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Endocrinology Flashcards

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1
Q

Thyroid Antibodies specific for Hashimoto’s Thyroiditis

A

Anti-thyroid peroxidase Ab

Anti-Thyroglobulin Ab

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2
Q

Thyroid Antibodies specific for Grave’s Disease?

A

Thyroid Stimulating Ab

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3
Q

Best thyroid function screening test?

A

TSH

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4
Q

Ordered when TSH is abnormal to determine hyper or hypo thyroid function

A

Free T4

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5
Q

Low TSH (<0.1) with High FT4

Tx:

A

Primary Hyperthyroidism (Thyrotoxicosis)

Methimazole or Propylthiouracil PTU (Pregnant)

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6
Q

High TSH (>5mU) with Low FT4

Tx:

A

Primary Hypothyroidism

Levothyroxine

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7
Q

Radio Active Iodine Test decreased uptake?

A

Thyroiditis (Hashimoto’s De Quervian)

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8
Q

Radio Active Iodine Test diffuse uptake?

A

Grave’s Disease or adenoma

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9
Q

Radio Active Iodine Test hot nodule

A

Toxic Adenoma

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10
Q

Radio Active Iodine Test multiple nodules

A

Multinodular Goiter

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11
Q

Radio Active Iodine Test cold nodule

A

Rule Out malignancy

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12
Q

Clinical Manifestations of Hyperthyroidism X5

A
  • Heat intolerance
  • weight loss
  • skin: warm/moist/ fine hair
  • anxiety
  • Hyperglycemia
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13
Q

Clinical Manifestations of Hypothyroidism X5

A
  • Cold Intolerance
  • Weight gain
  • Skin: dry/thick/ hair loss
  • depression and fatigue
  • hypoglycemia
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14
Q

Congenital hypothyroidism–> Macroglossia, hoarse cry, mental development abnormalities: Tx:

A

Cretinism Tx: Levothyroxine

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15
Q

Hypermetabolic state: palpitations, tachycardia, A-fib, high fever, NV, psychosis, tremors. –> coma and HYTN

Tx:

A

Thyroid Storm (Thyrotoxicosis)

Tx: + BBs +CS (Dex) PTU/Methimazole iodine : Cooling blankets: “in that order”

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16
Q

MC in women and in Cold weather: 2T infection: Bradycardia, hypoglycemia, hyponatremia:

Severe from long standing hypothyroidism Tx:

A

Myxedema crisis

Tx: IV Levothyroxine

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17
Q

Hyperthyroid Disorders?

A
  • Grave’s
  • Pituitary adenoma
  • Multinodular Goiter (Plummer’s)
  • Toxic Adenoma
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18
Q

Hypothyroid disorders?

A
  • Hashimoto’s
  • Lymphocytic
  • postpartum
  • De Quervian’s
  • Acute thyroiditis
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19
Q

Lid-Lag Exophthalmos, proptosis, Pretibial- myxedema: MCC is _______ 90% RAIU= Diffuse

A

Grave’s Disease

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20
Q

Nodular that causes dysphagia, dyspnea, stridor, hoarseness: RAIU Hot nodule

A

Toxic Adenoma

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21
Q

Diffuse enlarged thyroid MC in Elderly: with RAIU=patchy areas multi nodules

A

Multinodular Goiter (Plummer’s Disease)

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22
Q

inappropriate TSH elevation with FT4 elevation: RAIU diffuse uptake: MRI pituitary abnormality

A

Pituitary adenoma

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23
Q

Anti-thyroid Ab/Peroxidase Ab: Painless enlarged thyroid: MCC of hypothyroidism

A

Hashimoto’s

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24
Q

Anti-thyroid Ab/Peroxidase Ab: painless enlarged thyroid : returns to euthyroid state w/I 12-18 months Tx:

