Dit - Endocrine 1

Front 1

What is the Somogyi effect.

How do you correct it?

Back 1

High morning glucose d/t evening dose being too high and blood sugar bottoming out around 2-3AM, then cortisol causing it to spike in reaction

TX: decrease evening dose

Front 2

What is the Dawn phenomenon?

How do you correct it?

Back 2

High morning glucose d/t inadequate evening dose, and blood sugars climbing all night

TX: incr. eveneing dose

Front 3

Which oral agent used in the TX of diabetes has the following effect?

1. Lactic acidosis
2. Hypoglycemia
3. Oldest and cheapest
4. Often used in combo with any other agent

Back 3

1. Lactic acidosis = METFORMIN
2. Hypoglycemia = SULFONYUREA, METGLITINIDES
3. Oldest and cheapest = SULFONYUREAS
4. Often used in combo with any other agent = METFORMIN

Front 4

Which oral agent used in the TX of diabetes has the following effect?

1. Also help lower LDL
2. Cx in CHF
3. Cx in elevated serum creatinite
4. Cx in IBS

Back 4

1. Also help lower LDL = METFORMIN
2. Cx in CHF = GLITAZONES
3. Cx in elevated serum creatinite = METFORMIN, SULFONYUREAS
4. Cx in IBS =ALPHA GLUCOSIDASE INHIBITORS

Front 5

Which oral agent used in the TX of diabetes has the following effect?

1. must monitor hepatic serum transaminase levels
2. not associated with wt gain
3. metabolized by liver, not kidney
4. affects post-parandial hyperglycemia; taken with meals

Back 5

1. must monitor hepatic serum transaminase levels = METFORMIN, GLITAZONES
2. not associated with wt gain = METFORMIN
3. metabolized by liver, not kidney = GLITAZONES
4. affects post-parandial hyperglycemia; taken with meals = ALPHA GLUCURONIDASE INHIBITORS

Front 6

What is the TX for DKA?

Back 6

IV fluids**
Continuous Insulin drip
KCl - will have elevated K in blood, but the cells are depleated d/t acidosis
search for an infection
monitor levels of Ca, Mg, P
Monitor Anion gap and Ketons

Front 7

HYQ: How is diabetic gastroparesis Dx'd and Tx'd?

Back 7

Dx: Gastric emptying study

Tx: GI motility agents Cisapride, Erythromycin, Metoclopiramide

Front 8

What is the LDL goal for a diabetic?

Back 8

<100

<70 if evidence of vessel dz

Front 9

What is the Tx for Thyroid storm?

Back 9

1) B-blker: Propanolol
2) PTU: blocks conversion of T4 --> T3
3) Methimazole


for graves dz, give glucocorticoids

Front 10

HYQ: pt has exopthalmos--> what is the likely cause?

Back 10

Graves dz

Front 11

HYQ: In which of the following hyperthyroid dz's is radioactive iodine most likely to result in hypothyroidism?

A) Graves dz
B) Toxic multinodular goiter
C) Toxic Adenoma

Back 11

Graves dz bc the entire thyroid takes up the Iodine, as opposed to just the nodules

Front 12

HYQ: what is the MCC of hyperthyroidism?

How do you TX it?

Back 12

MCC of hyperthyroidism: Graves dz

Tx: radioactive Iodine

Front 13

HYQ: What can cause hypoglycemia in a non-diabetic pt?

Back 13

Insulinoma
Exogenous insulin
ETOH while fasting
Adenral Insufficiency

Front 14

HYQ: Name 4 hallmark Sxs in a pt with DKA

Back 14

Nausea and Vomitting w/o Diarrhea
Kussmaul respirations, decr LOC, Polyurea, Polydipsia,
Incr. ketones, anion gap

Front 15

HYQ: What lab abnormalities necessitate obtaining a TFT to r/o thyroid dz?

Back 15

Incr TSH, decr T4
Incr serum CPK
Hyperlipidemia
Unexplained Hyponatremia

Front 16

HYQ: A pt with hypothyroidism and elevated anti-TPO antibodies is at an incr. risk of which type of cancer?

Back 16

Thyroid Lymphoma d/t Hashimotos

Front 17

What would you suspect to be the cause of hyperthyroidism?

1. extremely tender gland
2. Pretibial myxedema
3. pride in recent weight loss, medical professional
4. Palpation of a single thyroid nodule

Back 17

1. extremely tender gland = DeQuervian
2. Pretibial myxedema = Graves
3. pride in recent weight loss, medical professional = Factitious, exogenous thyroid abuse
4. Palpation of a single thyroid nodule = Toxic Adenoma

Front 18

What would you suspect to be the cause of hyperthyroidism?

1. Palpation of multiple thyroid nodules
2. recent study using IV contrast dye (iodine)
3. eye changes: proptosis, edema, injection
4. Hx of thyroidectomy

Back 18

Toxic Multinodular thyroid
Jod Bastow Phenom
Graves
Overdose of exogenous thyroid hormone replacement

Front 19

What thyroid abnormalities do you expect in pregnancy?

Back 19

Incr TBIG --> incr total, nml free T4

Front 20

What are common complications of thyroid surgery?

