, polyphagia)
  3. Abnormal glucose tolerance test
  4. HgA1c > 6.5%
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2
Q

Best initial treatment for Type 2 diabetes?

A

diet, exercise, weight loss

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3
Q

Best initial medical therapy for type 2 diabetes?

A

metformin (blocks gluconeogenesis)

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4
Q

When is metformin contraindicated?

A

Renal insufficiency

Use of contrast agents

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5
Q

Mechanism of action of sulfonylureas?

A

Increase release of insulin from pancreas

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6
Q

Mechanism of action of thiazolidinediones?

A

Increases peripheral insulin sensitivity

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7
Q

Mechanism of action of alpha-glucosidase inhibitors?

A

block absorption of glucose at the intestinal lining

side effect- diarrhea. abdominal pain, bloating

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8
Q

Mechanism of action of insulin secretagogues?

A

increase release of insulin

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9
Q

What are the long acting insulin agents?

A

Glargine(lantus)
Detemir
NPH

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10
Q

What are the short acting insulin agents?

A

Aspart
Lispro
Glulisine

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11
Q

Best initial test for DKA?

A

Serum bicarb(tells severity)- low bicarb=severe DKA

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12
Q

What to you need to supplement when treating for DKA?

A

K, when giving insulin, the initial high potassium will go into cells and cause hypoK. Need to replace this

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13
Q

What is the initial treatment for DKA?

A

Labs (chemistry, ABG, Acetone)
Fluids (bolus NS)
IV insulin

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14
Q

What is the goal of BP in a diabetic patient?

A

< 130/80

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15
Q

What is the goal of LDL in a diabetic patient?

A

<100

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16
Q

What test should be ordered with regards to the eye with diabetics?

A

Dilated eye exam every year to detect proliferative retinopathy

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17
Q

What needs to be ordered in long standing diabetics with regards to their kidney function?

A

Urine microalbumin, if any albumin is in the urine is present give ACEi

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18
Q

If neuropathy is present in a diabetic what treatment should they be on?

A

gabapentin

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19
Q

How do you treat gastroparesis in a diabetic?

A

metoclopromide or erythromycin

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20
Q

Best initial test for hypothyroid?

A

T4- decreased

TSH- increased (feedback mechanism)

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21
Q

Treatment for Graves disease?

A

PTU (propylthiouracil) or methimazole for acute control
Radioactive iodine
Propranalol for symptomatic treatment

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22
Q

What are the diagnostic findings for subacute thyroiditis?

A

low RAIU
high T4
low TSH
- treat with aspirin

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23
Q

Treatment for thyroid storm?

A

Iodine- blocks uptake of iodine into thyroid
PTU or methimazole- blocks production of thyroxine
dexamethasone- blocks conversion of T4 to T3
propranolol- treats symptoms

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24
Q

What to do for solitary thyroid nodule?

