USMLE Step 3 MN > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

diagnosis for diabetes made by ONE of the following (4 different ways)

A
  1. 2 FASTING glucose greater than or equal to 126
  2. ONE RANDOM glucose greater than or equal to 200 WITH symptoms (polyuria, polydipsia, polyphagia)
  3. ABNORMAL GTT (2-hour GTT with 75G glucose load)
  4. HbA1c greater than 6.5%
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2
Q

STRONGEST indication for screening for diabetes

A

HTN

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3
Q

mechanism for type 2 diabetes

A

excess fat = insulin deficiency

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4
Q

best INITIAL treatment for type 2 diabetes

A
  • DIET
  • EXERCISE
  • WEIGHT LOSS
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5
Q

best INITIAL MEDICAL treatment for type 2 diabetes

A

metformin (biguanide)

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6
Q

metformin MOA

A

blocks gluconeogenesis

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7
Q

main advantages of metformin (2)

A
  • no risk of hypOglycemia

- does NOT increase obesity

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8
Q

metformin CONTRAindications (2 main ones)

A
  • renal insufficiency

- use of contrast

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9
Q

name the sulfonylureas (3)

A
  • glyburide
  • glimepiride
  • glipizide
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10
Q

sulfonylurea MOA

A

increase insulin RELEASE from pancreas

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11
Q

sulfonylurea ADVERSE EFFECTS (2 main ones)

A
  • hypOglycemia

- SIADH

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12
Q

name the dipeptidyl peptidase 4 (DPP-4) inhibitors

A
  • sitaGLIPTIN
  • linaGLIPTIN
  • aloGLIPTIN
  • saxaGLIPTIN
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13
Q

dipeptidyl peptidase 4 (DPP-4) inhibitor MOA

A

block metabolism of INCRETINS

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14
Q

mechanism of incretins (GLP and GIP)

```
GLP = glucagon-like peptide
(GIP = glucose insulinotropic peptide)
~~~

A

increase insulin and decrease glucagon secretion from pancreas

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15
Q

name the thiazolidinediones

A
  • rosiGLITAZONE

- pioGLITAZONE

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16
Q

thiazolidinedione MOA

A

increase PERIPHERAL insulin sensitivity

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17
Q

thiazolidinediones CONTRAindication

A

CHF

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18
Q

name the a-glucosidase inhibitors

A
  • acarbose

- miglitol

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19
Q

a-glucosidase inhibitor MOA

A

block glucose ABSORPTION in intestinal lining

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20
Q

name the insulin secretagogues

A
  • nateGLINIDE

- repaGLINIDE

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21
Q

secretagogue MOA

A

increase insulin RELEASE from pancreas

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22
Q

name the SGLT inhibitors (sodium-glucose transport)

A
  • canaGLIFLOZIN
  • dapaGLIFLOZIN
  • empaGLIFLOZIN
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23
Q

