Endocrinology Flashcards
(74 cards)
1
Q
autoantibody for type 1 DM?
A
glutamic acid decarboxylase (GAD65)
2
Q
5 clinical presentations of DM?
A
- polyuria, polydipsia, polyphagia
- unexplained weight loss
- dec wound healing
- infections (skin, vulva, urinary tract)
- blurred vision
3
Q
what is the pathologic characteristic of DM type 1?
A
insulitis
4
Q
what is the underlying pathophysio of type 2 DM?
A
insulin resistance
5
Q
will anti-GAD antibody positive or neg in type 2 DM?
A
negative
6
Q
pathologic findings of type 2 DM?
A
fibrosis and hyalinzation (no insulitis)
7
Q
3 autoimmune endocrine dz associated with Down?
A
- hypothyroidism
- T1DM
- Addison’s dz
8
Q
what is the diagnosis test for gestational DM?
A
OGTT (oral glucose tolerance test), 2hr > 153 mg/dl
9
Q
what is another name for metabolic syndrome?
A
insulin resistance syndrome
10
Q
how do you diagnose metabolis syndrome?
A
need 3 out of 5 below:
- inc waist circumference: men > 40 inches, women > 35 inches
- high TG > 150 mg/dl
- reduced HDL, men 100 mg/dl
11
Q
Kussmaul respiration is
A
hyperventilation seen in type 1 DM
12
Q
first step of treatment for type 1 DM ketoacidosis
A
IV fluid resuscitation (3-6 L) + IV insulin
13
Q
for DKA, keep the IV insulin infusion until
A
the anion gap closes
14
Q
is urinary ketones useful for diagnosis/management of DKA?
A
no
15
Q
3 examples of microvascular complications of DM?
A
retinopathy, nephropathy, and neuropathy
16
Q
3 examples of macrovascular complications of DM?
A
coronary artery dz, peripheral vascular dz, cerebrovascular dz
17
Q
treatment for non-proliferative retinopathy
A
tighter glucose control
18
Q
treatment for proliferative retinopathy?
A
laser photocoagulation to prevent visual loss
19
Q
2 skin manifestations of DM?
A
- acanthosis nigricans
2. necrobiosis lipoidica diabeticorum
20
Q
2 rapid acting insulin?
A
lispro, aspart
21
Q
time of onset of rapidly acting insulin?
A
5 - 20 min
22
Q
time of onset for regular insulin?
A
30 - 60 min
23
Q
time of onset for intermediate NPH?
A
2-4 hrs
24
Q
duration of action for NPH intermediate?
A
18 - 28 hrs (dosed twice a day)
25
what are somogyi effect and the dawn phenomenon
cause high BG in the morning before breakfast in people with diabetes due to either an over or under treatment of their diabetes
26
what is Somogyi effect?
an early morning hypoglycemia results in a rebound hyperglycemia due to the secretion of growth hormone, cortisol, and catecholamines which are released to overcome the low BG
27
treatment for Somogyi?
dec dose of insulin
28
treatment for Dawn phenomenon?
increase the bedtime insulin dose
29
what is Dawn phenomenon?
counter regulatory hormones (growth hormone, cortisol, and catecholamines) not only induce hepatic gluconeogenesis as part of the normal circadian rhythm, but also act to block the actions of insulin
30
2 main causes for hyperthyroidism
1. Grave's (diffuse toxic goiter)
| 2. Plummer's dz (multinodular toxic goiter)
31
the name of the antibody in Graves?
TSI (thyroid stimulating immunoglobulin), IgG against the TSH receptor
32
name 3 specific signs of Graves dz?
1. proptosis/exophthalmos
2. pretibial myxedema
3. thyroid infiltrative dermopathy
33
2 types of thyroid test (other than serum TSH, T3 test)
1. radioactive T3 uptake
| 2. free thyroxine index
34
what is unique about radioactive T3 uptake test?
gives info regarding the status of thyroid binding globulin (TBG)
35
explain the mech of radioactive T3 uptake test
radioactive T3 can bind either to TBG or to resin that has been given (binds to resin only if there is no space on TBG, as in hyperthyroidism when T4 is bound to TBG)
Consequently, you measure how much radioactive T3 was taken up by the resin.
36
the importance of radioactive T3 uptake test?
helps differentiate btw elevations in thyroid hormones due to inc TBG from true hyperthyroidism (due to an actual inc in free T4)
37
you get an inc radioactive T3 uptake, what is your interpretation?
all of the binding sites on TBG will be bound by T4 --> inc uptake of T3, which means that it is "hyperthyroidism" due to thyroid gland producing excess T4.
