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Flashcards in Rapid Review Endocrine Deck (99):
1

Most common cause hypothyroidism

Hashimotos

2

Lab findings in Hashimotos

High TSH, low T4, anti-TPO ab, antimicrosomal ab

3

Exopthalmos, pretibial myxedema, decreased TSH, thyroid bruits

Graves

4

Most common cause Cushing's syndrome

Iatrogenic corticosteroid administration
2nd: Cushing's disease

5

Pt presents w/ signs hypocalcemia, high P, low PTH

Hypoparathyroidism

6

Stones, bones, groans, psychiatric overtones

S/S hypercalcemia

7

Pt c/o HA, weakness, polyuria; exam: HTN, tetany; Labs: hyperNa, hypoK, metabolic alkalosis

Primary hyperaldosteronism (due to Conn's syndrome of bilateral adrenal hyperplasia)

8

Pt presents with tachycardia, wild BP swings, HA, diaphoresis, altered mental state, sense of panic

Pheochromocytoma

9

First in Tx of pheochromocytoma

Alpha antagonist: phentolamine or phenoxybenzamine

10

Pt w. Hx lithium use presents with copious amounts of dilute urin

Nephrogenic DI

11

Tx central DI

DDVAP and free water restriction

12

Postop pt with significant pain presents with hyponatremia and normal volume status

SIADH due to stress

13

Antidiabetic agent associated with lactic acidosis

Metformin

14

Pt presents with weakness, N/V, weight loss, new skin pigmentation. Labs show hyponatremia and hyperkalemia. Tx

Primary adrenal insufficiency- Addision's
Tx: glucocorticoids, mineralocorticoids, IVF

15

Goal HgA1c for DM

<7.0

16

Beta blockers CI in DM

Mask hypoglycemia Sx

17

HLA association with DM I

HLA DR 3,4,DQ

18

4 ways to dx DM

1. Random plasma glc >=200 with sx DM
2. FPG>=126 on 2 occasions
3. Plasma glc >=200 after 74 g OGT
4. HgA1c >=6.5^

19

Mechanism biguanides
Adverse effects

METFORMIN
Dec hepatic gluconeogenesis, inc insulin activity, reduce LDL and raise HDL

GI, lactic acidosis, dec b12 absorption,

CI Renal and liver insufficiency

20

Sulfonylureas
Mechanism
Adverse effects

Glyburide, glimepiride, glipizide
Stimulate insulin release, reduce glucagon, inc insulin binding on tissue receptors

Adverse: hypoglycemia

CI: renal and hepatic insufficiency due to in risk hypoglycemia

21

Thiazolidinediones
Mechanism
Adverse

"Glitazones"
Increase tissue uptake of glc, dec gluconeogenesis

Adverse: weight gain, fluid retention (CI CHF), inc LDL, rare liver toxicity

22

Oral hypoglycemic associated with increased risk MI

Rosiglitazone

23

DPP IV inhibitors
Mechanism
Adverse effects

"Gliptin"
Inhibits degradation of incretin-->dec glucagon, inc insulin, delays gastric emptying

Adverse: diarrhea, constipation, edema

24

Incretin mimetics
Mechanism
Adverse

Exenatide, liraglutide
Agonizes GLP 1 receptor- same as DPP IV inhibitors

Adverse: mild weight loss, n, hypoglycemia, GI, risk pancreatitis

SC injection!!

25

Alpha glucosidase inhibitors

Acarbose
Decreases GI absorption of starch and disaccharides

Adverse: diarrhea flatulence, GI

26

Meglitinides
Mechanism
Adverse

Stimulate insulin release

Adverse: hypoglycemia, expensive with little added benefit over sulfonylureas

27

HHNS vs DKA labs

HHNS: glc >800. No acidosis
DKA: glc 300-800, dec Na, normal or inc K (total body K decreased), dec P, anion gap metabolic acidosis, serum and urine ketones

28

2 types diabetic retinopathy
Tx

Background retinopathy: no neovascularization, tx by controlling risks
Proliferation retinopathy: neovascularization which increases risk hemorrhage, tx photo coagulation