A

Silent Lymphocytic Thyroid

Tx: Aspirin

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25
Anti-thyroid Ab/Peroxidase Ab: painless enlarged: occurring after pregnancy
Post Partum Thyroiditis
26
Medications that can induce Thyroiditis or Hypothyroidism
Amiodarone or Lithium
27
Painful fluctuant MC by Staph Aureus: Tx
Acute Thyroiditis Tx: Abx
28
MC post viral: Painful tender thyroid: Increased ESR: usually hyperthyroid acutely: Tx:
De Quervian's Tx: Aspirin
29
Best initial test to evaluate nodule
Fine Needle Aspiration
30
MC type of thyroid nodule (90% benign)
Follicular Adenoma
31
Suspect malignant nodule when nodule is X3?
- rapid growing - Fixed in place - no movement with swallowing
32
Thyroid Carcinoma Least to most aggressive? "Name most specific characteristic for each"
- Papillary (Least and MC) - Follicular (Distant METS) - Medullary (Secretes Calcitonin and no Iodine uptake) - Anaplastic (Most aggressive and rapid growing)
33
Incr. serum Ca+2, intact parathyroid, dec. phosphate Stones, Bones, abdominal groans and psychic moans Tx:
Hyperparathyroidism Tx: Sx
34
Types of hyperparathyroidism
Primary- Inc. PTH from adenoma (MC Type) MEN-1/2 | Secondary- Inc. PTH 2T hypocalcemia/ Vit. D deficiency
35
Hypocalcemia causes what ECG finding
Prolonged QT interval (Hyper=Short)
36
Types of osteoporosis?
Primary: Postmenopause or Senile Secondary: Chronic disease or Meds
37
Osteoporosis highlights:
- Pathologic Fracture [Compression Fx] (1st sign) - Back pain - Dexa scan
38
Osteoporosis Drug for postmenopause?
- Raloxifene | - Estrogen
39
Genetic type I mutation collagen: spontaneous fractures in childhood: Blue sclera: presenile deafness
Osteogenesis Imperfecta
40
soft bones and demineralization of bones due to vitamin D deficiency; Cortical thinning in adults rachitic rosary: Delayed fontanelle or growth retardation Dec. Vit. D, calcium and phosphate:
Osteomalacia (Adults) Rickets (children)
41
Adrenal Gland secretes what hormone in what zone and layer?
Glomerulosa -Aldosterone Fasciculata -Cortisol Reticularis -Estrogen/Androgen
42
Hyperpigmentation 2t melanocyte stimulation, Hyperkalemia, hypoglycemia, HYTN, hyponatremia Myalgia, fatigue, abdominal pain, anorexia, weigh loss. Adrenal cortisol insufficiency Dx: Tx:
Chronic Adrenocortical Insufficiency (Addison's) (Pituitary failure= secondary) Dx: ACTH challenge (@ 30-60 min) Tx: Hydrocortisone
43
refractive hypotension and hypovolemia: Hyperkalemia, Hyponatremia, hypoglycemia: Tx:
Adrenal (Addisonian) Crisis (Adrenal corticol insufficiency)
44
MCC of Adrenal (Addisonian) Crisis (Adrenal cortisol insufficiency)?
Abrupt withdrawal of glucorticosteroids
45
HTN, weight gain (central trunk), moon facies, buffalo hump, protein catabolism, hirsutism, amenorrhea: Cortisol Excess: Dx: Tx:
Hypercortisolism (Cushing's Disease) Dx: LD Dexamethasone Suppression test 24 hour free cortisol (Most reliable) Tx: Ketoconazole (pituitary Transphenoidal Sx)
46
What is the difference between Cushing's Syndrome and Cushing's Disease?
Syndrome- S/Sx related to Cortisol excess Disease- syndrome specifically caused by Pituitary inc. ACTH secretion
47
hypertension, hypokalemia, polyuria: Headaches, hypo magnesium--> decreased DTRs
Hyperaldosteronism
48
Types of hyperaldosteronism
1ry- Adrenal hyperplasia or Conn's(Aldesteroneoma) Renin-independent 2ry- Inc. renin: Renal Artery stenosis MC
49
Anterior Pituitary Hormones
``` TSH ACTH Prolactin E FSH/LH GH ```
50
Galactorrhea, Amenorrhea, and hypothyroidism: Hypogonadism, infertility, impotence, vaginal dryness Tx:
