MTB 2 CK - Endocrinology Flashcards Preview

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Flashcards in MTB 2 CK - Endocrinology Deck (71):
1

GH deficiency clinical picture

Central obesity, Inc. LDL/Cholesterol levels, reduced muscle mass (Dwarfisim in children)

2

Cortisol profile in Pituitary insufficiency

Increased in recent disease, Decrease with chronicity (atrophy)

3

Adrenal stimulation test using _______________ agent to check integrity of adrenals in ACTH deficiency

Cosyntropin

4

Low GH levels are assessed with ______________ infusion test

Arginine and GHRH

5

Low Prolactin levels are assess with ________________ infusion test

TRH

6

ACTH levels shoud normally ____________ (rise/fall) in response to mytyrapone

Increase (cortisol production inhibited -11b-hydroxylase deficiency)

7

_____________ (thyroxine/cortisone) replacement should precede the other in panhypopituitarism

Cortisone before thyroxine

8

Electrolyte disturbances that can cause nephrogenic DI

Hypercalcemia, Hypokalemia

9

Rx for Nephrogenic DI

HCTZ, Amiloride, Prostaglandin inhibitors like NSAIDs

10

Best initial test for acromegaly

Low IGF-1 (Prolactin also cosecreted by adenoma -levels also tested)

11

Confimatory test for acromegaly

Glucose suppresion test

12

Rx for Acromegaly

Cabergoline, Osteotride Pegvisomant (GH antagonist inhibiting release of IGF-1)

13

_____________ Thyroid derangement causes prolactinoma

Hypothyroidism (elevated TRH levels)

14

Prolactin levels can be elevated by _____________ drugs

Antipsychotics, Methyldopa, Metochlopromide, opioids, TCAs, Verapamil

15

Systemic conditions that elevate Prolactin levels

Renal insufficiency, Cirrhosis

16

Increased prolactin levels subsequent labs needed

Thyroid function, Pregnancy, BUN/Creatinine, Liver Function (Do MRI only after excluding sec. causes and pregnancy)

17

Prolactinoma Treatment

Cabergoline (dopamine agonist), Transphenoidal resection

18

Hypothyroidism effects on menstruation

Increased flow (apart from effects on all other body systems)

19

Thyroid replacement indications based on lab results

Normal T4 and Very high TSH; moderately high TSH + Antithyoid peroxidase/antithyroglobulin Ab

20

Rx for Graves Ophthalmopaathy

Steroids

21

Rx for Graves Thyroid Disease

Radioactive Iodine

22

Thyroid Nodule biopsy is indicated with ______________ Thyroid profile results

Normal TSH/T4 levels (euthyroid nodules can be malignant, hyperfunctioning cannot)

23

Acute symptomatic hypercalcemia presentation

Confusion, stupor, lethargy, constipation

24

Rx for acute hypercalcemia

Saline hydration, Bisphosphonates (pamidronate), Calcitonin

25

CVS findings of acute hypercalcemia

short QT syndrome, HTN (unknown etiology)

26

GI effects of hyperparathyroidism

Peptic ulcers (Ca stimulates gastrin)

27

Rx for hyperparathyroidsm when surgery is not feasible

Cinacalcet

28

Decreased _____________ ion levels can lead to hypoparathyroidsm

Mg2+ (also causes inc. Ca2+ loss)

29

Liver function effects on blood Calcium levels

Low albumin levels cause hypoparathyroidism >> dec. Ca2+

30

Ophthalmologic findings of parathyroid abnormalities

Early cataracts on slit lamp in hypoparathyroidism (hypocalcemia)

31

Cushing's Disease presents as _____________ (hypertension/hypotension)

Hypertension (Glucocorticoid insufficiency = hypotension)

32

Best initial test for Hypercorticolism

24h urinary cortisol excretion

33

_____________ (los dose dex. suppression/24h urine cortisol) is more specific for hypercortisolism

24h urinary cortisol

34

Causes of false positives in low dose dex. suppression test

Depression, alcoholism, obesity

35

Cortisol level that suppresses with high dose dexa: Source of ACTH is ____________

