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105 Cards in this Set
- Front
- Back
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What is the best way to test for catecholamine testing
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24 hr urine sample
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What drugs should you monitor serum levels of
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lithium
phenytoin digoxin Carbamazepine Theophylline |
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What is the biggest concern with steroid administartion
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adrenal suppression
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Why is it unsafe to stop steroids abruptly
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Adrenals are unable to kick back in as fast as the pt will need it.
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What is the most common pituitary tumor
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prolactinoma - if someone is lactating for no reason it is indicative of one of these
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What should be done in a lactating women who should not be lactating
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Test serum prolactin levels. If high do a brain MRI to r/o prolactinoma
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What does waking in the night d/t thirst suggest
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diabetes or diabetes insipidus
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What is happening in a person with diabetes insipidus
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lack of ADH
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What is the difference btw 5 alpha redutase and 5' Deiodinase
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5 alpha redutase - used in T metabolism
5' Deiodinase - converts T4 to T3 |
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What medication is used for Graves Dz
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propylthiouracil
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What are the two herbs that are good for Graves dz
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Lycopis and Leanoris
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What endocrine fnx can Lithium decrease
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Thyroid fnx - often not reversable
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How often should TSH be checked when first starting someone on thyroid therapy
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Every 6 weeks
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Pheocromocytoma
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Person that looks like graves dz but thyroid labs are normal - do the DNA test
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What is the classic presentation of Addison's dz
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Not producing enough cortisol
Most often due to autoimmune adrenalitis Sometimes TB or idiopathic atrophy Adrenal medulla unaffected Weakness Fatigue Weight loss Diarrhea Vomiting Hyperpigmentation from Incr. ACTH (mimics MSH hormone) WHY IS THE ACTH HIGH????? Low Na, Cl, Cortisol High K |
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What is the classic presentation of Cushing's
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Hyperadrenalism
Iatrogenic: Steroid administration long term Pituitary adenoma with ACTH production Ectopic ACTH production by neoplasm Thyroid carcinoma Adrenalcortex tumor Sn-Sx Truncal obesity “Moon like facies” (facial edema) Buffalo hump (edema and cellular hypertrophy in the C7 area) Plethora Osteoporosis Wasting of extremities |
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What can occur with thymus in a myastemia gravis
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Hypertorphy
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What is Zollinger-Ellison Syndrome
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It is a tumor in the pancreas that secretes gastrin and could therefore cause ulcers.
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What eating habits to you see in a pt with an insulinoma
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have to eat every 2 hours d/t hypoglycemia. This is a tumor in the pancreas of the beta cells
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What does Type 1 DM look like
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Ketoacidosis - smell like acetone
Retinopathy (blindness) Nephropathy |
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In an acute situation where a person has severe hyperglycemia and you must choose a type of insulin to use what type should you use
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short acting
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What is the clinical presentation of diabetic ketoacidosis
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Hypotension, Tachycardia, Ketosis (acetone breath), Vomiting, abdominal pain (acute abdomen)
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Does lower blood sugar help the DKA?
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No.. add
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What is the difference btw hypoglycemics and reactive dysglycemics
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hypoglycemic won't want to eat
reactive dysglycemic will feel really bad about 1-2 hours after a meal |
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What is the parathyroid's job
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If there is too low Ca - release parathyroid hormone and do 3 things -
inc gut absorption by increasing Vit D inc osteoclast activity add one more thing |
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What malignancy should be on the DDX when a high Ca++ serum is seen in a pt
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Melanoma - or some other type of bone met - lytic bone lesion
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What is the number one cause of elevated serum Ca
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Hyperparathyroidism
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What do bisphosphonate drugs all end in
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ronate
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What are the two main concerning side effects of alendronate and other bishosphonates
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Esophagitis and osteonecrosis
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What are some negative side effects of Raloxifene
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Menapausal sx - hot flashes, artharalgia, myalgias, edema, pruritis, and small risk for DVTs (can use Vit E to reduce these sx and this risk)
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What nutrient/ion can be given to inhibit the thyroid in Grave's dz and why is it no longer commonly used
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Iodine - in high doses shuts the thyroid down. At these high doses you can get foliculitis fever and a
HA (the HA is why people don't do it anymore, b/c it is really uncomfortable) |
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What is propylthiouracil
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A drug that inhibits oxydation of iodine in the thyroid gland therefore blocking thyroid hormone production. It requires tight dosing schedule
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What herb is good to use with Grave's dz to inhibit the thyroid
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Lycopis - can also be used for someone who has overdosed on thyroid meds
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What drug used for bipolar can cause hypothyroidism?
