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MTB STEP 2 (R) > MTB 2 CK - Endocrinology > Flashcards

MTB 2 CK - Endocrinology Flashcards

(71 cards)

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1
Q

GH deficiency clinical picture

A

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

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2
Q

Cortisol profile in Pituitary insufficiency

A

Increased in recent disease, Decrease with chronicity (atrophy)

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3
Q

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

A

Cosyntropin

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4
Q

Low GH levels are assessed with ______________ infusion test

A

Arginine and GHRH

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5
Q

Low Prolactin levels are assess with ________________ infusion test

A

TRH

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6
Q

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

A

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

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7
Q

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

A

Cortisone before thyroxine

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8
Q

Electrolyte disturbances that can cause nephrogenic DI

A

Hypercalcemia, Hypokalemia

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9
Q

Rx for Nephrogenic DI

A

HCTZ, Amiloride, Prostaglandin inhibitors like NSAIDs

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10
Q

Best initial test for acromegaly

A

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

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11
Q

Confimatory test for acromegaly

A

Glucose suppresion test

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12
Q

Rx for Acromegaly

A

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

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13
Q

_____________ Thyroid derangement causes prolactinoma

A

Hypothyroidism (elevated TRH levels)

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14
Q

Prolactin levels can be elevated by _____________ drugs

A

Antipsychotics, Methyldopa, Metochlopromide, opioids, TCAs, Verapamil

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15
Q

Systemic conditions that elevate Prolactin levels

A

Renal insufficiency, Cirrhosis

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16
Q

Increased prolactin levels subsequent labs needed

A

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

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17
Q

Prolactinoma Treatment

A

Cabergoline (dopamine agonist), Transphenoidal resection

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18
Q

Hypothyroidism effects on menstruation

A

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

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19
Q

Thyroid replacement indications based on lab results

A

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

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20
Q

Rx for Graves Ophthalmopaathy

A

Steroids

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21
Q

Rx for Graves Thyroid Disease

A

Radioactive Iodine

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22
Q

Thyroid Nodule biopsy is indicated with ______________ Thyroid profile results

A

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

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23
Q

Acute symptomatic hypercalcemia presentation

A

Confusion, stupor, lethargy, constipation

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24
Q

Rx for acute hypercalcemia

A

Saline hydration, Bisphosphonates (pamidronate), Calcitonin

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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

MTB STEP 2 (R) (12 decks)

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