SGLT inhibitor MOA

A

inhibits glucose reabsorption in kidneys

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24
Q

name the GLP (glucagon insulinotropic peptide) analogs

A
  • exenaTIDE

- liragluTIDE

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25
GLP analog MOA
slow gastric emptying and promote weight loss
26
name long-acting insulin
- glargine (daily) - detemir (daily, or Q12H) - NPH (Q12H)
27
name short-acting insulin
- aspart - lispro - glulisine
28
mechanism for type 1 diabetes
underproduction of insulin d/t destruction of pancreas
29
DKA presentation
- hyperventilation d/t metabolic acidosis - "fruity" breath from acetone - confusion from hyperosmolar state
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best INITIAL tests for DKA
- chemistry - arterial blood gas - acetone level
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marker of ketone production
B-hydroxybutyrate
32
DKA lab findings
- hyperglycemia (> 250) - hyperkalemia - low bicarb - low pH - elevated AG - elevated acetone, acetoacetate, and B-hydroxybutyrate - +/- pseudohyponatremia
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INITIAL treatment for DKA
NS bolus
34
once DKA is confirmed, next step in management
IV insulin
35
complications of diabetes: BP goal
less than 140/90
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complications of diabetes: LDL goal
diabetes = CAD less than 100 if BOTH DM AND CAD, less than 70
37
complications of diabetes: retinopathy
ANNUAL dilated eye exam to detect PROLIFERATIVE RETINOPATHY
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treatment for proliferative retinopathy in DM
laser photocoagulation
39
complications of diabetes: nephropathy
microalbumin
40
if ANY protein is found in urine of DM patient, should be treated with
ACEI/ARB
41
complications of diabetes: neuropathy
ANNUAL foot exam
42
treatment for diabetic neuropathy
gabapentin, or pregabalin
43
complications of diabetes: erectile dysfunction
no routine screening test: just ask
44
treatment for erectile dysfunction
PDE inhibitor (e.g. sildenafil) n.b. CI with nitrates
45
complications of diabetes: "bloating," constipation, abdominal fullness, and diarrhea
gastroparesis
46
treatment for gastroparesis
metoclopramide, or erythromycin
47
hypOthyroidism: - weight = - intolerance = - hair = - skin = - mental = - heart = - muscle = - reflexes = - fatigue? = - menstrual changes =
- gain - cold - coarse - dry - depressed - bradycardia - WEAK - diminished - yes - yes
48
hypERthyroidism: - weight = - intolerance = - hair = - skin = - mental = - heart = - muscle = - reflexes = - fatigue? = - menstrual changes =
- loss - heat - fine - anxious - tachycardia, tachyarrhythmias (e.g. atrial fibrillation) - WEAK - N/A - yes - yes
49
mechanism of weight gain in hypOthyroidism
low thyroid = decreased metabolic rate (decreased use of glucose and FFA) = weight gain
50
best INITIAL tests for hypothyroidism
- free T4 (decreased) | - TSH (increased)
51
treatment for hypothyroidism
levothyroxine (T4 replacement, which gets converted in tissues to T3)
52
4 forms of hyperthyroid
1. Graves (diffuse toxic goiter) 2. silent thyroiditis 3. subacute 4. pituitary adenoma
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Graves disease (diffuse toxic goiter): - physical findings - RAIU (radioactive iodine uptake) - treatment
- eye, skin, and nail findings - elevated - radioactive iodine ablation (RAI)
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silent thyroiditis - physical findings - RAIU (radioactive iodine uptake) - treatment
- none - low - none
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subacute thyroiditis - physical findings - RAIU (radioactive iodine uptake) - treatment
- tender thyroid gland - low - aspirin
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pituitary adenoma - physical findings - RAIU (radioactive iodine uptake) - treatment
- none - elevated - surgery
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ophthalmopathy seen in Graves disease
- exophthalmos (eyes are bulging) | - proptosis (eyelids are retracted)
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dermopathy seen in Graves disease
pretibial myxedema
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nail finding seen in Graves disease
onycholysis (separation of nail from nailbed)
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ACUTE treatment for Graves disease
PTU (propylthiouracil), or methimazole
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definitive treatment for Graves disease
radioactive iodine ablation (RAI)
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treatment for symptoms in Graves disease (tremor, and palpitations)
propranolol
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PTU (propylthiouracil) MOA
inhibits thyroid peroxidase: - iodination of tyrosine residues of thyroglobulin - coupling of DIT and MIT - decreases PERIPHERAL conversion of T4 to T3
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methimazole MOA
