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MTBs Step 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

dx diabetes

A

need 1 of the following:

  1. fasting glucose of >126 of two seperate occations
  2. one random glucose of >200 with symptoms(polydip/uria/phagia)
  3. abnormal glucose tolerance test
  4. A1c >6.5%
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2
Q

strongest indication for screening for DM?

A

HTN

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3
Q

best initial therapy for DM

A

weight loss and exercise

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4
Q

best initial pharm therapy for DM

A

metformin = blocks gluconeogenesis

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5
Q

C/I to Metformin

A

renal insufficiency, use of contrast agents

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6
Q

Sulfonylureas drugs +mechanism+ side fx

A

glyburide, glimepiride, glipizide = increase the release of insulin
- cause hypoglycemia and SIADH

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7
Q

DPP-4 inhibitors drugs + mechanism + side fx

A

sltagliptin, linagliptin, alogliptin, saxagliptin, exenatide
- work by blocking metabolism of GLP = allows GLP to stop glucagon release and stimulate insulin release

-fx: weight loss!!!

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8
Q

Thiazolidinedions drugs + mech + side fx?

A

rosiglitazone, pioglitaone

  • increase peripheral insulin sensitivity by activating PPARy or some shit.
  • obesity, worsen CHF, bone crap
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9
Q

A-glucosidase inhibitors drugs? + mech? + fx?

A

acarbose and miglitol = block absorption of glucose at the intestinal lining.
- diarrhea, ab pain, bloating, flatulence

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10
Q

SGLT inhibitors, mech fx?

A

anything that ends in -gliflozin

- causes UTI

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11
Q

DKA causes what type of pH disturbance? why?

A

metabolic acidosis! = no insulin = body is hungry and cant use glucose so starts making ketones = acid! = body starts to hyperventilate to blow of acid & attempt to absorb bicarb. = anion gap acidosis!

*hyperglycemia and HYPERKALEMIA = kidneys remove H via taking up K but cells are also trying to remove H so they suck H up in exchange for K!

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12
Q

tx of DKA?

A

IV BOLUS saline + insulin IV + K(later)

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13
Q

when do you start giving K in DKA

A

when K levels normalize = start giving K as the body is starting to shift K back into the body in exchange for H.

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14
Q

target BP in DM

A

130/80

*normal targer is 140/90

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15
Q

target LDL in DM?

A

LDL <100

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16
Q

ppl with DM need yearly….

A

eye exam, foot exam, influenza and regular pneumococcal vaccine

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17
Q

sx of hypothyroidism

A

slow, tired, fatigue, weight gain, increased menstration, cold, hair loss, dereased reflexes, coma, constipation, bradycardia

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18
Q

Graves Disease?

sx? RAIU?

A

Stimulating ab to TH-receptor
sx: exophthalmos and proptosis, pretibial myxedema, onycolysis(separation of the nail form the nailbed)
RAIU: elevated

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19
Q

tx of Graves Disease

A
  1. Metimazole or PTU to bring gland under crontrol
  2. Radioactive I ablation
  3. Propranolol to tx sx
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20
Q

Slient Thyroiditis?

tx?

A

AI to thyroid peroxidase or TG-antibodies = nontender gland and hyperthyroidism = thyroid is leaking
- no tx, normal RAIU

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21
Q

Subacute Thyroiditis

sx? tx? RAIU?

A

viral etiology?
sx: tender thyroid, low raiu, T4 elevated, TSH low

tx: ASA

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22
Q

Pituitary Adenoma as the cause of hyperthyroidism

whats different about this form other forms?

A

only one that will have an elevated TSH and T4. the rest just have elevated t4s

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23
Q

tx of thyroid storm

A

PTU, Dexamethasone, Propranolol, I

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24
Q

MCC of Hypercalcemia?

A

primary hyperparathyroidism

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25
Q

other causes of hypercalcemia besides primary hyperparathyroidism

A

malignancy(MM), granulomatous disease(sarcoid), vitaD intoxication, Thiazide diuretics, TB, Histoplasmosis, Berylliosis

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26
Q

sx of hyperparathyroidism

A

kidney stones, osteoporosis/osteomalacia/fractures, confusion, stupor, lethargy, constipation, abdominal pain, polyuria, polydipsia, renal insufficiency, ATN, short QT syndrome

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27
Q

Person with hypercalcemia due to primary hyperparathyroidism should be suspected/worked up for…

A

MEN 1 and MEN2
MEN1: pituitary, PTH, Pancreas
MEN2: PTH, Pheo, Medually Thryoid

28
Q

Tx of hypercalcemia

A
  1. hydration
  2. bisphosphonates
  3. furosemide
  4. steroids
29
Q

sx of hypocalcemia

A

twitchy, hyperexcitable, seizures, arrhythmia, prolonged QT, Chvostek & Trousseau sign

30
Q

causes of hypocalcemia

A

surgical removal of PT glands, hypomagnesmia, vit D deficiency, acute hyperphosphatemia, fat malabsoption, PTH resistance

31
Q

Cushing Syndrome vs Cushing Disorder

A

syndrome: ACTH excess from ectopic sources
dz: ACTH excess from overproduction by pituitary

32
Q

sx of cushing

A

moon face, buffalo hump, thin arms and legs, easy bruising and striae(loss of collagen due to breakdown to make protein & gluco), HTN due to Na retention(mild mineralo effect of cortisol), Muscle wasting(protein breakdown for gluco), hirsutism(+irregular menstation), insulin resistance = polyuria,polydipsia, leukocytosis

33
Q

what type of PH disorder will you see with cushings? why?

