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MOHD KEYSTONE Exam 1 (Jordan) > Rahhal Study guide / Lecture Review > Flashcards

Rahhal Study guide / Lecture Review Flashcards

1
Q

What are the 3 sulfonylureas to know??

A

glipizide, glyburide, glimepiride

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2
Q

What is the action of the sulfonylureas?

A

insulin secretagogues- lead to glucose independent insulin release (can cause hypoglycemia - eat when taking it)

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3
Q

Side effects of sulfonylureas

A

can cause hypoglycemia - eat when taking it

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4
Q

How do you monitor nephropathy in diabetes patients?

A

by checking urine microalbumin every year.

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5
Q

how do you treat diabetic neuropathy?

A

-ACE inhibitor or ARB

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6
Q

What are the “statin benefit groups”? -4

A
  • all people with atherosclerotic cardiovascular disease
  • all people with LDL >190
  • People 40-75, with LDL>70, and Diabetes
  • People 40-75, LDL >70, without diabetes or heart disease, but 10 year risk of atherosclerotic CVD is >7.5% (use calculator.
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7
Q

What is the differential for PTH independent hypercalcemia? -5 categories

A
  • malignancy/ cancer - overproduction of PTH-rP/ 1,25 OH D
  • granulomatous disease - production of 1,25OH D
  • drug induced (vitamin D toxicity, vitamin A toxicity)
  • immobilization for long time

0milk alkali syndrome (excess Ca intake

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8
Q

what is the most common cause of hypercalcemia in inpatients in the hospital?

A

malignancy/cancer

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9
Q

acute treatment of hypercalcemia

A

fluids to dilute the serum calcium, induce urine excretion of Ca and correct dehydration.

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10
Q

Differential diagnosis of hypocalcemia with elevated PTH.

A
  • Calcium deficiency

- vitamin D deficiency

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11
Q

Differential of hypocalcemia with low or normal PTH.

A

hypoparathyroidism

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12
Q

treatment for hypoparathyroidism.

A
  • oral calcium

- 1,25 OH vit D - active form since there is no PTH to activate vitamin D in the kidney.

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13
Q

What is the treatment goal for hypoparathyroidism?

A

Ca at the low end of normal - any higher would increase the urine calcium and risk kidney stones and nephrocalcinosis)

There is a risk for these since in the absence of PTH, there will be increased urine Ca, since it normally increases reabsorption of calcium in the kidney.)

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14
Q

In clinic, you see a thyroid nodule. You get a TSH. It is high. What is the next step?

A

Fine Needle Aspiration of the tumor.

If the serum TSH is normal or high, you need to do FNA, since malignant nodules typically don’t produce thyroid hormone.

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15
Q

In clinic, you see a thyroid nodule. You get a TSH. It is low. What is the next step?

A

Get a radionuclide scan.
If it is cold (no increased uptake), then get a Fine Needle Aspirate test, to check for cancer.
If it is hot (increased uptake) it is not malignant. Treat hyperthyroidism

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16
Q

Cushing’s disease is?

A

hypercortisolism (can be due to many causes)

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17
Q

What are the symptoms of Cushing disease (elevated cortisol)

A
  • weight gain
  • round face
  • striations
  • thin skin/bruising
  • mood disturbances, insomnia
  • bone loss/fractures.
  • hypertension
  • diabetes/hyperglycemia

NOTE: ectopic cushings (cancer) may present with weight loss due to malignancy/ rapid onset.

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18
Q

What is the treatment for hypoparathyroidism?

A

Calcium + calcitriol (active vitamin D, since kidney can’t activate it without parathyroid hormone.)

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19
Q

T/F: proptosis (exopthalmos) and lid retraction are hyperthyroid signs associated exclusively with graves disease.

A

False.
proptosis is exclusively in Graves, but lid retraction happens in all hyperthyroid cases, due to increased sympathetic activity.

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20
Q

Three types of thyroiditis

A
  • silent (painless)
  • postpartum
  • subacute (painful)
21
Q

“lid lag” is seen in which condition?

A

all types of hyperthyroidism. See whites of eye when you shouldn’t

22
Q

You see a case: high T4, low TSH. you posit that it is hyperthyroidism of thyroid origin. What’s on the differential? What’s the next step?

