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109 Cards in this Set
- Front
- Back
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Low serum calcium and phosphate and elevated alkaline phosphatase suggest the diagnosis of...
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osteomalacia (low levels of vitamin D results in low calcium and phosphate, and the elevated alk phos is a reflection of increased osteoblast activity)
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Paget's disease effect on alkaline phosphatase
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Elevated due to intense osteoblast activity
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Osteoporosis lab values of calcium, phosphate, and alkaline phosphatase
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Normal calcium and phosphate levels, and alkaline phosphatase increases after a fracture
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Hyperparathyroidism lab values of calcium and phosphate
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Increased calcium, decreased phosphate
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Hypoparathyroidism lab values of calcium and phosphate
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Decreased calcium, increased phosphate
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Thyroid replacement therapy effect on a patient who is on an oral hypoglycemic
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Serum levels of the oral hypoglycemic may increase, requiring a lower dose of the agent
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Primary hyperthyroidism effects on thyroid function blood tests
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Decreased TSH, increased T4 and T3
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The single best test for assessing thyroid function
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TSH. High TSH = hypothyroidism. Low TSH = hyperthyroidism.
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Primary hypothyroidism effects on thyroid function blood tests
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Increased TSH, decreased T3 and T4
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Most common cause of hypothyroidism
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Hashimoto's thyroiditis
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Complication of severe hypothyroidism
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Myxedema coma (decreased mental status, hypothermia, and other parasympathetic symptoms. Mortality is 30-60%)
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Hyperthyroidism with exopthalmos, pretibial myxedema, and thyroid bruits
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Graves' disease
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Mainstay of treatment for hyperthyroidism
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Radioactive thyroid ablation. If contraindicated, then thyroidectomy or antithyroid drugs (methimazole or propylthiouracil)
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Best method of assessing a thyroid nodule for malignancy
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Fine needle aspiration
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Type of thyroid carcinoma that is associated with MEN II
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Medullary thyroid carcinoma
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MOA of repaglinide (of the meglitinide class of oral hypoglycemics)
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Stimulates pancreatic beta cells to secrete insulin
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Treatment of hyperthyroidism in patients who are pregnant
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Antithyroid drugs such as propylthiouracil (PTU) or methimazole (tapazol)
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Treatment for thyroid storm
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Beta-blocker to control arrhythmia and tachycardia, antithyroid drugs (PTU or methimazole), verapamil for severe heart failure in the presence of asthma or arrhythmia
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Thyroid lab values in thyroid storm
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Elevated T4, free T4, and T3, and low TSH
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Symptoms of hyperthyroidism with hyperpyrexia, heart failure, shock, coma, or death
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Thyroid storm. Commonly occurs after surgery, radioactive iodine therapy, or during a severe illness such as uncontrolled diabetes, trauma, acute infection, severe drug reaction, or MI
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Secondary hypothyroidism is due to...
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Pituitary TSH deficit. Characterized by normal or low TSH and low T4
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Elevated TSH, decreased free T4, and elevated thyroid peroxidase antibodies (TPO) and microsomal thyroid antibodies
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Hashimoto's thyroiditis
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Cautions in initiating levothyroxine therapy
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Use lower starting dose in cardiac disease as it may exacerbate angina. Concomitant administration of cholestyramine, antacids, and iron supplements may interfere with absorption.
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Most aggressive form of thyroid cancer
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Anaplastic carcinoma
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Name the 4 types of thyroid cancer
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Papillary, follicular, medullary, and anaplastic
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PTH can be suppressed by excess amounts of what vitamin?
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Vitamin D (at a dosage >50,000 IU)
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Treatment for hyperparathyroidism
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Calcitonin to suppress PTH secretion, reducing bone resorption. More aggressive therapy includes pamidronate or bisphosphanates to inhibit osteoclast bone resorption. Plicamycin for refractory patients.
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Immediate treatment for very high calcium (>14)
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IV hydration with normal saline, diuresis with IV furosemide, monitor and replace potassium and magnesium.
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Sudden onset (1-3 weeks) of polyuria, polydypsia, weakness/fatigue, polyphagia, weight loss, and nocturnal diuresis.
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Type I diabetes
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Type I diabetes basic principles of insulin therapy
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Split doses of rapid acting (lispro or regular) and intermediate-acting (NPH or Lente) insulin BID. Adjust according to home blood sugar values.
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Lab criteria for the diagnosis of DM II
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Fasting blood sugar >126 on 2 occasions, 2-hour postprandial glucose >200 after 75g oral glucose, or random glucose >200 on 2 occasions with sxs of diabetes.
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MOA of sulfonylureas such as glyburide
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Stimulates pancreatic beta cells to secrete insulin and may increase number of insulin receptors on hepatocytes, improving glucose uptake. (Reduce blood glucose by 70-80)
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Sulfonylurea major contraindication
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Pregnancy.