Pituitary

36

Source of elevated Cortisol level that does not suppress with high dose dexa: Source of ACTH is ___________

ectopic usually (but can still be pituitary); Adrenal tumor also possible

37

Two ways to detect ACTH secreting pituitary lesions

MRI; Inferior Petrosal sinus sampling after CRH (contains pituitary drainage)

38

________________ tests confirms presence of hypercortisolism

24h urinary cortisol excretion; low dose dexa suppression of ACTH negative

39

__________________ tests establishes the sourceof elevated ACTH

High dose dexa suppression, Brain scan, Petrosal sinus sampling, Chest CT

40

Asymptomatic adrenal lesion investigations include _____________ labs

Blood/urine Metanephrine levels, Renin and aldosterone levels, 1mg dexa suppression test (Can be incidentaloma)

41

Dexamethasone suppression test works by detecting suppressed _____________ (Cortisol/ACTH) levels

Cortisol

42

Acute adrenal insufficiency presentation

Profound hypotension, fever, confusion and coma

43

Peripheral blood findings in hypoadrenalism

Eosinophilia

44

Cosyntropin stimulation test is used to detect _____________ organ failure

Adrenal cortex (it is an ACTH analogue

45

Pharmacologic steroids according to minerolocorticoid activity

Fludrocortisone > Hydrocortisone

46

Cortisol/steroids increase blood pressure by ______________ mechanism (distinct from minerolocorticoid activity)

Permissive effects on NE on vessel wall (inc. vascular reactivity)

47

Symptoms of hypokalemia

Muscular weakness, DI

48

Diagnostics of primary hyperaldosteronism

Hypokalemia, High aldosterone, Low renin (high renin excludes primary hyperaldosteronism)

49

Pharmacologic treatment of Conn's Disease in _______________ pathology

Bilateral hyperplasia (recetion in unilateral adenoma)

50

Consider Conn's in the case of HTN with ______________ clinical picture

Atypical Age (under 30 or over 60); Not controlled by 2 Anti-HTN drugs

51

Radionuclear options of detecting pheochromocytoma

MIBG scanning (detects pheochromocytoma outside adrenals)_

52

Diagnostic tests in correct order for pheochromocytoma

Plasma metanephrines > 24h urine metanephrine (urine VMA less sensitive)

53

Getting ______________ (positive/negative) on a sensitive test results in more diagnostic certainty

Negative (few false negatives -rules out)

54

Getting ______________ (positive/negative) on a specific test results in more diagnostic certainty

Positive (few false positives -rules in)

55

Rx for Pheochromocytoma

Phenoxybenzamine (irreversible alpha blocker); CCB and BB second line

56

Defining lab diagnostics for DM

Fasting glucose > 125 mg/dL on two occassions

57

First line therapy for DM type 2

Diet exercise and weight loss

58

Best Initial treatment using drugs for DM type 2

Metformin (does NOT cause hypoglycemia -can cause lactic acidosis in those with renal failure)

59

DM drug that increases fluid overload and can worsen CHF

TTZs

60

Non sulfa insulin releasing agents

Nateglinide, repaglinide

61

_______________ DM drugs accentuate oral glucose effects on I/G balance

Exenatide, sitagliptin, sazagliptin (Incretins)

62

_______________ DM drug is amylin analog and decreases gastric emptying, glucagon levels and appetite

...

63

Common causes of DKA

Non compliance, infection, pregnancy, serious illness (stressors)

64

Best initial test to assess DKA

Serum Bicarbonate (correlates with severity and mortality risk)

65

CVS medications routine for all DM patients

Aspirin; Statins (if LDL>100 mg/dL -lower target); ACEi (if BP>130/80 mmHg -lower target)

66

Microalbuminuria in DM management

Start ACEi

67

Vaccines for DM patients

Pneumococcal vaccine

68

Routine exams for DM patients

Slit lamp exam, foot exam

69

Gastroparesis in DM treated with _______________ agents

Motility agents -metoclopromide, erythromycin

70

Management for Retinopathy of DM

Good glycemic control; Laser photocagulation retards progression if proliferation present

71

Rx for Diabetic neuropathy

Pregabalin, gabapentin, TCAs, Duloxitine