Family Medicine: Endocrine Topics (Ep 13)

Hello and welcome to Physician Assistant in a Flash. The Flash Card Style podcast to get you ready for your clinical medicine exams and a rotation exam, pack rat, pants or pantry. By now you should know all of the content and you're ready to start actively recalling the information that you need to pass your exam. Join me if you are ready to become a Physician Assistant in a Flash. As we delve into family medicine endocrinology, we're primarily focusing on disorders of the thyroid, adrenal gland and diabetes mellitus. More or less, these three categories alone make up 5% of the family medicine and a rotation exam. You'll get five questions on thyroid balance, adrenal balance and diabetes. The pants on the other hand is 7% endocrinology and it covers way more content than the family med EOR. The family med exam might throw you a curveball but if you're not sure when you're taking the family med exam, it's a safe bet to assume that the answer is either thyroid, adrenal or diabetes. Again, this is not true for the pants. Okay, endocrin can be intimidating to some folks, so hopefully we can demystify it a little bit in this episode. Let's get to it. What is the main hormone affected by Addison's disease? Aldosterone. What is the most serious complication of diabetic ketoacidosis? Cerebral edema and coma. How do you treat the most common cause of cushing's disease? It's usually caused by pituitary adenoma, so refer them to surgery. It is pre-tibial mixidema. Plaques of thick, scaly skin and swelling of the lower legs caused by hyperthyroidism. Next some physical characteristics of a person with cushing's disease. Lean limbs with truncle obesity, purple or blue strie or stretch marks on the abdomen, chercidism, moon faces or facial plethora and buffalo hump, which is a dorsoservical fat pad. Describe the results of a thyroid function test in patients with hypothyroidism. Increased thyroid stimulating hormone, TSH, low T3 and T4. What is first-line treatment for type I diabetes? Insulin. When should you begin screening for diabetes mellitus? Test anyone with a BMI greater than 25 and one other risk factor and test everyone starting at age 45 and repeat that testing every three years. Which endocrine disorder is most strongly linked to sugar and syndrome? Hypothyroidism. What is first-line treatment for diabetic ketoacidosis? IV insulin, be sure to monitor potassium as well and repeat as needed. Define secondary amenorrhea. Absence of mences for six months after having at least three previous cycles. What is the most common functional pituitary adenoma? Perlactenoma. A patient presents two clinic with weight loss, hypotension and hyperpigmentation along the anticubital fossa. All of this has been going on for the past six months. A morning cortisol test is low. What is the best treatment for the suspected diagnosis? This sounds like Addison's Disease. Treat with steroids, so hydrochloridazone or hydrochloridazone. And increase intake of salt and sugar. What is the leading cause of an adrenal crisis? Exogenous steroid withdrawal. Give five signs or symptoms of Hashimoto's thyroiditis. There's a bunch I'll run through them quickly. Hashimoto's and thinking weight gain, thin, brittle, nails and hair, dry skin, cold intolerance, thick lips, enlarged tongue, bradycardia, goiter, anorexia, constipation, umbilical hernia, fatigue, hyporeflexia and depression. What is the pathophysiology of Type 1 diabetes? Autoantibodies to pancreatic cells causing insulin deficiency. There is little to no secretion of insulin. What lab values are indicative of Type 2 diabetes? Random blood glucose greater than 200. Fasting blood glucose greater than 126 or an A1C of 6.5 or higher. What is levothyroxene used for? Treating hypothyroidism. In patients with diabetic ketoacidosis, do you expect to see an anion gap or no? Yes, decay will cause anion gap acidosis. Which organ secretes follicle stimulating hormone? The pituitary gland. A patient has an autoimmune condition causing destruction of the adrenal gland. What condition does she have? Addison's disease, which causes adrenal insufficiency. That is metabolic syndrome. Hypertension, hyperlipidemia, obesity and insulin resistance. A 34-year-old