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Family Medicine EOR > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

Addison’s disease is?

A

Primary adrenal insufficiency

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2
Q

How do labs look for Addison’s Disease?

A

Increased ACTH
Decrease cortisol
Hyponatremia
Hyperkalemia

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3
Q

What is the MC cause of Addison’s?

A

autoimmune destruction

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4
Q

What is the MC cause Addison’s worldwide?

A

TB, HIV

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5
Q

What labs are seen in Secondary adrenal insufficiency?

A

Decrease ACTH

Decrease cortisol

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6
Q

Cause of secondary adrenal insufficiency?

A

pituitary macroadenoma or central nervous system tumor

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7
Q

No increase in ACTH after CRH injection is what?

A

Secondary adrenal insufficiency

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8
Q

No increase in cortisol level after ACTH stimulation test is what?

A

Primary adrenal insufficiency (Addison’s Disease)

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9
Q

What does the labs for tertiary adrenal insufficiency look like?

A

decrease cortisol

normal aldosterone

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10
Q

ACTH levels increase after CRH injection

A

Tertiary adrenal insufficiency

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11
Q

What is the MC cause of tertiary adrenal insufficiency?

A

sudden withdrawal of glucocorticoid therapy

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12
Q

What is the mechanism of Addison’s disease?

A

destruction of adrenal cortex resulting in loss of cortisol production

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13
Q

What is the screening test for Addison’s disease?

A

High dose ACTH (cosyntropin) stimulation test

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14
Q

What is the treatment for Addison’s disease?

A

Glucocorticoids + Mineralocorticoid (Hydrocortisone + Fludrocortisone)

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15
Q

What is the treatment of 2ndry adrenal insufficiency?

A

Glucocorticoids (Hydrocortisone 1st line, Prednisone, Dexamethasone)

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16
Q

What is the treatment for Adrenal (Addisonian) Crisis?

A

IV fluids, IV hydrocortisone, glucose,

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17
Q

What symptoms are seen in Addison’s?

A

Hyperpigmentation, Orthostatic hypotension (syncope, dizziness), hyponatremia, hyperkalemia, metabolic acidosis, hypoglycemia, decrease sex hormones in women (loss of libido, amenorrhea, loss of hair)

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18
Q

Mechanism of Cushing Syndrome?

A

s/s due to prolonged exposure to excess cortisol

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19
Q

What are symptoms seen in Cushing?

A

buffalo hump, moon facies, pigmented striae, obesity, hypertension, hypokalema

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20
Q

Diagnosis of Cushing?

A

Dexamethasone supression test

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21
Q

Suppression of cortisol =

A

Cushing’s disease

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22
Q

No suppression=

A

Cushing’s syndrome

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23
Q

Treatment for Cushing disease?

A

Transsphenoidal surgery

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24
Q

What two medications can be used if a adrenal tumor can’t be removed?

A

Ketoconazole or Metyrapone

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25
4 Medications that cause Addison's?
Ketocanzole, Rifampin, Phenytoin, Barbiturates
26
What causes Type I DM?
Autoimmune
27
Whom do Type I DM occur in?
young people before school age or near puberty
28
What is Dawn Phenomenon?
normal glucose until rise of serum glucose between 2am-8am. Results from decreased insulin sensitivity and nightly sure of counter regulatory hormones
29
What is Somogyi effect?
Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone
30
What is insulin waning?
progressive rise in glucose form bed to morning
31
What are the symptoms of Diabetic Ketoacidosis?
fruity breath, weight loss, rapid respirations, hypotension
32
What is the treatment for DKA?
Large volume IV fluids (normal saline), Insulin IV pump
33
A random glucose of what is dx for DM?
200mg/dl w/ classic symptoms
34
A fasting glucose of what is dx for DM?
>126 mg/l on more than one occasion
35
A HGB A1c represents of what is dx for DM?
6.5% or higher
36
What is the treatment of Type I DM?
Dietary control + insulin
37
What is the A1C goal of Type I DM?
< 7
38
What is the BP goal for DM?
<140/90
39
All DM pts 40-75 should take a?
statin
40
What are the 4 diagnostic criteria for DM?
Random glucose > 200 Fasting glucose > 126 2 postprandial glucose > 200 HgA1c >6.5%
41
How does Metformin work?
decreases hepatic glucose production and increases peripheral glucose uptake
42
What is the side effect of Metformin?
lactic acidosis
43
What is the mechanism of Sulfonylureas?
stimulates pancreatic beta-cell insulin release
44
What is the side effect of Sulfonylureas?
hypoglycemia and weight gain
45
What is the mechanism of Thiazolidinediones?
increases insulin sensitivity in peripheral receptor site adipose and muscle
46
What is the sde of Thiazolidinediones?
fluid retention and edema
47
What labs are seen in hyperthyroidism?
Decrease TSH Increase free T4 or T3 Sometimes radioactive iodine uptake
48
What is the initial dx used for hyperthyroidism?
TSH
49
What test is used after TSH to confirm hyperthyroidism?
Radioactive iodine uptake
50
What is used to treat cardiac symptoms of Graves disease?
beta blockers (atenolol)
51
What are the two antithyroid drugs used to treat Graves disease?
Methimazole and Proylthiouracil (PTU)
52
What med is used in preggo with Graves?
PTU
53
What symptoms are seen in Graves?
heat intolerance, weight loss despite increased appetite, exopthalmos, nervousness, sweating, pretibial myxedema, goiter with a bruit
54
What are the labs in hypothyroidism?
Increase TSH | Decrease free T4
55
What is the most common cause of hypothyroidism?
Hashimoto's thyroiditis
56
Hashimoto's is confirmed by what?
Antithyroid peroxidase (TPO) antibodies
57
What two other associations are seen with Hashimoto's?
Anemia and high cholesterol
58
Treatment for Hashimoto's?
Thyroid replacement hormone therapy (Oral T4) L-thyroxine
59
What is the preferred txt for Hashimoto's?
Oral T4 L-thyroxine, Levoxyl, Synthroid
60
What are complications of Hashimoto's?
Hashimoto encephalopathy, goiter, heart failure, depression decreased libido, myxedema
61
What symptoms make up the Thyroid storm?
Fever, tachycardia, delirium
62
What disease has discrete areas of high uptake?
Toxic multinodular
63
What antibodies are seen in Graves?
Anti-thyrotropin antibodies
64
Thyroidectomy mostly likely complication is?
recurrent laryngeal nerve (hoarseness)
65
What is the recommendation for PTU?
given only in the FIRST TRIMESTER! switch to methimazole for the rest of pregnancy
66
What is the sde of PTU?
liver damage
67
What are the symptoms of Hashimoto's?
cold intolerance, fatigue, constipation, depression, weight gain, bradycardia

Family Medicine EOR (15 decks)

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