ENDOCRINOLOGY Flashcards
(93 cards)
1
Q
ADA recommendation for diabetes screening
A
>45 years every 3 years
* Screening should be earlier if overweight (BMI>25) + one additional risk factors for DM
2
Q
Most common pattern of dyslipidemia in DM
A
hypertriglyceridemia and reduced high-density lipoprotein (HDL)
3
Q
best initial therapy for type 2 diabetes.
A
Diet, exercise, and weight loss
4
Q
preferred initial pharmacologic agent for T2DM
A
Metformin
5
Q
DM drugs that promotes weight gain
A
o Sulfonylureas
o TZD
o Insulin
6
Q
Promotes weight loss
A
o Metformin
o SGLT2 inhibitor
o GLP1 receptor agonist
7
Q
Weight neutral drug
A
DPP-4 inhibitor
8
Q
- Insulin secretagogues: increases insulin secretion
- can cause Hypoglycemia, Weight gain
A
Sulfonylureas (SU)
- Gliclazide
- Glibenclamide
- Glimepiride
- Glipizide
Non-Sulfonylureas
- Repaglinide
- Nateglinide
9
Q
Insulin sensitizers
A
Biguanides - metformin
Thiazolidinediones - Pioglitazone
10
Q
Inhibits intestinal absorption of sugars
A
Alpha-glucosidase inhibitors
- Acarbose
- Voglibose
- Miglitol
11
Q
Incretin-related drugs: prolongs endogenous action of GLP-1
A
DPP-IV Inhibitors
- Sitagliptin Saxagliptin Linagliptin Vildagliptin
GLP-1 agonists
- Exenatide SC Liraglutide SC
12
Q
Treatment goals for DM
A
13
Q
Increases urinary glucose excretion
A
Na-Glucose Transporter-2inhibitors (SGLT2i)
- Dapagliglozin, Canagliflozin, Empagliflozin
14
Q
first defense against hypoglycemia.
A
Decrease in insulin secretion
15
Q
second defense against hypoglycemia; Epinephrine is third.
A
Glucagon
16
Q
play no role in defense against acute hypoglycemia.
A
Cortisol and growth hormones
17
Q
A
18
Q
The most serious complication of therapy for DM
A
hypoglycemia
19
Q
Drugs proven to decrease rate of progression of nephropathy
A
ACE inhibitors dilate the efferent arteriole and ↓ intraglomerular hypertension (ACE and ARB)
20
Q
The most effective therapy for diabetic retinopathy
A
prevention
21
Q
The most common form of diabetic neuropathy
A
distal symmetric polyneuropathy
22
Q
one of the earliest signs of diabetic neuropathy
A
Erectile dysfunction and retrograde ejaculation
23
Q
The most common skin manifestations of DM
A
xerosis and pruritus.
24
Q
pathophysiology of DKA
A
Relative or absolute insulin deficiency combined with counterregulatory hormone excess (glucagon, catecholamines, cortisol, and growth hormone)
25
Triad of DKA
o Hyperglycemia
o Metabolic acidosis (high anion gap)
o Ketosis
26
predominant ketone in ketosis.
3-hydroxybutyrate
27
in DKA, once the blood glucose reaches 250 mg/dl, what fluid should be added?
D5 containing fluid
28
5 I’s for precipitating factors of DKA:
o Infection
o Ischemia
o Infarction
o Ignorance (poor control)
o Intoxication
29
The major nonmetabolic complication of DKA therapy
cerebral edema
\* Sudden reduction in hyperglycemia can lead to vascular collapse with shift of water intracellularly
30
What symptoms are Notably absent in HHS compared to DKA?
nausea, vomiting, and abdominal pain and the Kussmaul respirations characteristics of DKA
31
Management of DKA/ HHS
32
Metabolic Syndrome definition
33
method of choice when it is important to determine thyroid size accurately
UTZ
34
What is the initial test of choice for hyperthyroidism?
TSH
35
When do you repeat thyroid function test after staring treatment?
4-6 weeks
36
What is the most common sign of thyrotoxicosis?
Tachycardia
37
ovarian tissues houses active thyroid tissues secreting FT4 and FT3. The ectopic thyroid tissue acts like a target organ hence classified as primary hyperthyroidism
Struma ovarii
38
happens when an iodine-deprived thyroid is exposed suddenly to an iodine-rich diet. The thyroid avidly takes up more iodine and the thyroid machinery produces more FT4 and FT3.
Jod Basedow phenomenon
39
thyrotoxic hypokalemic periodic paralysis (THPP) is associated with
Graves disease
40
Most common cardiovascular manifestation of graves disease
sinus tachycardia
41
EXCLUDES Graves' disease as a cause of diffuse goiter
normal TSH
42
Evaluation of thyrotoxicosis
43
definitive treatment for graves
Radioiodine (RAI)
* To reduce amount of thyroid tissue
* Avoid in patients with moderate to severe ophthalmopathy
* Contraindicated: Pregnancy and breast feeding
44
What treatment will reduce adrenergic manifestation and peripheral conversion of T4 to T3?
Propranolol
45
most serious manifestation of Grave’s ophthalmopathy and may lead to permanent loss of vision if left untreated
Optic nerve compression
46
aplasia cutis congenita is a side effect of what drug?
methimazole
47
* Fever; Painful, enlarged thyroid
* Associated with URTI
SUBACUTE THYROIDITIS (de Quervain thyroiditis, viral thyroiditis)
Treatment:Aspirin, Glucocorticoid
48
What treatment blocks thyroid hormone synthesis via WolffChaikoff effect?
