Step 2 Endocrine

Front 1

list the 5 criteria for metabolic syndrome....also known as what?

Back 1

AKA: syndrome X

1- abdominal obesity: >40 inches in men, >35 in women
2- Triglycerides: >150
3- HDL: <40 in men, <50 in women
4- BP >130/85
5- Fasting glucose: >100

Front 2

mnemonic for syndrome x criteria

Back 2

ATHa Big Fellow

(thats a big fellow---say it with a lisp you wanker)

Front 3

there are primary, secondary and tertiary forms of adrenal insufficiency.....which present with bronzing of the skin? why?

Back 3

only primary----Addisons

you get HIGH ACTH in addisons and ACTH and MSH (melanocyte stimulating hormone) share the same precursor so as ACTH goes up so does MSH

Front 4

patient with a gastric bypass is undergoing thyroidectomy....whats important to remember?

Back 4

that the parathyroid glands MUST be preserved since calcium is absorbed in the duodenum and the duodenum is bypassed in gastric bypass surgery. they could end up getting Ca deficiency.

Front 5

MEN 2A and 2B
Neurofibromatosis
Von hippel landau syndrome

all three have what disease in common?

Back 5

pheochromocytoma

Front 6

hyperglycemic hyperosmolar state (hyperglycemic hyperosmolar nonketotic coma) is generally precipitated by what? what age group do you usually see it in? what illness does it usually follow?

Back 6

precipitated by profound dehydration

people in their 70s

usually follows acute febrile illness

Front 7

peripheral sensory neuropathy, decreased DTRs, babinski sign, fatigue....what deficiency are these associated with?

Back 7

vit B12

Front 8

kid cant whistle...what might he have?

Back 8

FSHD

fasioscapulohumeral muscular dystrophy

crazy, huh?

Front 9

randomness......read the HIV infections/CD4 count stuff on pg 174 in the step 1 book

Back 9

read it!

Front 10

what is the HbA1C level when insulin is recommended as the first-line therapy?

Back 10

10%

Front 11

do you see hyper or hypoglycemia in addisons?

Back 11

HYPO

Front 12

what are the lab results for nutritional rickets?

Back 12

elevated alk phos, elevated PTH, low phosphate

Front 13

you inflate a BP cuff on someones arm and see carpal spasm...what is this sign?

how about the sign when you tap on facial nerve near the tragus and get facial twitching?

Back 13

trousseau's sign

chvostek's sign

Front 14

what is the initial treatment of choice for newly diagnosed DM II?? assuming the A1C is below 10%

Back 14

metformin

Front 15

lady with osteoporosis (undergoing Ca treatment) comes in acute mental status change, nausea, vomiting and EKG changes.....what is she suffering from? what EKG changes do you see?

Back 15

she has milk-alkali syndrome, aka: Burnett's syndrome

basically too much calcium from the calcium carbonate she takes

EKG changes seen: QT shortening, PR longation

Front 16

untreated milk-alkali syndrome (also known as what?) can lead to what?

Back 16

acute renal failure

Front 17

what is first line for osteoporosis?

Back 17

bisphosphonates

Front 18

euthyroid patient with a persistent painless nodule...what do you do next?

Back 18

FNA to rule out malignancy

Front 19

patient comes in with fluttering in her chest and its obvious that shes suffer from hyperthyroidism. it has not been proven by labs, but what medication do you start her on?

Back 19

propranolol to treat the beta-adrenergic stimulation until labs can prove the differential

once proven start propylthiouracil or methimazole

Front 20

patient is being treated for hypothyroidism and labs come back showing low levels of albumin...what should be adjusted?

Back 20

her thyroid replacement (levothyroxine) since it is highly protein bound and there will now be more of it floating around

LOWER her levothyroxine

Front 21

what is the best test for assessing a diabetics kidneys? its very cost effective too, if you care to know

Back 21

albumin/creatinine ratio (ACR)

values: >3.5 mg/mmol in females or 2.5 mg/mmol in males is indicative of microalbuminuria

Front 22

what is the most common cystic lesion of the pancreas and when does it show up? how do you treat it

Back 22

pancreatic pseudocyst

shows up after a bout of acute pancreatitis

control pain and follow up later. they usually resolve in 6 weeks

Front 23

what is important to check before starting metformin? how is this checked?