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Lithium - should be screened every 6 months
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What autoimmune condition is suggested by these sx:
Weight loss, tachycardia, heat intolerance, Lid retraction, lid lag, proptosis, (exophthalmia) Secondary to autoimmune swelling of the periorbital fat Goiter Increased T3 & T4 Decreased TSH |
Grave's dz
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What is the concern with nodules on the thyroid. how are they evaluated
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Thyroid cancer
Secretory nodule - caution can induce a thyroid storm Serum Thyroid pannel U/S Tracer scan |
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Who is at greater risk for cancerous nodules of the thyroid
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Post menopausal women and younger men
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What is the response to low blood sugar in the body
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Produce Epi
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What stimulates the production of Aldosterone
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ACTH
HYPERKALEMIA ANGIOTENSIN - 2 |
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What are possible SE of corticosteroid use
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Avascular necrosis of the hip (fat emboli) (sudden unilateral hip pn)
Cushing's syndrome |
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How does a tumor in the adrenal medulla present and what is it called
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Pheochromocytoma
Secretes catecholamines Hypertension Arrhythmias Hyperglycemia Hypermetabolism |
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What is a Pheochromocytoma in a child under 5 y/o
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Neuroblastoma
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What should be on the DDX for a child with an abdominal mass and how can you tell them apart
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Neuroblastoma
Will's tumor - won't have the catacholamine effects Obstruction |
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How does Addison's dz present
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Adrenal cortex doesn't want to work. Leads to ACTH elevated - causing hyperpigmentation.
Weakness Fatigue Weight loss Diarrhea Vomiting |
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What are the Sx of Cushing's dz
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Truncal obesity
“Moon like facies” (facial edema) Buffalo hump (edema and cellular hypertrophy in the C7 area) Plethora Osteoporosis Wasting of extremities |
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What are possible causes of cushing's dz
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Iatrogenic: Steroid administration long term
Pituitary adenoma with ACTH production Ectopic ACTH production by neoplasm Thyroid carcinoma Adrenalcortex tumor |
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What is the main autoimmune condition that you can have thymus hyperplasia
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Masythenia gravis
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Child with polydypsea, polyurea, constant hunger, very catabolic
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Type I diabetes
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Why do Type I DM pts die
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Undiagnosed and have a major metabolic event
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How does a pt with an insulinoma present
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similar to someone who is over injecting insulin. Big crash, resolves with sugar then happens again.
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What type of diabetes is associated with ketoacidosis
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Type 1 DM
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What is Glyburide and what is it used to tx
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Stimulate Insulin release, Inhibits Hepatic Glucose prod.
It used to tx DM (more commonly type 2) It is given orally - it can have cross reactivity with sulfa allergies. |
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What is metformin and what is it used to tx
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decreases the amount of glucose made by the liver while increasing glucose uptake by target tissues.
It is used to tx T2 DM |
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What is rosiglitazone and what is it used tx
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increases target cell sensitivity to insulin (improves insulin resistance).
Used to tx T2DM - note it is not a steroid even though it ends in zone. |
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What conditions must you use caution in with rosiglitazone
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CV and Liver Dz
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What are the sx of overdosing insulin?
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HYPOGLYCEMIA
Obtundation Fatigue Sympathetic response Coma / Death |
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What are the sx of underdosing inulin?
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HYPERGLYCEMIA – KETOACIDOSIS
Thrist, Nausea and other GI symptoms Fatigue, Hypotension, Tachycardia Ketosis (acetone breath) Death |
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What are the sx of Diabetic Ketoacidosis
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METABOLIC CHANGES
Hyperglycemia Glycosuria Non-respiratory Acidosis Ketonemia Ketonuria Uremia Hyperkalemia Hypertriglyceridemia Hemoconcentration |
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What are you concerned about when someone presents with n/v, stomach upset (seem really sick), smell sweet, have ketones in the urine, high blood sugar
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They are in ketoacidosis and will die without tx
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Who is at risk for ketoacidosis
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Previously undiagnosed diabetes
Interruption of insulin therapy Stress of comorbidity, e.g. MI, CHF… Infection Emotional disturbance |
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What does calcitonin do
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It brings serum Ca levels down
increases Ca into the bone Increases excretion of Ca, Na, K Dec excretion of Mg |
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What does parathyroid hormone do
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it increases the levels of Ca in the serum
dec the Ca going into the bone Acts on Vit D to manipulate serum Ca levels |
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What is the clinical presentation of someone in ketoacidosis
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Thirst
Polyuria leading to Oliguria Dehydration Hypotension, Tachycardia Peripheral circulatory failure Ketosis Acetone breath odor Hyperventilation Vomiting Abdominal pain (acute abdomen) Drowsiness, Coma |
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What does increased Alkaline Phosphatase in the serum indicate
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Inc osteoclast activity - inc levels normal in a broken bone or child
Inc levels trigger blastic activity |
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What is the first step when a serum Ca level comes back low or high
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order ionized Ca level, if that is high or low then you need to do a 24 hr urine Ca + if high or low:
Work up Parathyroid, Vitamin D Metabolites CONSIDER LYTIC BONE LESIONS |
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What is raloxifene and what is it used to tx
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Decreases bone resorption and turnover. It is a E response modifier
It is used to tx osteoperosis SE are similar to menopausal sx including inc risk for DVG |
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What do the following sx indicate
Low serum calcium & high serum phosphate Cramping sn-sx: Positive Chvostek’s sign Positive Trousseau’s sign |
Hypoparathyroidism
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What condiditon has increased production of gastrin
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Zollinger Hellinger Syndrome
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When are progesteron levels highest in a cycling female
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Progesterone will is the main production in Leuteal phase – days 16-25 Can test when suspect a problem in this phase
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What is ketosteroid test used for
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Test for adrenal fnx (old test)
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What test do you run if you suspect a pheochromocytoma
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24 hr urine Cortisol + VMA assay
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How do you test for pregnancy
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HcG most sensitive test is the serum quantitative (not qualitative!)
