Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

STEP 2CK Review > 10 Endocrinology > Flashcards

10 Endocrinology Flashcards

1
Q

Female pt presents with galactorrhea and amenorrhea.

How to workup?

A

DDx:

  1. prolactinoma
  2. hypoT (leads to high TRH, stimulating prolactin)
  3. DA blockers (antipsychotics)
  • taking antipsychotics?
  • get TSH, Prolactin

If prolactin elevated, get MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

prolactinoma

-tx med

A

bromocriptine, cabergoline (DA agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acromegaly

-how to workup

A

workup:

  1. high IFG-1 (GH varies too much during day, even though tumor secretes this)
  2. glucose supproession test (does giving glucose lower GH?)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acromegaly

  • what kills them
  • tx, medical
A
  • cardiomegaly and diastolic HF

- somatostatin (octreotide) before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hormones of ant pit (5) vs post pit (2)

A

post pit has 2: oxytocin, ADH

ant has the rest:
GH, TSH, ACTH, LH/FSH, Prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

chronic hypopituitarism

  • how does it present?
  • how to dx
  • tx
A

Less important hormones lost first: LH/FSH and GH, then TSH, then ACTH (BP)

So, first is reduced libido and menstruation, fatigue, vague sxs

  • insulin stim test (induce hypoglycemia, does GH increase?)
  • MRI to confirm, replace hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute hypopituitarism

  • what 2 dx to know, how present?
  • tx?
A
  1. sheehans–ischemic pituitary post-partum
    - reduced lactation post-partum is 1st sign
  2. apoplexy–pit tumor outgrows blood supply, bleeds
    - rapid decompensation–Think sudden HA with vision change and N/V, followed by adrenal insuff, lethargy, coma. Catastrophic.

Tx: replace hormones! (esp cortisol, T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MRI shows no pituitary. what is going on

A

Empty Sella syndrome.

pituitary is located somehwere else.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Male pt presenting with low libido and vision change. think what

A

Prolactinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diabetes insipidus tx:
central
nephrogenic

A
  • desmopressin

- gentle diuretics (HCTZ +/- amiloride)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SIADH causes

-think what 3 categories

A
  1. brain–tumor, infxn, trauma
  2. lung–small cell CA, COPD, TB
  3. hypothyroid (high TSH can stim ADH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SIADH tx

A

tx underlying cause (eg head trauma, etc)

-Demeclocyline to induce nephrogenic DI to get rid of free water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sick euthyroid syndrome

A

TSH normal, but T4 wacky.

Pt in ICU can get this. Disregard the T4 if TSH is normal!

This is only time to get a rT3 level. (in sick euthyroid rT3 is elevated, confirming sick euthyroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When to get free T3 level

A

Only get if you suspect hyperthyroid (low TSH), but T4 is normal/low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What things affect total T4 level? (2 to remember)

A
  1. estrogen (pregnancy) increases proteins (thyroid binding globulin). So, increased total T4
  2. Cirrhosis is low protein. So, low total T4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Female pt with hyperthyroidism sxs. TSH low, T4 high, cold RAIU.

-DDx, and what is next step

A

Suspicious for:

  1. factitious hyperT
  2. struma ovarii
  3. thyroiditis (acute stage)

Get thyroglobulin levels. Elevated with T4 production, so struma ovarri and thyroiditis have elevated thyroglobulin.

If low, then factitious!b Can also do Sestamibi scan of ovaries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pt with hyperthyroid sxs. You confirm labs–low TSH, high T4.

What is next step, and what results possible?

A

Do RAIU test

  • diffuse–Graves
  • diffuse nodules–nodular goiter
  • hot adenoma

If thyroid NOT hot, then:

  • Thyroiditis (wait for thyroid to calm down, might be temp hypothyroid)
  • factitious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hashimoto’s

-how to dx

A
  1. anti-TPO (thyroid peroxidase),
  2. anti-TG (thyroglobulin).
    (these 2 are 90% spec) Definitive is Bx.

Can present with transient hyper and hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Grave’s unique sxs (2) among all hyperT

-how to tx

A
  1. exophthalmos–tx with steroids

2. pretibial edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thyroid storm tx in what order, mechs

A

First, IVF and cooling blankets. Then 3 P’s

  1. Propranolol–reduce HR to increase BP
  2. PTU/methimazole–reduce T4 production
  3. Prednisone (more likely IV methyprednisolone)–reduce T4-T3 conversion

Iodide can also be used (Wolff-Chaikoff). Thyroid preferential picks up iodide instead of making T4, so temporizing measure. However, if thyroid storm not fixed, that iodide will be used to make more T4! (Wolff-Chaikoff escape)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Thyroid storm, what alarm sxs?

A

Alarm sxs:
Fever
Delirium
Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pt with hyperthyroidism. TSH low, T4 high.

How to know if this is Graves or early Hashi’s?

A

ESR/CRP is elevated in Hashi’s only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thyroid nodule

-how to workup

A

Get TSH first, even if asx. If euthyroid, then get FNA.

If obvious dx is CA (hx of neck CA), then go straight to excision.

24
Q

Papillary cancers:

what to remember about each

A

PFA-M

Papillary–MCC. orphan annie, psammoma, resection with good prognosis

Follicular–“sneaky.” FNA cannot dx, spreads hemotogenously. However, full resection and iodine ablation will find and kill all mets.

