Endocrine Stepup Step2

Front 1

in DKA one will see what symptoms

Back 1

diaphoretics,
NV but no D - b/c there is NO ENTERITIS.

seen usually w/ type1 and unusually w/ type2

Front 2

viral causes for autoimmune DM (type1)

Back 2

coxsackie
mumps
rubella

Front 3

habitus of a DM1 pt

habitus and usual outlook of a DMtype2 pt?

Back 3

skinny, autoimmunity,
fat, develops insulin Resistance over time, B-islet cells produce too much insulin and this over time causes the b-iselt cells to atrophy

Front 4

Dx criteria for DM

Back 4

random plasma glucose >200 w/ sx
random plasma after 2 hr OGT >200 on 2 visits
fasting plasma glucose >126

Front 5

examples of different types of insulin:

rapid acting
regular
long acting

Back 5

lispro, aspart
pump
nph glargine and detemir - onset w.in 2 hrs and last till maxx - 24+ hrs.

Front 6

management for type2DM

Back 6

start w/ metformin and then put on sulfonylurea or thiazolidonenoe if hba1c >7 after 2-3 mo

Front 7

if hba1c after 2nd drug added is still >8.5 then start on insulin additionally or?

Back 7

third agent, acrarbose, etc?

Front 8

#1 complication for dm2

Back 8

hhnk

then retinopthy, nepropathy, neuroapthy, atherosclerosis

Front 9

dka patho and sx?

Back 9

extremely low insulin levels leads to too much glucose 300-800 and sx: dry membranes, kussmal = slow deep breaths, and mental status change, polyuria, polydip, and hypervent, and hypovolemic

Front 10

tx

Back 10

aggressive IVF and insulin, kcl and tx the cause

Front 11

causes of dka

Back 11

mi or high stress, infections, mucromycosis, burns, etoh high use

Front 12

hhnk >800 seen in

Back 12

type 2 dm pts w/ same reasons as above card and NO ACIDOSIS seen w/ this versus in DKA

Front 13

dm drug that causes gi issues most comonly and acidosis most rarely usually first line, what is its moa?

Back 13

decreases hepatic gluconeogenesis, increases insulin activity - metformin

Front 14

dm drug that causes a 24hr hypoglycemia and are contraindicated in pts w/ RF and hepatic issues most common problem is weight gain, moa?

Back 14

stimulate insulin release from the b-islet cells - sulfonyl - glyburide

Front 15

dm drug that causes a 24hr hypoglycemia and $$$, like a sulfonyls and even have same moa, moa?

Back 15

stimulate insulin release - meglitinide

Front 16

causes flatulence and decreases gi carb absportion

Back 16

acarbose

Front 17

moa for glitazones and issues w/ them?

Back 17

cause hpeatic gluconegenesis reduction and wt gain and increase serum ldl and rare liver tox also a/w chf!!

Front 18

2 types of diabetic retinonopathy?

Back 18

background retinopathy (no neo vascularazation) -cotton wooling and edema.
proliferative retinopathy ( w/ neovasc) - hemmoraghic type - use laser photocoag to correct

Front 19

kimmelstein gn - findings?

Back 19

see nodules, mesangial expansion, basement membrane degeneration and, see labs w. hypoalbuminurura

Front 20

diabteic neuropathy sx

Back 20

begins in feet, and ascend w/ stocking glove pattern
decreased pain and vibratory sense
can also get gastroparesis and impotence commonly and tx w/ gabapentin and carbamzapeine, PHEYNTOIN

Front 21

complications w/ dm neuropathy

Back 21

charcot joints = repetitive foot trauma can cause foot deformity and joint destruction.

Front 22

htnsive pt/ dm never give?

Back 22

bb they mask hypoglycemia

Front 23

hypoglycemia common causes:

Back 23

reactive - decrease in serum gluc after eating so eat smaller meals more frequently

iatrogenic = too much insulin, excess administration due to sulfonylurea (glipizde) problem, cpep will be elevated, will see a high insulin lvl and low glucose.

insulinoma - b-iselt tumor, cpep elevated and will see on ct or mri get surgery done or use octreotide

fasting

etoh induced -

pit/adrenal insuff -lo cortisol, so tx is replace cortisol. do acth stim test, if still high then - d/t a non renal/adrenal cause (small cell) if low levels of acth - adrenal tumor

Front 24

in pregnancy tbg is high and total t3,4 is high but?

