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First Aid Step 2 > Rapid Review Endocrine > Flashcards

Rapid Review Endocrine Flashcards

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1
Q

Most common cause hypothyroidism

A

Hashimotos

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2
Q

Lab findings in Hashimotos

A

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

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3
Q

Exopthalmos, pretibial myxedema, decreased TSH, thyroid bruits

A

Graves

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4
Q

Most common cause Cushing’s syndrome

A

Iatrogenic corticosteroid administration

2nd: Cushing’s disease

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5
Q

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

A

Hypoparathyroidism

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6
Q

Stones, bones, groans, psychiatric overtones

A

S/S hypercalcemia

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7
Q

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

A

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

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8
Q

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

A

Pheochromocytoma

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9
Q

First in Tx of pheochromocytoma

A

Alpha antagonist: phentolamine or phenoxybenzamine

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10
Q

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

A

Nephrogenic DI

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11
Q

Tx central DI

A

DDVAP and free water restriction

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12
Q

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

A

SIADH due to stress

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13
Q

Antidiabetic agent associated with lactic acidosis

A

Metformin

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14
Q

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

A

Primary adrenal insufficiency- Addision’s

Tx: glucocorticoids, mineralocorticoids, IVF

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15
Q

Goal HgA1c for DM

A

<7.0

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16
Q

Beta blockers CI in DM

A

Mask hypoglycemia Sx

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17
Q

HLA association with DM I

A

HLA DR 3,4,DQ

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18
Q

4 ways to dx DM

A
  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^
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19
Q

Mechanism biguanides

Adverse effects

A

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

GI, lactic acidosis, dec b12 absorption,

CI Renal and liver insufficiency

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20
Q

Sulfonylureas
Mechanism
Adverse effects

A

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

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21
Q

Thiazolidinediones
Mechanism
Adverse

A

“Glitazones”
Increase tissue uptake of glc, dec gluconeogenesis

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

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22
Q

Oral hypoglycemic associated with increased risk MI

A

Rosiglitazone

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23
Q

DPP IV inhibitors
Mechanism
Adverse effects

A

“Gliptin”
Inhibits degradation of incretin–>dec glucagon, inc insulin, delays gastric emptying

Adverse: diarrhea, constipation, edema

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24
Q

Incretin mimetics
Mechanism
Adverse

A

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

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

SC injection!!

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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

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