29

EM findings in diabetic nephropathy

Kimmelstiel Wilson nodules in glomeruli

30

Changes of diabetic kidney

Inter capillary glomerulosclerosis, mesangial expansion, BM degeneration

31

3 types diabetic neuropathy and define S/S

1. Sensory: stocking glove, pain and vibration
2. Motor: weakness or loss coordination
3. Autonomic: postural hypotension, impotence, incontinence, gastroperesis

32

Infections associated with onset DM I

Rubella
Coxsackie
Mumps
-Destroy beta islet cells

33

What increasesTBG? Decreases
What happens to T4 levels

Pregnancy, OCP increase; nephrotic syndrome and androgen use decreases TBG

Total will either increase or decrease with amt of TBG, amt of free T4 always same

34

Painful goiter, mild hyperthyroidism Sx, neck pain, fever, increased ESR, decreased uptake on thyroid scan

Subacute thyroiditis
de Quervain

35

Increased uptake on thyroid scan

Graves
Toxic adenoma (Plummer), toxic multinodular goiter

36

anti-TPO

Hashimoto

37

Antithyroglobulin

Hashimoto

38

2 complications of thyroid surgery

Hoarseness: recurrent laryngeal
Hypocalcemia: hypoparathyroidism 2/2 surgery

39

Indications that nodule is malignant

Cold
Male
Age 20-60
Solid on US

40

Best prognosis thyroid cancer

Papillary

41

Worst prognosis thyroid cancer

Anaplastic

42

Parafollicular C cells

Medullary

43

Columnar gland cells

Papillary

44

Undifferentiated cells

Anaplastic

45

Most common thyroid cancer

Papillary

46

Makes calcitonin

Medullary

47

Increased calcium with decreased PTH

Hyperparathyroidism 2/2
-Malnutrition
-Malabsorption
-Renal disease

48

Inc Ca, Dec P, Inc PTH

hyperparathyroidism

49

Dec Ca, Inc P, Dec PTH

HYpoparathyroidism

50

Dec Ca, Inc P, Inc PTH

Pseudohypoparathyroidism

51

Pseudo vs hypoparathyroidism

Pseudo: nonresposiveness to PTH
Hypo: not making enough

52

Associated pseudohypoparathyroidism

Albright Hereditary Osteodystrophy

53

Chvostek's

Tap facial n cause spasm

54

Trousseau

Carpal spasm with BP cuff inflation

55

Drugs block DA synthesis

Haloperidol
Risperdone
Verapamil
Phenothiazines
Methyldopa
Verapamil

56

Major complication acromegaly

Cardiac failure

57

Order of hormone def in hypopituitarism

GH-->LSH/FH-->TSH-->Prolactin-->ACTH

58

Main product of zona glomerulosa

ACTH - conserve Na

59

Main product zona fasciculata

Cortisol

60

Main product zona reticularis

Androgens

61

Function of medulla

Epi and NE

62

Causes Cushing syndrom

Iatrogenic
Pituitary adenoma- Cushing disease
Paraneoplastic ACTH production
Adrenal tumor

63

Dec K, INc Na, metabolic alkalosis, inc aldo:renin ratio

Hyperaldosteronism (Conn's if adrenal adenoma)

64

Addison vs. secondary and tertiary adrenal insufficiecy

Addison: AI destruction adrenal cortices (hyperpigmentation)
2nd: insufficient ACTH from pit
3rd: insufficient CRH from hypothal

ACTH inc w/ Addison, dec 2nd and 3rd
Tx ACTh analogue (cosyntropin) decreases cortisol in 2nd and 3d, not Addison

65

Why is cortisol deficiency in CAH not symptomatic?