inhibits thyroid peroxidase: - iodination of tyrosine residues of thyroglobulin - coupling of DIT and MIT
65
silent thyroiditis may have which antibodies?
- thyroid peroxidase Ab | - antithyroglobulin Ab
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ONLY cause of hyperthyroidism with ELEVATED TSH
pituitary adenoma
67
treatment for pituitary adenoma
- MRI of brain | - surgery
68
- elevated T4 - low TSH - nonpalpable thyroid d/t atrophy of gland
exogenous thyroid hormone abuse
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- acute - SEVERE - life-threatening hypERthyroidism
thyroid storm
70
treatment for thyroid storm
- iodine (blocks iodine uptake and hormone release) - PTU, or methimazole (blocks thyroxine production) - dexamethasone (blocks PERIPHERAL conversion of t$ to T3) - propranolol (blocks PERIPHERAL EFFECTS)
71
can you determine etiology thyroid function from presence of goiter?
NO, can hypOthyroidism, hypERthyroidism, or normal thyroid
72
next best in management if there is a solitary thyroid nodule
fine needle biopsy (FNA)
73
if solitary thyroid nodule shows cancer, next step in management
surgery
74
MCC of hypercalcemia
PRIMARY hyperparathyroidism
75
other causes of hypercalcemia
- malignancy - granulomatous disease - vitamin D toxicity - thiazide diuretics - TB - histoplasmosis - berylliosis
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mechanism of PTH (parathyroid hormone) (4 effects)
- reabsorbs Ca++ at DISTAL tubule - excretes phosphate at PROXIMAL tubule - activates vitamin D - reabsorbs Ca++ and phosphate from bone
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target organ damage from hyperparathyroidism
- kidney stones - osteoporosis/osteomalacia/fractures - confusion - constipation (initially, diarrhea)
78
diagnostic tests for hyperparathyroidism
- PTH (elevated) | - Ca++ (elevated)
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treatment for hyperparathyroidism
surgery
80
when is surgical removal the answer for hyperparathyroidism?
- symptoms - renal insufficiency - markedly elevated 24H URINE Ca++ - serum Ca++ more than 12.5
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acute, severe hypercalcemia presentation
- confusion - constipation - polyuria/polydipsia (from nephrogenic DI) - short QT syndrome - renal insufficiency (ATN/kidney stone)
82
treatment for acute, severe hypercalcemia
1. hydration (high volume: 3-4 liters of NS) 2. bisphosphonate (very potent, but slow) 3. furosemide (ONLY AFTER hydration) 4. calcitonin (IF hydration and furosemide do NOT work quickly enough) 5. steroid (IF etiology is granulomatous disease)
83
mechanism of volume depletion in hypercalcemia
- inhibits ADH effect in collecting duct = nephrogenic DI | - high Ca++ filtration promotes osmotic diuresis
84
causes of hypocalcemia
- surgical removal of parathyroid glands - hypomagnesemia (PTH needs magnesium to work) - vitamin D deficiency - acute hyperphosphatemia (binds Ca++) - fat malabsorption (binds Ca++ in gut) - PTH resistance (pseudohypoparathyroidism)
85
presentation of severe hypocalcemia
- seizures - neural twitching (Chvostek's and Trousseau's signs) - arrhythmia/prolonged QT
86
treatment for hypocalcemia
- replace Ca++ | - vitamin D if deficient, or hypoparathyroidism
87
clinical presentation, regardless of cause, of hyperadrenalism AKA hypercortisolism (Cushing syndrome)
- fat REdistribution - easy bruising and striae - HTN - muscle wasting - hirsutism
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name the 3 sources of Cushing disease
1. pituitary tumor 2. ectopic ACTH production 3. adrenal adenoma
89
Cushing disease: pituitary tumor - ACTH level - effect of high-dose dexamethasone - specific test for diagnosis - treatment
- high - suppression - MRI, or petrosal vein sampling - removal
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Cushing disease: ectopic ACTH production - ACTH level - effect of high-dose dexamethasone - specific test for diagnosis - treatment
- high - NO suppression - scan chest and abdomen - removal
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Cushing disease: adrenal adenoma - ACTH level - effect of high-dose dexamethasone - specific test for diagnosis - treatment
- LOW - NO suppression - scan adrenals - removal
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lab findings in hypercortisolism
- hyperglycemia - hyperlipidemia - osteoporosis - leukocytosis - metabolic alkalosis (d/t increased urinary loss of H+)
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mechanism of metabolic alkalosis in hypercortisolism
cortisol = mineralocorticoid/aldosterone effects increased H+ excretion at a-intercalated cell of late distal/early collecting duct
94
best INITIAL diagnostic tests
- 1 mg overnight dexamethasone suppression testing | - 24-hour urine cortisol
95
LOW ACTH level
adrenal gland ORIGIN
96
HIGH ACTH level
either pituitary gland or from ECTOPIC production