Back 24

free t3,4 is normal

Front 25

______________ can occur from increase basal metabolic rate, from hyperthyroid

Back 25

osteoporosis

Front 26

a factituous hyperthyroidism will show a ___________ scan

Back 26

normal thy uptake scan

Front 27

a increased thy scan seen w._________________

Back 27

graves and adenomas (tox multinodular goiter)

Front 28

main indications for calcitonin

Back 28

paget's bone disease ( disease of too much osteoblasts and osteoclasts and you get tibial bowing, deafness, kyphosis and increased cranial diameter

and post menopausal osteoprosis

Front 29

graves sx -

Back 29

exopthalmos, pretibial myxedema, painless goiter, and tsi ab's found on serum

Front 30

tx for graves

Back 30

subtotal thyroidectomy and radioablation

prorpthyouracil and methimazole

atenolol

Front 31

plummer's disease or toxic multinodular goiter sx or labs?

Back 31

single or multiple hyperactive nodules

increased scan at site of nodule, and hot nodule seen on labs

Front 32

subacute thyroiditis - de quervain's thyroidits sx and labs?

Back 32

enlarged goiter and hyper then hypo condition due to viral stimulus

PAINFUL GOITER AND FEVER AND INCREASED ESR AND DECREASED UPTAKE ON THYROID SCAN.

NSAIDs and b-b

Front 33

decreased uptake on thyroid scan seen w. (2) disease?

Back 33

silent thyroiditis - post partum and bx shows inflammation ( not really hypo, hyper)

de quervain's- painful, fever, decreased uptake on thyroid scan.

Front 34

ab's seen w/ hashimoto thryoidsitis

Back 34

increased tsh, antimicrosmal abs, antithyrolgobulin abs, decreased uptake on thyroid scan - cold scan!! - HYPO CONDItion

Front 35

THYROID CA - nodules should be worked up by?

Back 35

tsh levels, thyroid function tests and us, fna w/ biopsy

Front 36

most common form of thyroid cancer

Back 36

papilary- of columnar gland cells

Front 37

most aggressive cancer form for thyroid

Back 37

anaplastic - poorly diff, can cause hoarseness and dysphagia and can hit the recurrent laryngeal nerve and prognosis is poor

Front 38

produces calcitonin, thyroid cancer?

Back 38

produces calcitonin - medullary thyroid ca a/w men type 2a,2b cancer of the parafolicular c cells see spiral things.

Front 39

malignant nodule workup?

Back 39

scan - cold usually,

observe - small and cystic nodules
solid and benign - do sx and radioablation
levothyroxine

malignant tumor - resect - <1cm lobectomy if larger do total thyroidectomy w/ ablation

synthroid post surgery for replacement

Front 40

labs:

primary hyperPTH

Back 40

HIGH PTH

HIGH CA

LO PO4

Front 41

MAIN CAUSES OF HYPERPTH

Back 41

ADENOMA (PIT) OR/AND HYPERPLASIA OF THE GLAND

Front 42

sx of hyperpth

Back 42

bones, groans, stones, and psych overtones

Front 43

tx for hyperPTH

Back 43

single adenoma- remove nodule

hyperplasia - remove all 4 and implant a portion of one in the forearm muscle so there is some endogenous pth