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Major side effect of sulfonylureas
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Hypoglycemia
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MOA of biguanides (metformin)
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Decrease hepatic gluconeogenesis
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Side effects of metformin
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GI upset, lactic acidosis, and decreased B12 absorption
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MOA of thiazoladinediones (TZDs)
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Improve insulin sensitivity in muscle and fat cells and may inhibit hepatic glucose output
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MOA of alpha-glucosidase inhibitors
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Decrease postprandial hyperglycemia by decreasing the rate of absorption of most carbohydrates by binding more readily to intestinal disaccharides than digested carbohydrate products.
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Common side effect of alpha-glucosidase inhibitors (Acarbose)
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Flatulence
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C-peptide levels in type 2 diabetes
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Normal or elevated
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C-peptide levels in type 1 diabetes
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Low
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Purpose of measuring c-peptide levels in patients who are injecting insulin
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Determine how much of their own insulin they are producing
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What do low levels of C-peptide and hypoglycemia indicate?
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Patients who are abusing insulin, a sign of malingering.
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Natural physiologic functions of C-peptide
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1. Repairs the muscular layer of arteries
2. Prevents diabetic nephropathy, and improves blood flow to the heart |
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2 fundamental pathogenic defects that are the hallmarks of type 2 diabetes
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Insulin resistance and impaired insulin secretion
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The liver's response to decreased insulin production by pancreatic beta cells.
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Increased glucose production. (The loss of the insulin inhibitory effect on the liver causes an increase in hepatic glucose output)
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The first step and cornerstone in the management of type 2 diabetes
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Lifestyle interventions aimed at weight reduction and increased physical activity in order to improve insulin sensitivity.
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Name the classes of oral antidiabetic agents that are considered insulin secretagogues
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Sulfonylureas, meglitinides, and dipeptidyl peptidase-IV inhibitors (sitagliptin aka Januvia).
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MOA of biguanides (metformin)
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Sensitize the liver to insulin and decrease hepatic glucose output
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MOA of incretin mimetics (exenatide aka Byetta)
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Reduces hyperglycemia by stimulating glucagon-like peptide (GLP)-1 receptors only when levels of glycemia exceed basal levels. Administered subcutaneously.
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Low HDL, high triglycerides, high uric acid levels, central obesity, fasting hyperglycemia, and high blood pressure
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Metabolic syndrome (syndrome X)
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ADA recommended target for hemoglobin A1C in diabetic patients
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<7.0
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Test to detect postprandial hyperglycemia in patients with impaired glucose tolerance but no symptoms of diabetes
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2 hour oral glucose tolerance test
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Most common complication and cause of death in patients with type 2 diabetes
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Cardiovascular disease
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ADA recommendations for HDL level in female patients with type 2 diabetes.
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>50
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Recommended annual assessments in patients with type 2 diabetes
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Dilated eye exam, urinary albumin measurement, and comprehensive foot exam
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Regular insulin: Onset of action, peak effect, and duration
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Onset: 30-60 mins
Peak: 2-4 hours Duration: 5-8 hours |
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Humalog (Lispro): Onset, peak, and duration
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Onset: 5-10 minutes
Peak: 0.5-1.5 hours Duration: 6-8 hours |
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Novalog (Aspart): Onset, peak, and duration
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Onset: 10-20 minutes
Peak: 1-3 hours Duration: 3-5 hours |
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Apidra (glulisine): Onset, peak, and duration
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Onset: 5-15 minutes
Peak: 1-1.5 hours Duration: 1-2.5 hours |
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NPH insulin: Onset, peak, and duration
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Onset: 2-4 hours
Peak: 6-10 minutes Duration: 18-28 hours |
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Levemir (detemir): Onset, peak, and duration
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Onset: 2 hours
Peak: Not discernible Duration: 20 hours |
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Lantus (glargine): Onset, peak, and duration
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Onset: 1-4 hours
Peak: Not discernible Duration: 20-24 hours |
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Diagnostic study to evaluate for adrenal insufficiency
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ACTH stimulation test: shows decreased morning serum cortisol and increased ACTH
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Etiology of secondary adrenal insufficiency
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Decreased ACTH production by the pituitary, caused by cessation of long-term glucocorticoid treatment
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Autoimmune adrenal cortical destruction leading to defiencies of miralocorticoids and glucocorticoids
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Addison's disease
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Increased ACTH secretion can cause what dermatologic manifestation?
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Hyperpigmentation. Seen in Addison's disease.
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4 S's of adrenal crisis management?
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Salt: 0.9% saline
Steroids: IV hydrocortisone 100mg q8hours Support Search for underlying illness |
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2 types of corticosteroids
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glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
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What type of corticosteroid is dexamethasone?
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Almost purely glucocorticoid
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What type of corticosteroid is prednisone?