A

FNA

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25
Causes of hypercalcemia?
``` Primary hyperparathyroid(most common) malignancy granulomatous disease Vit D intoxication Thiazide diuretics TB ```
26
How does acute sever hypercalcemia present?
confusion, constipation, polyuria, polydipsia, short QT, renal insufficiency
27
Treatment for acute severe hypercalcemia?
IV fluids- a shit load- 3-4 L bisphosphanates-inhibits osteoclasts furosemide- loops lose calcium- only after hydration calcitonin- if hydration and furosemide dont work
28
Causes of HYPOcalcemia?
``` surgical removal hypomag (Mg needed for release of PTH) Vit D deficiency hyperphosphatemia(P binds to calcium) fat malabsorption ```
29
Diagnostic findings for HYPOcalcemia?
``` seizures neural twitching(Chvosteks, Trousseau's) arrythmia- prolonged QT ```
30
Treatment for HYPOcalcemia?
Replace calcium | If vitamin D deficient- give Vit D and calcium
31
In a pituitary tumor... | What is the level of the ACTH?
High
32
In a pituitary tumor... | What happens when high dose dexamethasone is given?
supression of ACTH
33
In a pituitary tumor... | What specific test needs to be ordered?
MRI | Petrossal vein sampling
34
In a pituitary tumor... | What is the treatment?
removal of tumor
35
With ectopic ACTH production.... | What is the level of the ACTH?
high
36
With ectopic ACTH production.... | What happens when high dose dexamethasone is given?
no supression
37
With ectopic ACTH production.... | What specific test needs to be ordered?
scan chest and abdomen
38
With ectopic ACTH production.... | What is the treatment?
removal of site of ectopic production
39
In an adrenal adenoma.... | What is the level of ACTH?
low
40
In an adrenal adenoma.... | What happens when high dose dexamethasone is given?
no supression
41
In an adrenal adenoma.... | What specific test needs to be ordered?
scan adrenal glands
42
In an adrenal adenoma.... | What is the treatment?
removal
43
Best initial test for Cushing's syndrome?
1 mg overnight dexamethasone supression test - normal person will suppress the morning level of cortisol if given dexamethasone at 11pm the night before 24-hour urine cortisol (BEST INITIAL TEST) - get this if overnight supression test is positive - more accurate than overnight test
44
Where is the origin if ACTH levels are low in Cushing's disease?
adrenal gland, scan gland, and remove
45
Where is the origin if ACTH levels are high in Cushing's disease?
pituitary gland or ectopic production of ACTH
46
What is the most accurate diagnostic tests for Adrenal insufficiency (Addison's Disease)?
Cosyntropin (synthetic ACTH) stimulation test - measure level of cortisol before and after administration of cosyntropin, if there is adrenal insufficiency, there will be no rise in cortisol CT scan of adrenals
47
What is the treatment for Addison's disease?
steroid replacement- acute episodes prednisone- for stable patients fludricortisone- use if patient still hypotensive after replacement of prednisone
48
How does hyperaldosteronism present?
HTN, hypokalemia, metabolic alkalosis | aldosterone reabsorbs Na, excretes K, increases water reabsorption
49
What are the diagnostic findings with hyperaldosteronism?
Low renin HTN Elevated aldosterone
50
What is the treatment of hyperaldosteronism
Solitary adenoma- surgical resection | Hyperplastic adrenals- spirinolactone
51
Best initial test for pheochromocytoma?
high plasma and urinary catecholamine levels | plasma free metanephrine and VMA levels
52
Most accurate test for pheochromocytoma?
CT or MRI adrenals
53
Treatment for Pheochromocytoma?
phenoxybenzamine (1st to control BP) Propranalol after alpha blockade Surgical resection
54
What are the characteristics of Congenital Adrenal Hyperplasia?
Elevated ACTH | Low aldosterone and cortisol
55
What are the different forms of CAH?
- 21-OH deficiency(most common)- associated HYPOtension; diagnose with increased 17 hydroxyprogesterone - 11 hydroxylase deficiency- associated HYPERtension - 17 hydroxylase deficiency- low adrenal androgen levels
56
How does prolactinoma present?
Men- impotence, decreased libido, gynecomastia, headache, visual disturbance Women- amenorrhea, galactorrhea (in absence of pregnancy)
57
What is the diagnostic test for prolactinoma?
MRI brain
58
Best initial treatment for prolactinoma?
``` dopamine agonist (bromocriptine, cabergoline) - surgery (removal) for those who's medical therapy does not work ```
59
Best initial test for acromegaly?
IGF level (confirmatory)
60
Most accurate test for acromegaly?
supression of GH by giving glucose will EXCLUDE acromegaly
61
Treatment for acromegaly?
resection (cures 70%) - octreotide - cabergoline
62
What are the causes of primary amenorrhea?
``` Turner's (XO karyotype) Testicular feminization (genetically male, acts like female) ```
63
What are the causes of secondary amenorrhea?
Pregnancy, exercise, weight loss, hyperprolactimemia, PCOS
64
What are the characteristics of Klinefelter's syndrome?
- Tall men, insensitivity to FSH and LH on their testicles - XXY karyotype - FSH, LH levels high, but no testosterone produced
65
What is the treatment for Klinefelter's?
testosterone
66
What are the characteristics of Kallman's syndrome?
Anosmia(can't smell) with hypogonadism | - low GnRH, FSH, LH

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