male has gained significant weight in his midsection over the last year. On exam, he has facial plethora, purplish striay on the abdomen and a prominent dorsoservical fat pad. His extremities are lean in proportion to his trunk, which endocrine condition is most associated with this presentation. Cushing's disease. Fluid electrolyte imbalances are associated with adrenal insufficiency. Low sodium, high potassium. An elevated morning cortisol test might lead you to think of what diagnosis. Cushing's disease. A patient tests positive for anti-thyroid peroxidase and anti-thyroglomulan antibodies. What is the diagnosis? Hashimoto thyroiditis. The glutamic acid decarboxylase antibody should make you think of which diagnosis. Type 1 diabetes. What is the A1c goal for patients with diabetes? A1c should be less than or equal to 7. Which anti-thyroid agent is preferred during the first trimester of pregnancy? Propyl thiorecyl. List three signs of diabetic ketoacidosis. 30-breath altered mental status, vomiting, tecipnea, lethargy, hyperglycemia, dehydration, cerebral edema, and ketoneuria. Which organ secretes luteinizing hormone? The pituitary gland. List four signs or symptoms of atticence disease. Weight loss, darkening or bronzing of the skin, amenorrhea, scant pubic hair, salt craving, hypotension, fatigue, muscle weakness, and hypoglycemia. That is the most common cause of Cushing's disease. Pituitary adenoma, secreting adrenocortico-tropic hormone, A-C-T-H. Where does a fiochromocytoma develop? The adrenal gland. List three possible causes of hypothyroidism. Autoimmune thyroiditis, Hashimoto's is most common. Could be an iodine deficiency, metabolic underactivity, or a drug reaction linked to lythium or amiodarone. If five signs or symptoms of graves disease. To just run through a bunch of them, weight loss, fine straight hair, sweating, heat intolerance, eggs up thalmos, palpitations, tachycardia, increased appetite, diarrhea, frequent urination, pre-tibial mixidema, irritability, hyperreflexia, and tremor. What is first-line treatment for type 2 diabetes? Vagonides like metformin. What drug class increases the renal excretion of glucose and causes glucose urea? The SGLT2 blockers, which are the drugs ending in flows in. What medications can be used to treat diabetic peripheral neuropathy? Light-a-cane patches, guppapentin, pre-gablin, tramadol, and tricyclic antidepressants. What drug class is Desmopressin? It's an ADH analog, so it's an anti-diuretic. What tests are part of the diagnostic workup for atticence disease? Morning cortisol, which will be low. Adrenal corticotropic hormone will be high, that's ACTH. You can do a cortisol stimulation test. What ophthalmic conditions are associated with cushing's disease? Glacoma and cataracts. What is the diagnostic workup for afiocromocytelma? Share it with urine metaneffrons or catacolamines and confirm with a CT or MRI. Give three possible causes of hyperthyroidism. Graves disease is most common. Could also be metabolic overdrive, iodine excess, amiodarone, or interferons. Let the results of a dexamethasone suppression test in a patient with cushing's disease. Cortisol will be normal to high, meaning the body did not suppress the steroids. What drug class is metformin? Black winide. It decreases glucose production in those with diabetes. Which anti-hypertensive agents are recommended for patients with diabetes? Ace inhibitors and arbs. List some medications that may increase the effect of insulin, causing hypoglycemia. Alcohol, alpha blockers, anabolic steroids, and beta blockers. What is the pathophysiology of diabetic ketoacidosis? The body digests fat and oxidizes lipids rather than glucose. Alright everyone, as far as family medicine endocrinology goes, I think we did a pretty good review. Like I mentioned in the intro, your exam might have a few questions that are not on thyroid adrenals or diabetes. I think they'll generally be pretty basic questions. So I tried to throw a few of those in there as well, gotta keep you on your toes. If you're looking for a more comprehensive endocrinology review, check out some of the other episodes. Or you can keep hanging out with me here as we finish up the PAEA topic list for the family medicine and a rotation exam.