tx hypercalcemia w/ ivf and alendronate

Front 44

hyperpth - secondary causes

Back 44

malnurtition, malabsp, and renal disease, or ca-wasting drugs

Front 45

secondary hyperpth (NON RENAL) labs

Back 45

HIGH PTH
LO PO4
LO CA AND VIT D

Front 46

SECONDARY HYPERPTH ( RF) LABS

Back 46

HIGH PTH
HIGH PO4
LO CA, VITD

Front 47

HYPOPTH MOST COMMON CAUSE

Back 47

D/T SURGICAL REMOVAL - OF PARATHYOID OR AUTOIMMUNE GLAND DESTRUCTION - LEADS TO HYPO CA

Front 48

HYPO PTH LABS

Back 48

lo ca, high phos, lo pth

Front 49

signs and symptoms seen w/ hypopth

Back 49

trosseou sign - carpal spasm w/ bp cuff inflation

chvostek sign - tap facial nerve

Front 50

tx for hypopth

Back 50

ca and vitD suuplementaion

Front 51

psuedohypoparathyroidism

Back 51

hypocalcemia resulting from tissue non responsiveness to pth

high pth
lo calcium
high po4

--- looks like secondary hyperpth w/rf

Front 52

tx of psueohypopth?

Back 52

ca supplementation. vitD

Front 53

TRH stimulates? (2)

Back 53

tsh and PTL

Front 54

drugs that cause hyperPTL

Back 54

phenothiazines

risperidone

haldol

m-dopa

verapamil

Front 55

sx for hyperPTL

tx?

Back 55

amenorrhea, galatorrhea, lo libido, ED, bilateral hemianopsia, gynecomastia
cabergoline, bromocriptine, pergolide, transphenoidal surgery

Front 56

to test for excess GH like in acromegaly?

Back 56

give 1 hr 100g glucose test look for increased GH

Front 57

sx for acromegaly?

Back 57

organomegaly,LVH, diastolic dysfunction, dm, cord compression,vision loss, insulin resistance

childhood form - gigantism

Front 58

tx for acromegaly?

Back 58

surgical resection for adenoma ( adenoma is mcc)

Front 59

ORDER OF HORMONE DEFICIENCIES SEEN IN PANHYPOPIT

Back 59

GOOD LUCK FINDING TX FOR PITUITARY ACCIDENTS

GH - GROWTH FAILURE

LH
- AMENORHEA, IMPOTENCE
FSH

TSH - HYPOTHY

PTL - NO LACTTAION

ACTH - DECREASED SKIN PIGMENT, FATIGUE, WT LOSS, LO APPETITE.

Front 60

TEST FOR LO LH?

LO GH?

LO TSH?

LO PTL?

LO ACTH?

Back 60

GIVE MEDROXYPORGESTERONE - STILL LOW

GIVE 2 HR INSULIN OGT - STILL LOW

LO TSH, T4 T3

CORTISOL DOES NOT INCREASE FOLLOWING ADMINISTRATION OF INSULIN

Front 61

CUSHINGS DISEASE

Back 61

EXCESS ACTH BY PIT ADENOMA

Front 62

CUSHINGS SYNDROME

Back 62

EXCESS CORTISOL INTAKE - MCC FOR CUSHINGS

Front 63

DETERMINE CAUSE OF CORTISOL EXCESS

Back 63

LO DEXAME TEST SUPP TEST - 1-2 MG GIVEN PM AND LO CORTISOL NORMALLY FOUND


HIGH SUPP TEST - 8MG/DAY FOR 2 DAYS AND USED TO DETERMINE CAUSE OF CORTISOL EXCESS.

Front 64

WHAT WILL LOW DOSE DEXAMTHASONE SUPPRESSION TEST SHOW FOR A CUSHING'S SYNDROME PT?

Back 64

NO DECREASE

Front 65

cushing's syndrome sx

Back 65

mr. cushings

menstural iregularities

rounded facies

central obestiy

cervical fat pad

urinary cortisol increase

glucose increased = insensitivity

purple striae on abdomen

suppression of immune system

htn, hyper cortisolism, hirsutism

iatrogenic

neoplasm

glucose intolerance

growth retardation

Front 66

cushings labs

Back 66

hyperglycemia, glycosuria, hypokalemia

Front 67

if after low dose dexameth test the next am the cortisol level is still found low that means

Back 67

cushing's not due to intrisnsic cause, due to exogenous steroid administration - remove the pills

Front 68

if after low dose dexameth test there is no change in cortisol following the morning then we will say:

Back 68

dx of cuhsing's do 24 hr urinary cortisol

Front 69

if after no change is seen on dexameth test and ater 24hr urinary cortisol is done, we see high urinary cortisol, what does that tell us?

normal urinary cortisol?