Hyperprolactinemia Tx: Cabergoline or Bromocryptine (D. Agonist)
51
Hyperprolactinemia work up?
- Prolactin - TSH - B-HCG - FSH/LH - Testicular exam
52
Gynecomastia causing medications top 4
- Spironolactone (Antiandrogenic) - Ketoconazole - Cimetidine - 5 Alpha reductase Inh. (Finasteride dutasteride)
53
Gynecomastia treatment?
Tamoxifen (Selective Estrogen Modulators) Letrozole (Aromatase Inhibitors) Sx:
54
classic symptoms of DM
- Polyuria - Polydipsia - Polyphagia - Weight Gain/Loss
55
earliest sign of diabetic nephropathy? Tx:
Microalbuminuria Tx: ACEi
56
Earliest change in DM retinopathy?
Exudates Wool Spots "Micro aneurysms" (Flame shaped hemorrhages)
57
Hypoglycemia Symptoms
- sweating - Tremors - palpitations - tachycardia - Nervousness
58
Definition of hypoglycemia mild and severe?
Mild <60 Severe <40 Tx: D50 IV/SQ Glucagon
59
Diagnosis of DM lab values
Fasting- >/= 126mg/dL (x2 occasions GS) 2 Hours GTT >/= 200 (3h GS in Gest. DM) A1C >/=6.5 (Average 10-12 wks
60
Anti- hyperglycemic agent that stimulates insulin release: Insulin Secretagogue Se:?
Sulfonylureas ( Glipizide-Gliburide -ide) SE: Hypoglycemia/Weight Gain (Sulfa allergy)
61
Anti- hyperglycemic agent that stimulates insulin release that is glucose dependent: SE:
Meglitinides (- glinide) SE: Hypoglycemia
62
Anti- hyperglycemic agent that delays intestinal Anti- hyperglycemic absorption SE:
Alpha Glucoside inhibitors (Acarbose- Miglitol) SE: Hepatitis (Increases LFTs)
63
Anti- hyperglycemic agent that increases peripheral insulin sensitivity in adipose and muscle cells. SE:
Thiazolidinediones (-azone) Pioglitazone/Rosiglitazone SE: Fluid retention--> edema
64
Anti- hyperglycemic agent that lowers renal threshold --> increased Urinary Glucose excretion SE:
SGLT-2 Inhibitor (Canagliflozin- Dapagliflozin -ozin) SE: UTIs, thirst, abd. pain
65
Anti- hyperglycemic agent that mimics incretin --> insulin secretion injectable SE:
GLP-1 (Exanitide-Liraglutide -tide) SE: Hypoglycemia "CI gastroparesis"
66
Insulin given at the same time of meal: often used with intermediate or long acting
Rapid Acting Insulin (Lispro or Aspart)
67
Given 30 min prior to meal often used with intermediate or long acting
Short acting Regular insulin:
68
Covers insulin for 12 a day or over night: often combined with short or Rapid acting:
NPH or Lente
69
Covers insulin for 1 full day: "Basal insulin"
Long acting Detemir or Glargine
70
Nocturnal Hypoglycemia followed by rebound hyperglycemia due to surge in GH Tx:
Somogyi Effect Tx: Decrease nighttime NPH or bed time snack
71
normal glucose until Hyperglycemia 2 am-8 am due to decreased insulin sensitivity
Dawn Phenomenon Tx: Bed time NPH and no bed time snack
72
Hyperglycemia > 600, Arterial pH >7.30, Urine/Serum ketones= small: MC in DM type II: Potassium deficit
Hyperosmolar Hyperglycemic Syndrome
73
Diabetic Ketoacidosis is MC in what patients? What are the diagnosis labs X4
MC in DM-I - >250 hyperglycemia (Severe) - pH < 7.30 (< 7.0 severe) - < 10 Serum Bicarb - Positive ketones Serum/urine
74
Diabetic Ketoacidosis Management ?
``` #1. critical 1st- 0.9 NS #2. Regular insulin 0.1 mg/kg #3. Potassium < 5.5 (20-40 mEq) ```
75
Multiple Endocrine neoplasm (MEN 1 or Wermer's) inherited D/O highlights X3
- 3 Ps (Parathyroid 90%, Pancreas 60%, Pituitary 55% - hyperparathyroidism - Mein gene Genetic testing
76
Multiple Endocrine neoplasm (MEN 2) inherited D/O highlights X3
- MEN 2A 90% - Thyroid carcinoma, pheo, hyperparathyroidism - Proto-oncogene Genetic testing

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