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- fatigue - anorexia - weight loss - weakness with hypOtension - thin patient with hyperpigmented skin - hypERkalemia, with mild metabolic acidosis - hyponatremia - may have hypoglycemia and neutropenia
adrenal insufficiency (Addison disease)
98
MOST ACCURATE test for adrenal insufficiency
- cosyntropin (synthetic ACTH) stimulation test | - CT scan of adrenal glands
99
treatment for ACUTE addisonian (hypoadrenal) CRISIS
- check cortisol level | - IVF and hydrocortisone
100
treatment for STABLE (nonhypotensive) adrenal insufficiency
prednisone
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treatment for adrenal insufficiency, if patient is STILL hypotensive AFTER prednisone
fludrocortisone
102
- HTN - hypOkalemia - metabolic alkalosis
hyperaldosteronism (Conn syndrome)
103
diagnostic tests for hyperaldosteronism
- LOW renin - HIGH aldosterone - HTN
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how do you confirm diagnosis for hyperaldosteronism
CT scan of adrenal glands
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treatment for hyperaldosteronism: solitary adenoma
surgical resection
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treatment for hyperaldosteronism: hyperplasia
spironolactone
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- HA, palpitations, tremors, anxiety, flushing (all nonspecific) - EPISODIC HYPERTENSION
pheochromocytoma
108
best INITIAL tests for pheochromocytoma
- serum and urinary catecholamine levels (HIGH) | - serum free metanephrine and VMA levels
109
MOST ACCURATE test for pheochromocytoma
CT or MRI of adrenal glands
110
what test is used to detect metastatic disease in pheochromocytoma?
MIGB scan
111
FIRST treatment used for pheochromocytoma
phenoxybenzamine (alpha blockade)
112
treatment for pheochromocytoma AFTER a-blocker
propranolol
113
definitive treatment for pheochromocytoma
surgery
114
ALL forms of congenital adrenal hyperplasia (CAH)
- elevated ACTH - low aldosterone - low cortisol - treatable with prednisone
115
name the 3 kinds of CAH
- 21-hydroxylase deficiency - 11-hydroxylase deficiency - 17-hydroxylase deficiency
116
MOST COMMON TYPE of CAH
21-hydroxylase deficiency
117
- hirsutism (virilization) | - HYPOTENSION
21-hydroxylase deficiency
118
diagnostic test for 21-hydroxylase deficiency
increased 17-hydroxyprogesterone level
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- hirsutism (virilization) | - HYPERTENSION
11-hydroxylase deficiency
120
- HYPERTENSION ONLY | - NO hirsutism (virilization)
17-hydroxylase deficiency
121
MC pituitary tumor
prolactinoma
122
presentation for prolactinoma: men
- impotence - decreased libido - gynecomastia - presents LATE - MORE LIKELY to have signs of mass effect (HA, and visual disturbance)
123
presentation for prolactinoma: women
- amenorrhea - galactorrhea in ABSENCE of pregnancy - presents EARLY
124
MOST ACCURATE test for prolactinoma
MRI of brain
125
best INITIAL treatment for prolactinoma
- dopamine agonist (bromocriptine, or cabergoline) | - surgery, if medicine doesn't work
126
- growth hormone-secreting adenoma in pituitary | - excess production of growth hormone (GH)
acromegaly
127
acromegaly presentation
- enlarged head, fingers, feet, nose, and jaw | - intense sweating (enlarged sweat glands)
128
acromegaly also causes
- joint abnormalities - amenorrhea - cardiomegaly - HTN - colonic polyps - DM
129
best INITIAL test for acromegaly
insulinlike growth factor (IGF)
130
which test is NOT done first for acromegaly, and why?
- growth factor | - bc max secretion is in middle of night and has short half-life
131
MOST ACCURATE test for acromegaly
GH suppression with glucose EXCLUDES acromegaly
132
treatment for acromegaly
transsphenoidal resection
133
somatostatin analog that has some effect on inhibiting GH release
octreotide
134
dopamine agonists that inhibit GH
bromocriptine, and cabergoline
135
GH receptor antagonist
pegvisomant
136
primary amenorrhea causes
1. Turner syndrome | 2. testicular feminization
137
secondary amenorrhea causes
1. pregnancy (MCC) 2. exercise 3. extreme weight loss 4. hyperprolactinemia 5. polycystic ovary syndrome (PCOS)
138
- short stature - webbed neck - wide-spaced nipples - scant pubic and axillary hair - XO karyotype
TURNER SYNDROME
139
- genetically male, but looks/acts/feels female | - does not menstruate (no cervix, fallopian tubes, ovaries, or top 1/3 of vagina)
testicular feminization
140
- obesity - amenorrhea - hirsutism - increased adrenal androgens
PCOS
141
treatment for glucose intolerance and DM in PCOS
metformin
142
treatment for virilization in PCOS
spironolactone
143
- tall male - insensitivity of FSH and LH receptors in testicles - XXY karyotype - VERY HIGH FSH and LH levels, BUT NO testosterone is produced from testicles
Klinefelter's syndrome
144
treatment for Klinefelter's syndrome
testosterone
145
- ANOSMIA (key to diagnosis) - hypogonadism - LOW GnRH, FSH, and LH
Kallman's syndrome
USMLE Step 3 MN
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