Adrenal hypperplasia can maintain cortisol in low to normal range

66

Amenorrhea, ambiguius genitalia, HTN

17 alpha def

67

Inc Na, dec K, dec androgens

17 alpha def

68

Tx 17 alpha def

cortisol to suppress ACTH
Estrogen prog if female
Reconstructive surg if male

69

Ambiguous genitalia and virilization in females
Macrogenitalia and precocious puberty in males
HYPOTENSION

21 alpha def

70

Dec Na, Inc K, Inc androgens

21 alpha def

71

Tx 21 alpha def

Cortisol to suppress ACTH
Mineralocorticoids- fludrocortisone
Reconstructive genital surgery

72

Ambiguous genitalia and virilization in females
Macrogenitalia and precocious puberty in males
HTN

11 beta def

73

Inc deoxycortisone, deoxycortisol, androgens

11 beta def

74

Tx 11 beta def

Cortisol- hydrocortisone or dexamethasone
HTN Tx

75

Most common def from CAH

21 alpha

76

Pheochromocytoma rule of 10s

10%:
Malignant
Multiple
Bilateral
Extra-adrenal
Children
Familial
Calcify

77

Test for pheochromocytoma

24 hr urinary catecholamines and metanephrines - inc VMA and free metanephrines

78

MEN I

Parathyroid hyperplasia
Pancreas or GI tumors
Pituitary dysfcn

79

MEN II A

Medullary thyroid cancer
Parathyroid hyperplasia
Pheochromocytoma

80

MEN II B

Mucosal neuroma
Medullary thyroid cancer
Pheochromocytoma

81

Zollinger ellison
Define
Which MEN

Caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach to maximal activity, with consequent gastrointestinal mucosal ulceration
MEN I

82

Congenital hypothyroid 2/2 I def or hereditary defect thyroid hormone synthesis

Cretinism

83

Ab found in serum of DM I

Anti islet
Anti glutamic acid decarboxylase

84

Cannot be detected on UA protein dipstick

Microalbuminemia

85

Dawn phenomenon

Morning hyperglycemia due to nocturnal release hormones that increase IR and glc
Tx: increase NPH in pm

86

Somogyi phenomenon

Rebound hyperglycemia from excess exogenous insulin; results in hypoglycemia overnight that cause hormones to be release that increase glc
Tx: decrease NPH in pm

87

Metabolic syndrome

Need 3 of 5
1. ABD obesity >40 M, >35 Fe
2. TG >=150
3. HDL =130/85 or requirement HTN meds
5. FG>=100

88

Causes primary hyperthyroidism

Graves
Toxic multinodular goiter
Toxic adenoma
Amiodarine
Postpartum thyrotoxicosis
Postviral thyroiditis

89

Causes primary hypothyroidism

Hashimoto
Iatrogenic - ablation/excision
Drugs - lithium and amiodarone

90

Major complication hypothyroidism

myxedema coma
Tx: Levothyroxine and IV hydrocortisone

91

Papillary thyroid cancer
What cells?
Prognosis

Papillary cells- produce thyroid hormone
Prognosis good - same as papillary
?Subtype papillary

92

The Ps of thyroid neoplasm

Popular is papillary:
Palpable LN
Papillae (branhing_
Pupil nuclei- Orphan Annie
Psammoma bodies
Positive Prognosis

93

Man presents increased serum calcium, normal PTH and low urinary calcium

Familial hypocalciuric hypercalcemia

94

Labs primary vs secondary vs tertiary hyperparathyroidism

All inc PTH
1: inc calcium; other dec or WNL
1: dec phosphate, other inc phosphate

95

Hyponatremia, eosinophilia, hyperkalemia

Adrenal insufficiency
Hyperkalemia only addison, not 2 or 3

96

4 S's of adrenal crisis management

Salt=0.9% saline
Steroids: IV hydrocortisone 100 mg q 8 hr
Support
Search for cause

97

5 P pheo

Pressure-BP
Pain-HA
Perspiration
Palpations
Pallor

98

Ovarian tumor that secrete thyroid hormone

Struma ovarii

99

Caused by maternal IgG autoAb
Infant presents with goiter, tachynpnea, tachycardia, cardiomegalt, diarrhea, poor weight gain 1-2 d after birth

Neonatal thyrotoxicosis