38
inc endogenous thyroid hormone can be proved by
inc thyroglobulin level
39
TSH, FT4 level in hyperthyroidism?
low TSH, high FT4
40
dec radioiodine uptake indicates
thyroiditis (NOT Hashimoto)
41
normal or elevated radioiodine uptake indicates
either toxic nodule or Grave's dz
42
3 examples for hyperthyroidism
1. Graves (high RAI, radioactive iodine uptake)
2. toxic adenoma/toxic multinodular goiter (high RAI)
3. thyroiditis (postpartum, postviral, subacute) --> low RAI
43
treatment for Graves?
radioactive iodine (RAI) --> both diagnostic and therapeutic for Graves
44
pharmacological treatment for Graves
1. methimazole
2. PTU
- -> block thyroid peroxidase
45
DOC for Graves as maintenance therapy?
methimazole (once daily dosing)
46
what is Wolff Chaikoff effect
(neg feedback) excess iodine temporarily blocks thyroid peroxidase --> dec iodine organificaiton --> dec T3/T4 production
47
thyroiditis (post partum, postviral, subacute) can be either
hyperthyroidism or hypothyroidism
48
clinical diagnosis for thyroid storm?
hyperthyroidism + fever + or - mental status changes
49
initial treatment for thyroid storm?
IV PTU (inhibition of peripheral T4 --> T3 conversion)
50
what is subclinical hyperthyroidism?
hyperthyroidism without any symptoms
51
TSH level in subclinical hyperthyroidism?
low TSH
52
two paths associated with subclinical hyperthyroidism?
osteoporosis, atrial fibrillation
53
MCC for hypothyroidism?
hashimoto
54
what is another name for Hashimoto?
chronic lymphocytic thyroiditis
55
4 acquired causes for hypothyroidism
1. post thyroidectomy
2. post ablative 131I
3. following head/neck radiation therapy
4. iodine def
56
4 drugs that can cause hypothyroidism?
1. Li
2. amiodarone
3. antithyroid drugs (PTU, methimazole)
4. bexarotene (vit A derivative)
5. tyrosine kinase inhibitor
57
5 clinical signs for cretinism
1. severe mental retardation
2. short stature
3. coarse facial features
4. large tongue
5. protuberant abdomen with umbilical hernia
58
what is myxedema?
severe, untreated form of hypothyroidism (not the same as pretibial myxedema
59
3 clinical signs for myxedema?
1. puffy hands, face, eyelids caused by the accumulation of glycosaminoglycans and hyaluronic acid
2. broadening and coarsening of facial features
3. lower pitched voice
60
definition of subclinical hypothyroidism?
elevated TSH with normal free T4 (affects 15-20% of individuals over 60 yrs old)
61
diagnosis and workup for hypothyroidism?
1. TSH
2. FT4
3. antithyroid peroxidase antibody for confirming Hashimoto
62
treatment for myxedema coma?
not oral, give IV thyroxine (T4), if no improvement add IV T3
63
what is the name of the sign to detect substernal goiters?
pemberton sign
64
what is pemberton sign?
within 30 sec after pt simultaneously raises both arms, there is marked facial plethora
65
a positive pemberton sign indicates
thoracic inlet obstruction
66
what is the common cause of thoracic inlet obstruction?
substernal goiter
67
papillary carcinoma is associated with what GI path?
Gardner syndrome (familial adenomatous polyposis coli)
68
how is follicular thyroid carcinoma diff from papillary carcinoma?
hematogenous spread with invastion of capsule and vascular system
69
name of the drug that inhibit PTH release?
Cinacalcet
70
what are the 6 indications for parathyroidectomy?
1. calcium at least 1 mg/dl > upper limit of normal range
2. 24 hr urine calcium > 400 mg/day
3. age under 50
4. GFR
71
hypomagnesemia can result in
functional hypoparathyroidism
72
congenital absence of parathyroid glands
DiGeorge syndrome
73
clinical characteristics of pseudohypoparathyroidism?
1. hypocalcemia --> seizures
2. shortened 4th, 5th digits
3. short stature
4. round facies
74
4 lab findings of osteomalacia/rickets (vit D def)
high ALP (alkaline phosphatase)
high PTH
low serum Ca2+
low phosphate