Back 23

check kidney function because it is contraindicated in renal disease

can check with creatinine and urinalysis

Front 24

what is the creatinine threshold above which metformin should NOT be used? what about GFR?

Back 24

1.5

<30 ml/min

Front 25

name two diabetic drugs that are contraindicated in CHF

Back 25

pioglitazone and rosiglitazone

known as the thiazolidinediones

Front 26

bisphosphonates, SERMS (raloxifene), calcitonin

rank in order of line of therapy

Back 26

1st----bisphospho
2nd---serms
3rd--calcitonin

Front 27

what kind of volemic and Na state does SIADH cause?

Back 27

euvolemic hyponatremia

Front 28

what are the RAI uptakes for Graves, toxic multinodular goiter, subacute thyroiditis

Back 28

HIGH for graves

NORMAL-HIGH for multinodular (it will be in nodules/regions)

LOW for subacute thyroiditis

Front 29

once it is established that a patient is hyperthyroid what is the next step?

Back 29

a radioactive iodine uptake scan

Front 30

a patient that is Post-op and suddenly hypotensive with a K+ level of 7 is likely suffering what?

what is the immediate course of treatment?

Back 30

adrenal insufficiency

initiation of corticosteroid therapy

Front 31

what type of hypersensitivity is graves? I, II, III, IV

Back 31

II

Front 32

whats the best way to operate on a unilateral adrenal tumor? open or closed?

Back 32

closed

Front 33

what is the first line therapy for Hyperosmolar hyperglycemic nonketotic coma?

Back 33

isotonic fluid

Isotonic saline fluid administration --> insulin therapy --> correction of electrolyte abnormalities.

Front 34

what bugs commonly cause diabetic foot infections

Back 34

group A strep
s. aureus

Front 35

three things trigger the release of aldosterone what are they?

Back 35

low blood volume
hyponatremia
hyperkalemia

Front 36

patient has hyperaldosteronism...what will their labs show

Na
K
Mg
acid/base
aldosterone/renin ratio

Back 36

HYPER-Na
HYPO-K
HYPO-Mg
metabolic ALKALOSIS
HIGH ratio

Front 37

sodium should be tested to confirm the Dx of hyperaldosteronism if the plasma renin activity (PRA) ratio is greater than what?

Back 37

25

Front 38

best drug treatment for bilateral adrenal hyperplasia

so what do you do for adrenal tumors?

Back 38

spironolactone

extirpate them

Front 39

what drug has been shown to slow the onset of diabetes in patients with syndrome X

Back 39

metformin

Front 40

what levels are elevated and tested for to Dx a pheochromocytoma? they also happen to be the most specific and sensitive test

Back 40

metanephrine levels

catecholamine metabolites (VMA) are also high from norepi and epi breakdown

Front 41

what angle of glaucoma is triggered by anti cholinergics?

what are some of the signs you see?

Back 41

closed

unilateral headache, painful vision loss, fixed mid-dilated pupil

Front 42

what is the NUMBER 1 way to prevent decubitus ulcers in diabetics?

Back 42

CONTROL YOUR SUGAR

Front 43

what is the BP goal for diabetics?

Back 43

<130/80

Front 44

what is non-functioning in sheehan syndrome?

Back 44

the anterior pituitary

Front 45

PCOS....do you see high or low LH?

Back 45

HIGH

Front 46

what is plummer disease?

Back 46

toxic multinodular goiter

Front 47

first trimester pregnancy treatment of hyperthyroidism...what drug do you use?

Back 47

propylthiouracil

Front 48

what are milkman lines and what are they seen in?

Back 48

pseudofractures

seen in osteomalacia

Front 49

patients shows symptoms of hyperthyroidism PLUS fever, profound tachy, and mental status change...what could it be? when does it occur?

Back 49

thyroid storm

occurs after surgery, trauma, infection, labor

Front 50

what is the major side effect of minoxidil?

what type of drug is it? what is the topical form called?

Back 50

hirsutism

anti-hypertensive via vasodilation

rogaine

Front 51

what diabetes drugs cause pancreatitis?

Back 51

incretins----exenatide

Front 52

what happens to potassium levels when you give a DKA patient insulin?

Back 52

it goes down as it is driven into cells