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Mixed glucocorticoid and mineralocorticoid action
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5 P's of Pheochromocytoma
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Pressure (BP)
Pain (headache) Perspiration Palpitations Pallor/diaphoresis |
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Unilateral adrenal adenoma
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Conn's syndrome
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Hyperaldosteronism presentation
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hypertension, headache, polyuria, and muscle weakness. In severe cases, may have tetany, parasthesias, and peripheral edema
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Treatment for hyperaldosteronism
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Lap or open adrenalectomy for adrenal tumors after correcting BP and potassium. Treat with spironolactone for bilateral adrenal hyperplasia.
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Is hypothyroidism associated with hypo- or hypernatremia?
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Hyponatremia. Obtaining a TSH is part of the evaluation for hyponatremia.
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Thyroid disease that presents with decreased cognitive functioning (memory) and depression
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Hypothyroidism
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What are the causes of primary hyperparathyroidism?
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Multiple endocrine neoplasia, excessive parathyroid hormone
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What are the causes of secondary hyperparathyroidism?
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Renal failure, metastatic bone disease, osteomalacia, and multiple myeloma
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What are the symptoms of hyperparathyroidism?
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"moans, groans, stones, bones, and psychiatric overtones"
Moans: not feeling well groans: abdominal pain, constipation stones: kidney stones bones: bone pain and arthralgias psychiatric overtones: lethargy, fatigue, depression, memory problems |
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Lab values show hypercalcemia and hypophosphatemia. What should be ruled out?
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Hyperparathyroidism
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What is the most common cause of hypoparathyroidism?
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Thyroidectomy
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Labs reveal increased T3 and Free T4, decreased TSH, and elevated antimicrosomal and antithyroglobulin antibody titers. Diagnosis?
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Graves disease
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What medication is used to treat the symptoms of Graves' disease until the hyperthyroidism is resolved?
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Propanolol
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What 3 drugs can lead to hypothyroidism?
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lithium, sulfonamides, and amiodarona
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What type of hypothyroidism is precipitated by an acute illness or trauma and has a very high mortality rate?
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Myxedema coma (treat with IV levothyroxine)
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Labs reveal low free T4, increased TSH, and high titers for antibodies to thyroperoxidase and thyroglobulin. Diagnosis?
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Hashimoto's thyroiditis
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What type of thyroiditis will present with a very painful, tender, red thyroid gland?
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Suppurative thyroiditis (rare disorder caused by pyogenic bacteria)
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Will a cancerous thyroid nodule be "cold" or "hot" on radionuclide scan?
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Cold
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What hormone that is released from the zona glomerulosa of the adrenal cortex helps to regulate sodium balance?
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Aldosterone
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What hormone controls the release of aldosterone?
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Renin
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What hormone that is released from the zona fasciculata of the adrenal cortex helps to maintain physiologic integrity?
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Cortisol
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What hormone controls the release of cortisol?
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ACTH
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What disease is characterized by an excess of glucocorticoids?
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Cushing's syndrome
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What is the most common cause of ACTH-dependent Cushing's syndrome?
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ACTH-secreting pituitary tumor.
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What are the ACTH-dependent causes of Cushing's syndrome?
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ACTH-secreting pituitary tumor, small cell carcinoma of the lung (secretes ACTH), endocrine tumors of foregut origin, pheochromocytoma, and ovarian tumors
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What are the causes of ACTH-independent Cushing's syndrome?
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Adrenal adenoma, adrenal carcinoma, and glucocorticoid administration
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What is the most common cause of chronic corticoadrenal insufficiency?
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Autoimmune. Other causes include tuberculosis and bilateral adrenal hemorrhage
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Which glucocorticoid has the highest potency?
A. Prednisone B. Hydrocortisone C. Dexamethasone D. Methylprednisone |
C. Dexamethasone
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Testing reveals a low plasma renin activity and elevated 24-hour urine aldosterone level. Diagnosis?
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Hyperaldosteronism (Conn syndrome)
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What are the treatment options for Conn syndrome?
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Adrenalectomy or lifelong spironolactone therapy
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What are the 2 primary hormones released from the posterior pituitary gland?
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Antidiuretic hormone (ADH) and Oxytocin
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What is the difference between gigantism and acromegaly?
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Gigantism occurs during childhood, before closure of the epiphyses. Acromegaly occurs after closure of the epiphyses.
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What is the most common cause of acromegaly?
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Pituitary adenoma
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After surgery, what is the treatment for persistent acromegaly?
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somatostatin analogs (octreotide and lanreotide)
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Low blood pressure, weight loss, and abdominal pain associated with hypoglycemia, hyponatremia, and hyperkalemia. Diagnosis?
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Addison's disease (adrenal insufficiency)
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What disease is caused by deficiency of or resistance to vasopressin?
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Diabetes insipidus
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What is the treatment of choice for central diabetes insipidus?
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Desmopressin acetate, intranasally
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What is the initial treatment of choice for hyperprolactinemia?
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Dopamine agonists (cabergoline, bromocriptine, pergolide)
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