Back 69

high- do high dose dexamth test to determine exact cause, if suppressed this time - think pit adenoma

if not suppressed - get acth level - think adrenal tumor if level is low, if high, no adrenal acth secreting tumor like paraneoplastic small cell


normal not cushings

Front 70

most common complication for cushin's adrenal tumor sugrery

Back 70

avn of hip

Front 71

excess aldosterone secretion caused by a unliateral adenoma

Back 71

hyperaldosteronism

Front 72

labs seen w/ hyperaldosteroneism

Back 72

lo k
hi na
met alkalosis
lo renin - in conns
always whether its primary or secondary hyperaldos will see - increased 24hr urinary aldosterone

Front 73

adrenal insufficiency types:

Back 73

primary - addison's - autoimmune destruction due to hemorrhage (waterhous F syndrome - meningococcal sepsis and hemorrhage into adrenals bilaterally) - see increased msh, and skin pigment (only seen w/ primary!!)

secondary - due to decreased acth production to chronic steroid use (adrenal atrophy) or insufficient acth production by pit. -
Tertiary - hypothalamic failure - CRH not produced.

Front 74

labs in hyperaldosteroneism

Back 74

decreased na and increased k ( like on k sparer) secondary to low aldosterone, decreased cortisol (adrenal insuff) and eosiniophillia

addisons/primary adrenal insuff - see increased acth, increase msh.

secondary insfuff/tertiary - see decreased acth

the low cortison goes UPPP w/ acth analog administration (cosyntropin stim test- dx test for addisons)

in primary insuff/addisons - NO CHANGE

in secondary/tert insuff - see increase!!

Front 75

tx for adrenal insuff

Back 75

mineralocorticoid and glucocorticoid replacment

Front 76

complications of adrenal insuff

Back 76

Addisonian crisis- weakness, fever, ams, vascular collapse, in times of stress, need for cortisol.

Front 77

causes of eosinophilia -

Back 77

drugs, neoplasm, allergies, addisons, ain, collagen vasc disease, parasitic pneumonitis, ascaris lumbracoides

Front 78

cah - types:

recall: 1 first number - then we see htn
1 2nd number - then we see virilization

Back 78

17a - amenorrhea, ambiguous genatalia, htn lo k, hi na, decreased androgens
21a- excess testoserone, ambiguous genitalia, virilization, precocious puberty, hotn, hi k lo na.
11b- virilization, precpuberty in males, ambig genitalia in women and htn, and increased secondary dexoycorticosterone, + androgens. WE SEE BOTH HTN AND VIRILIZATION!!!!

**21 is the most common form of cah

Front 79

what is the pheocromocytoma rule of 10s?

Back 79

10% malignant

10% multiple
10% bilateral
10% extradrenal
10%kids
10%familial
10%calcify

Front 80

diaphorectic w/ intermittent tachycardia and htn, headache

tx?

Back 80

pheo

get 24hr urinary metanphrines, catecholamines and vma


surgery a, before beta

Front 81

men 1 a/w

Back 81

PITY - acromegaly (GH secreting adenoma), cushings (excess cortisol- syndrome), galactorrhea

PARA- hyperPTH, hypercalcemia

Pancreas - zollinger ellison -gastrin producing tumor in duoenum or panc - increased fasting gastrin levels.

Front 82

men2a a/w

Back 82

medullary thyroid carcinoma (recall- psammoma bodies a/w papillary) - increased calcitonin lvls

parathroid - increased PTH - hypercalcemia

pheo- increased urine and serum catcholamines

Front 83

men2b a/w

Back 83

medullary thyroid ca

pheo

mucosal neuroma - NF? marfanoid habitus

Front 84

baby born w/ poor feeding, lethargy, bulgining fontanelles, thick tongue, constipation, umbilical hernia, poor growth, hypotonic, skin dry, jaundice prolonged

Back 84

severely hypothryoid infant - cretinism.

which sx is seen fist?? - prolonged jaundice!

Front 85

bx shows thyroid w/ germinal centers

Back 85

hypothyroidism