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What tests are run during pregnancy
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CBC – 28 wk, if anemica again at 36 wks
–Serum glucose (28 week) challenge –Serum antibody screen •At 28 weeks only in Rh- moms. –Cervical culture for Group B Strep •At 36 weeks –Nitrazine paper (senses amniotic fluid) |
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What are the most common tumors of the pituitary
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Prolactinoma – hyperprolactinemia
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When is there a surge in Progesteron during pregnancy?
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It is around 15-20 wks and it occurs when the placenta takes over in progesterone production – problem with this can lead to spontaneous abortions.
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What is the biggest concern with steroid use, when taking someone off the steroids
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Rebound adrenal shutdown
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What do LH and FSH do
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LH – androgen ovulation, oestrogen, progesterone
FSH – spermatogenesis, follicle growth |
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What is sheehan’s syndrome
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•Hypoxia leading to low production of pituitary hormones
•May affect one or (mainly) multiple hormones •Concern in women who have recently delivered a baby as the post-natal time period is the most likely time to see this. |
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What hormone does an adenoma secrete
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GH (acromegaly (adult) & giantism (kid keep growing))
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What do corticotrophic tumors produce
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ACTH - leads to high cortisol produciton
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What do you do if a woman or man is lactating when they shouldn’t be
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Serum prolactin → if high → Brain MRI (often E levels and Prolactin are related)
Can mean prolactinoma or cancer |
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What is a Pheochromocytoma
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It is an adrenal tumor of chromaffin cells that secrete catecholamines. There are the following PE HTN, Tachycardia, Diaphoresis and Palpitations
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Once a thyroiditis resolves what condition often then arises
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Hypothyroidism
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What murmur is associated with Graves dz
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midsystolic murmur
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What autoimmune conditions are associated with Hashimotos
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Type I DM
Celiacs Sjogrens |
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Is smoking associated with DM?
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No
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What is DeQuervain's syndrome
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Subacute thyroiditis - painful enlarged thyroid, hyperthyroid for about 1 month then hypo
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What does craniopharyngeoma cause
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hypopitary
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What is the best test for Acromegaly
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IGF-1 serology
this condition is caused by excess GH. |
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What is decreased in congenital adrenal hyperplasia d/t a defect in 21-hydroxylase
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DHEA
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What is the most sensitive test for hemochromatosis
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serum transferrin saturation
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What thyroid mass is located in the midline at the approx level of the hyoid and moves up and down with swallowing and up with protrusion of the tongue. Can have a hx of repeated episode of inflammation and pus drainage
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thyroid ductal cyst
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Diffuse enlargement of the thyroid gland can be found in all of the following
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Graves's dz
simple goiter Hashimoto's dz |
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What are the types of thyroid cancer
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follicular
anaplastic medulary papillary |
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What would suggest thyroitoxicosis in an a non elderly population
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nervousness, exopthalamos, heightened activity
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What are ways elderly pts can present with thyroitoxicosis
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Enlarged nodular thyroid
weakness in shoulder and hip mm atrial fibrillation w/ rapid ventricular rate Domination of cardiovascular complications |
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Polydipsia, polyuria and weight loss present together are all suggestive of what condition
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DM
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What is typically seen in prolactoma in a young male
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decreased libido and decreased testicular size
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What additional testing of a pt with known pheochomacytomas in order to screen for possible occurrence of MEN syndrome
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MRI of pituitary
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Add these conditions
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MEN I
Hyperpartathyroid Pitutary adenoma and |
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Add these conditions
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MEN II
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What are hypertriglyceridemia pts at incrased risk for
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obesity
DM T2 Cardiovascular dz |
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What are psammoma bodies (orphan annie nuclei) and thin projections of epithelium surrounding a fibrovascular core in a thyroid biopsy is associated with what
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Papillary thyroid cancer - the orphan annie nuclei are calcium
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WHat are HLA-DR5 receptors
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They are the receptors involved in Hashimotos
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What is the most common mass in the midline of the neck that can raise T4
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Thyroglossal duct cyst
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