A

DDx

  • graves (most common)
  • thyroiditis
  • nodular thyroid disease (single adenoma or multinodal goiter)

History will likely tell you the difference. If unsure, do radioiodine uptake test. If confident in diagnosis, treat.

23
Q

Difference b/t a radioiodine uptake test and a radioiodine scan

A

Uptake gives you numbers - tells you the function of the gland

Scan tells you where uptake is increased/decreased, “geography” of the gland.

24
Q

What is a normal thyroid uptake result?

A

-usually the thyroid will take up 25% of the iodine

25
Q

Thyroid uptake results in Graves

A

> 25% (overfunctioning)

26
Q

Thyroid uptake results in thyroiditis.

A

uptake will be

27
Q

Uptake result in nodular hyperthyroidism

A

> 25% (like Graves)

28
Q

Usefulness of radioactive thyroid uptake vs radioactive thyroid scan.

A

uptake differentiates b/t graves/goiter (high) vs. thyroiditis (low)

scan differentiates b/t graves (diffuse uptake) and goiter (nodular uptake))

29
Q

Name 3 tests you can do to screen for Cushing’s.

A
  • 24 hr urine cortisol
  • late night salivary cortisol
  • low dose dexamethasone suppression.
30
Q

What are the main signs of increased prolactin?

A
  • amenorrhea
  • breast discharge
  • infertility
31
Q

If you see high prolactin, what labs should you get?

A
  • pregnancy test
  • TSH (hypothyroid)
  • creatinine (renal failure)
  • look at her medication list.

DONT get a pituitary MRI before these labs!!

32
Q

Why does elevated prolactin cause amenorrhea?

A

high prolactin inhibits GnRH, which lowers LH / FSH, which inhibits gonadal function (inhibits estrogen, ovulation in woman.)

33
Q

What is on the differential for high prolactin (possible causes)

A
  • pregnancy
  • severe hypothyroidism
  • renal failure
  • meds (respiridone and others)
  • pituitary tumor.

-Order labs before getting pituitary MRI.

34
Q

What is the best treatment for pituitary tumors?

A

Dopamine agonists (Cabergoline/bromocriptine)

These will decrease prolactin synthesis, cell multiplication, reducing the tumor size. (95% EFFECTIVE at achieving normal prolactin/ reducing tumor)

-surgery on pituitary carries high risk. Only do it if it is impacting the optic chiasm, etc.

35
Q

Side effects of dopamine agonists

A

Nausea = main side effect.

36
Q

T/F: Prolactinomas, and tumors secreting TSH are the only pituitary tumors for which medical treatment is preferred.

A

False. Prolactinomas are the only ones in which medical treatment works well. All other tumors require surgical resection.

37
Q

When is it possible to treat a prolactinoma with sex hormone replacement instead of prolactin?

A

if the tumor is

38
Q

What are the 4 I’s that can cause diabetic ketoacidosis?

A
  • Insulin therapy stopped
  • infection
  • inflammation
  • infarction
39
Q

Name the 4 things that happen due to the absence of insulin that contribute to DKA.

A
  • decreased glucose uptake bby muscle and fat
  • increased gulconeogenesis in the liver
  • increased amino acid loss (turned into glucose by the liver)
  • increased lipolysis (fatty acids turned into ketones by liver—-> DKA.
40
Q

What are the three long-acting insulin drugs?

A
  • glargine (once/day)
  • detemir (2x/day)
  • NPH (2x/day)
41
Q

What kind of diet should Type 2 diabetics go on?

A

a diet limited in calories (weight) and carbs (glucose)

42
Q

T//F Exercise increases insulin sensitivity

A

True

43
Q

T/F: Tighter glycemic control (hba1c

A

False. Only in type 1.

44
Q

goal BP for diabetics

A

140/90 for all,

if nephropathy 130/80(slows progression).

45
Q

What are the causes of secondary hypercholesterolemia?

A

aromatase inhibitors

-hypothyroidism

46
Q

how do you check for growth hormone excess?

A

Check IGF-1

47
Q

Which five hormones would be affected by panhypopituitaryism?

A
  • TSH
  • ACTH
  • LH/FSH
  • GH (leading to decreased IGF-1)

Increased prolactin!!

48
Q

How does a prolactinoma present in men and women?

A

men - hypogonadism

women - galactorrhea

MOHD KEYSTONE Exam 1 (Jordan) (7 decks)

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