Stable Iodide
49
Burch-Wartofsky score parameters
o \< 25 storm unlikely
o 25-44 impending storm
o \>45 high likelihood of storm
50
Tx for thyroid storm that stops the production of thyroid hormone:
o Propylthiouracil (PTU) PO/ per rectum
o Methimazole
o Hydrocortisone
51
tx for thyroid storm that Inhibits hormone release
o Saturated solution of potassium iodide (SSKI), one hour after first dose of PTU.
o Sodium iodide
52
* Fever; Painful, enlarged thyroid
* Associated with URTI
SUBACUTE THYROIDITIS (de Quervain thyroiditis, viral thyroiditis)
* Treatment: Aspirin, Glucocorticoid
* inflammatory probably by virus. Initial hyperthyroidism, then transient hypothyroidism.
53
* Non-tender thyroid gland
* Seen 3-6 months postpartum
SILENT THYROIDITIS (painless thyroiditis)
54
Signs and symptoms of hypothyroidism
55
Signs and symptoms of thyrotoxicosis
56
approach to hypothyroidism
57
Presence of Thyroid peroxidase (TPO) Ab
(\>90% of autoimmune hypothyroidism)
58
What is the size of the nodule to be detectable on palpation?
\>1cm in diameter
59
The greatest concern in a patient with a thyroid nodule is
risk of malignancy.
60
Most common early consequence of estrogen deficiency
vertebral fracture
61
increased uptake = hyperfunctioning = almost never malignant
“Hot” nodule
62
decreased uptake = hypofunctioning = 1020%: malignant
“Cold” nodule
63
What is the operation definition of Osteoporosis?
Bone mineral density **\< 2.5 SDs** from normal peak bone mass or T-score less than **-2.5**
## Footnote
**T-Scores : Compare individual results to those in a young population that is matched for RACE and SEX**
**Z-Scores: Compare individual results to those of an AGE-MATCHED population that also is matched for RACE and SEX**
64
Most common cause of medication induced osteoporosis
steroids
65
the only adrenal-inhibiting medication that can be administered to pregnant women with Cushing’s syndrome
**Metyrapone** inhibits cortisol synthesis at the level of 11βhydroxylase
66
novel agent; human monoclonal antibody to RANKL, inhibiting formation of osteoclast
Denosumab
67
Osteopenia Dual-energy x-ray absorptiometry (DEXA scan) score
T score between -1 to -2.5 SD
68
prevention and treatment of osteoporosis and reduction of invasive breast cancer occurrence
Selective-estrogen modulator (Raloxifene)
69
What is the best initial diagnostic test for cushing syndrome?
1 mg overnight Dexamethasone suppression test and 24hour urine cortisol
70
What is the most accurate diagnostic test for cushing syndrome?
24-hour urine cortisol
71
excess cortisol from ACTH-producing pituitary adenoma.
Cushing’s disease
72
Adrenal, Pituitary and Ectopic cushing syndrome response to diagnostic tests
73
DIAGNOSTIC ALGORITHM FOR PATIENT WITH SUSPECTED CUSHING’S SYNDROME
74
Most common cause of cushingoid features
Iatrogenic hypercortisolism
75
The most common cause of Cushing's syndrome Overall
Medical use of glucocorticoids for immunosuppression or for the treatment of inflammatory disorders
76
Account for 70% of patients with endogenous causes of Cushing's syndrome
Pituitary corticotrope adenomas
77
Majority of patients with ACTHindependent cortisol excess
Cortisol-producing adrenal adenoma
78
Most important first step in the management of suspected Cushing's syndrome
Establish the correct diagnosis
79
Investigation of choice in ACTHDependent Cortisol Excess
MRI of the PITUITARY
80
Primary cause of DEATH in Cushing
Cardiovascular Disease
81
Treatment of choice for Cushing's Disease
Selective Transsphenoidal Resection of pituitary tumor
82
DOC for pheochromocytoma
α-adrenergic blockers (Phenoxybenzamine)
83
first described pheochromocytoma-associated syndrome associated with multiple neurofibromas, café au lait spots, axillary freckling of the skin, and Lisch nodules of the iris
Neurofibromatosis Type 1 (NF 1)
84
MEN 2A
o Medullary thyroid carcinoma (MTC): seen in virtually all patients
o Pheochromocytoma: occurs in only about 50%
o Hyperparathyroidism
85
MEN 2B
o Medullary thyroid carcinoma (MTC)
o Pheochromocytoma
o Multiple mucosal neuromas
o Marfanoid habitus
o Typically lacks hyperparathyroidism
86
What is the most common cause of mineralocorticoid excess?
Primary hyperaldosteronism (excess aldosterone by the adrenal zona glomerulosa)
87
What is the clinical hallmark of mineralocorticoid excess?
Hypokalemic Hypertension
88
Medical treatment of hyperaldosteronism consists primarily of?
Spironolactone
89
Differentiate primary vs secondary hyperaldosteronism
90
useful screening test for hyperaldosteronism
Ratio of plasma aldosterone to plasma renin activity (PA/PRA)
## Footnote
\* PA:PRA is INCREASED IN PRIMARY HYPERALDO BECAUSE Of THE NEGATIVE FEEDBACK
91
Differentiate Primary, secondary and tertiary adrenal insufficiency
92
Risk factors for DM
93
Criteria for DM diagnosis