Back 20

Horseness d/t damage to the recurrent laryngeal n.

Parathyroid removal

Front 21

What is the Tx for peripheral neuropathy?

Back 21

Gabapentin, Pregabalin, Duloxetine

Front 22

INSULIN comes from _____ cells and functions to_____; whereas GLUCAGON comes from _____ cells and functions to_____.

Back 22

Insulin: B-islet cells --> glucose uptake and storage

Glucagon: a-islet cells --> mobiliation of glucose

Front 23

Diabetes Melitus type __ is Autoimmune, and has association with HLA-__, HLA-___ and HLA-___

Back 23

DM-1 is Autoimmune, and is assoc with HLA-3, HLA-4, and HLA-DQ.

"kids with DM1 like to have 3 or 4 DQs"

Front 24

QH: _____,_____, and _____ have been associated with onset of B-islet cell destruction leading to DM1

Back 24

Rubella, Mumps, Coxsakie virus

Front 25

How is Diabetes Dx'd?

Back 25

Random BS > 200 AND sxs of DM
8hr fasting BS> 126 AND on 2 seperate occasions
BS > 200 after 75g oral glucose load
HGBa1C >6.5% can now be used to Dx DM

Front 26

Who gets HHNK and who gets DKA?

Back 26

DM1 gets DKA
DM2 gets HHNK but can also get DKA

Front 27

Name that diabetes drug:

Decr hepatic gluconeogenesis, and Cx in pts with hepatic and renal insufficiency

Back 27

Metformin

Sulfonylureas are also Cx in hepatic and renal insufficiency

Front 28

Name that diabetes drug:

No risk for hypoglycemia

Back 28

Metformin

Front 29

Name that diabetes drug:

Rare complication of Lactic acidosis

Back 29

Metformin

Front 30

Name that diabetes drug:

Stimulates insulin release

Back 30

Sulfonylureas: Tolbutamide, Glyburide, Glipizide

Meglitinides: repaglinide, Nateglinide

Front 31

Name that diabetes drug:

Causes hypoglycemia

Back 31

Sulfonylureas: Tolbutamide, Glyburide, Glipizide

Meglitinides: Repaglide, Nateglinide

Front 32

Name that diabetes drug:

Decreases hepatic gluconeogenesis AND incr tissue uptake of glucose

Back 32

Thiazolidinediones (Glitazones)
(actos)

Front 33

Name that diabetes drug:

Increases serum LDL, Cx in pts with CHF

Back 33

Thiazolidinediones (Glitazones)

Rosaglitazone --> incr LDL

Front 34

Name that diabetes drug:

Decreases GI abs

Back 34

Alpha-glucosidase inhibitors
(acarbose)

Front 35

Name the sulfonylureas, how they work, and their s/e

Back 35

Tolbutamide, glyburide, glipizide

Stimulate insulin release

s/e: hypoglycemia

Front 36

Name the thiazolidinediones, how they work and the pt populations who benefit most by their use

Back 36

end in "glitazone"

Decr hepatic gluconeogenesis and incr tissue uptake of glucose
Cant use in pts with CHF.
Metabolized by the liver, good choice in pts with renal failure

Front 37

Diabetic Nephropathy

Pathology:
Labs:
Buzz word:
Tx:

Back 37

Diabetic Nephropathy

Pathology: intercapillary glomerulosclerosis, mesangial expansion, basement membrane degeneration
Labs: Hypoalbuminemia, incr Cr, incr BUN, basement membrane thickening
Buzz word: Kimmel-Wilson nodules in glomeruli
Tx: ACE-I, ARB

Front 38

QH: pts with sensory neuropathy are at incr risk for developing ____ and need to be tought to ______.

Back 38

Foot infections, check their feet regulary to avoid ulcer formation

Front 39

QH: ______ results from repetitive trauma in cases of impaired pain sensation and can lead to severe deformity

Back 39

Carchot Joints

Front 40

QH: Diabetics are famous for having __(CV)____ d/t impaired pain sensation.

Back 40

Silent MIs

Front 41

Signs of Hypoglycemia can be masked by___

Back 41

Beta blockers

Front 42

QH: _____ is the greatest cause of death in diabetic pts

Back 42

Cardiac complications d/t atherosclerosis

Front 43

QH: _____ syndrome and ____ use decrease TBG leading to decr total T4 but nml free T4

Back 43

Neprotic syndrome and Androgen use lower TBG

Front 44

Pathophys of Graves Dz

Back 44

TSI Antibodies to the thyroid also stimulate it

Front 45

When taking this drug you need to check the PFTs LFTs and TFTs

Back 45

Amioderone

Front 46

Hypothyroidism can result from
_______ processes, ______surgery, _______radioablation, ______ dysfunction, chronic ______ use, and chronic _____ use.

Back 46

Hypothyroidism can result from autoimmune processes, thyroid surgery, thyroid radioablation, pituitray dysfxn, chronic lithium use, and chronic iodide use

Front 47

What is the MC type of thyroid carcinoma, and what type of cells does it affect? What is the prognosis?

Back 47

Papillary, affects columnar cells of gland. Good prognosis