A

metabolic alkalosis = loss of H via kidney and retention of Na due ot mild mineralocorticoid effect

34
Q

whats the first thing u do when you have high cortisol and wanna find out why?

A

measure ACTH! if High = pituitary prob or ectopic

if low = adrenal prob and you need to CT adrenals

35
Q

high cort + high ACTH what test do you need to do?

A

Dexamethasone supression test = if LD still has high ACTH = prob! try HD. if nothing supressed with HD = ectopic if supressed = pituitary = do MRI

36
Q

what do you do if u do a abdominal CT for some reason and happen to find a adrenal mass?

A
  1. metanephrin lvl to r/o pheo
  2. renin + aldo to r/o hyperaldo(Conns)
  3. LD dexamethasone to r/o cushing

*if all are negative your done =)

37
Q

Addisons Disease

sx?

A 
adrenal insufficiency(salt, sex, stress)
sx: fatigue weakness, weight loss, hypotension, hyperpigmented skin, hyperkalemia with mild metabolic acidosis(inability to excrete H or K), hyponatremia
38
Q

tx of addisons

A

acute addison = hydrocortisone(glutcocorticoid and mineralocorticoid acitivty) and when stable give prednisone

39
Q

Hyperaldosteronism

sx?

A

aka Conn’s syndrome = solitary adenoma of the adrenals causing increased aldo
sx: hypertension, Hypokalemia, metabolic alkalosis

40
Q

when should you be thinking about Conn’s syndrome?

A

when BP isnt controlled by 2+antiHTN drugs

41
Q

dx of Conns syndrome?

A

low renin, HTN, elevated aldo & confirmed with CT

42
Q

tx of Conn syndrome?

A

spironolactone for hyperplasia and resection for adenoma

43
Q

Pheochromocytoma

sx?

A

HA, palpation, tremors, axiety, flushing = episodic

44
Q

dx of pheochromocytoma

A

high plasma and urinary catecholamines, elevated urine metanephrin or plasma metanephrine

45
Q

tx of pheochromocytoma

A

phenoxybenzamine then propanolol

*if not reflex tachy

46
Q

21 OH deficiency sx

A

*salt comes before sex

low salt, high sex

47
Q

11 OH deficiency sx

A

mild elevation in salt, high sex

48
Q

17 OH def sx

A

high salt, low sex

49
Q

Prolactin may be elevated due to….

A

prolactinoma, pregnancy, cosecreted with GH in acromegaly, hypothyroid(elevated TRH triggers prolactin and TSH), antipsychotics

50
Q

sx of prolactinoma in men & women

A

men: ED, decreased libido, gynecomastic(late), HA, visual disturbances
women: amenorrhea & galactorrhea in absence of prego > same sx as men

51
Q

tx of prolactinoma?

A

bromocriptine or cabergoline

52
Q

Acromegaly

sx?

A

pit tumor secreting GH:
- enlargement of soft tissue: Feet, jaw(gap in teeth), fingers(carpel tunnel), head, nose, sweat glands(increased sweatig), obstructive sleep apnea, seep void, large tongue, colon polyps(increased risk of colon cancer), HTN & cardiomegaly(arteriol enlargment), joint abnormalites(50yoa = wheelchair due to pain), Diabetes(GH = anti-insulin) & Hyperlipiedemia

53
Q

best dx test for acromegaly

A

IGF level then Glucose supression test

54
Q

tx of acromegaly

A

Surgery > Cabergoline > Pegvisomant >Octreotide

55
Q

Turner Syndrome

sx?

A

XO karyotype, short, webbed neck, wide spaced nippes, scant pubic and axillary hair = streak ovaries, primary ammorhea

56
Q

Androgen Insensitivity

A

46XY but looks female bc androgen receptors do not respond to testosterone = looks female bc estrogen receptors are fine

57
Q

Mullerian Agenesis

A

46XX but mullerian ducts fail to fuse = normal female with out a uterus

58
Q

PCOS

how do you dx?

A

need 2 of the following:

  1. elevated Test/DHEA or Hirsutism
  2. U/S showing PCOS
  3. Irreg. menstration
59
Q

PCOS sx?

A

gradula onset hirsutism, obesity, acne, irregular bleeding and infertility, elevated LH»FSH + insulin resistance

60
Q

PCOS tx

A

OCP, Spironolactone(anti-androgen), Metformin(for DM), Clomiphene if trying to get prego

61
Q

Klinefelters syndrome

sx? tx?

A

XXY karyotype

  • insensitive FSH and LH recepters on testicles = VERY high FSH and LH but no testosterone = feminization
    tx: give testosterone
62
Q

Kallman Syndrome

A

anosmia with hypogonadism

*low GnRH, FSH and LH + Anosmia = dx!

63
Q

Central DI

causes?

A

stroke, tumor, trauma, hypoxia, infiltration(sarcodosis, hemochromatosis), infection

64
Q

Central DI

tx?

A

caused by decreased ADH = tx with desmopressin!

65
Q

Nephrogenic DI

causes?

A

chronic pyelo, amyloidosis, meyloma, SSD, lithium use, elevated Ca & low P

66
Q

Nephrogenic DI

tx?

A

caused by ADH insensitivty in kidney –> tx w/HCTZ, NSAIDs, Amiloride

*not gonna fix kidneys just memorize this

67
Q

whats Demeclocyclin used for?

A

abx and induces DI = can be used to tx SIADH

MTBs Step 3 (30 decks)

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