Anaplasic–bad, chokes esophagus and trachea. Death 1 yr

Medullary–MEN 2a/b, Calcitonin producing (so HypoCa)

25
MEN syndromes
diamond, square, triangle with tip MEN 1--pit, parathyroid, panc MEN 2a--parathyroid, thyroid medullary, pheo MEN 2b (lincoln--tall)--mucosal, thyroid medullary, pheo
26
rT3 level
Only get if suspect sick euthyroid. will be increased, confirming sick euthyroid
27
thyroglobulin level | -how does this correlate with other thyroid labs
Thyroglobulin is increased when T4 production is increased. So, you can use to see factitious hyperT
28
Thyroiditis | -name types and differences
All can present with transient hyperT (can be months), then transient hypoT. 1. Hashi's--stays hypothyroid 2. de Quervain (tender thyroid) 3. silent lymphocytic--eventually recovers.(in hypothyroid state, distinguish from Hashi's with Ab tests)
29
New Grave's dx | -what meds
Propranolol first, PTU/methimazole takes time for effect Prednisone for exophtalmos
30
Hyperthyroidism meds in pregnancy
'PTU in Pregnancy' but more complicated: PTU in 1st trimester and women who might become pregnant Methimazole in 2nd/3rd trimester to reduce liver complication risks that PTU has
31
Nuclear emergency, what med
Potassium Iodide. Blocks uptake of radioactive iodide in nuclear emergency
32
Pt with thryoid nodule, asx, euthyroid. FNA is equivocal. Do what next?
RAIU when FNA equivocal. If cold area, tx as CA If hot area, tx as toxic adenoma
33
Follicular thyroid Ca, CT does not show mets | -how to tx
General rule--total thyroidectomy, then radioactive iodine (kills all possible mets)
34
you suspect hypercortisolism | -DDX and full workup algorithm?
"Low THen High" 4 DDx: Adrenal adenoma, extra-adrenal tumor, pituitary tumor, exogenous steroids 1. low-dose DST overnight, or 24h urine cortisol. If not suppressed, Cushing's syndrome confirmed. Do: 2. ACTH If low, then primary-hypercort--adrenal tumor or exogenous steroids. MRI/CT. If high, then: 3. High dose DST If cortisol suppresses, then Pit tumor. MRI/inferior petrosal sinus sampling. If cortisol not suppressed, then Ectopic ACTH (small cell/panc CA)
35
You suspect hyperaldosteronism - DDx - Workup algorithm
DDx: primary (Conn's) vs secondary (renovascular, CHF, cirrhosis, nephrotic) 1. 8am Aldo, Renin, Aldo:Renin. D/C HTN meds beforehand. Aldo high, Renin high, Aldo:Renin<10: Likely 2ndary. Do Angiogram of renal arteries. Aldo high, Renin low, Aldo:Renin >20: Likely Primary. Next step: 2. Salt Suppression Test. If Aldo not lowered, then confirm primary. CT/MRI to find tumor.
36
Hyperaldosteronism. You confirmed primary with Salt suppression test. Now you do CT/MRI looking for adrenal tumor. What to be careful about
50% of hyperaldo pts have incidentaloma. Don't cut out GOOD ADRENAL Use Adrenal Vein sampling to confirm mass is indeed the adenoma.
37
Pheo | 5 P's, +2 more
``` Pressure--BP high Pain--HA or chest Palpitations Pallor--vasoconstriction Perspiration ``` Add 2 more P's: phentolamine phenoxybenzamine
38
Pheo - what dx tests (2) - what if tumor does not appear on CT/MRI
``` 24h urine metanephrines (better test), or Urine VMA (cheaper) ``` If CT/MRI doesn't show, use a MIBG scintillography scan. Can also do Adrenal vein sampling.
39
You see an adrenal incidentaloma - Do what tests - what size importance
R/o the 3 main tumors: Conn's--Aldo, Renin Pheo--24h urine metanephrines/urine VMA Cushing's--low dose DST If <4cm, can observe. >4cm or increase in size over time, intervene.
40
You suspect Adrenal insuff: | how to workup?
Main ddx: Addison's vs Pit issue 1. 3am cortisol. If low, then: 2. ACTH (cosyntropin) stim test, measure cort in 60min If cort still low, then primary. CT/MRI abd, replace hormones If cort high, then secondary. MRI head
41
Adrenal insuff: | -tx of primary vs secondary
Primary (Addison's, TB): 1. prednisone 2. fludrocortisone Secondary (Pit issue) 1. prednisone only
42
Migratory necrolytic dermatitis | -what's going on
If pt also has DM, then this is Glucagonoma! CT to find it, resect. Can also get glucagon level
43
You suspect insulinoma - how to dx and confirm - how to know not factitious?
72h fast, with monitoring for sxs (including sz). Confirm with somatostatin receptor scintigraphy (SRS) test +/- CT scan. Factitious can be exogenous insulin and sulfonylurea. - C peptide level (low in exogenous) - sulfonylurea level
44
Diabetes dx tests (3)
1. Random BGx1, with sxs 200+ 2. Fasting BGx2 125+ both times= DM 100-125: do 2h OGTTx1: ``` 200+ = DM 140-200 = pre <140 = normal ``` 3. A1C 6. 5+ = DM 5. 7 - 6.5 = pre
45
T2DM pts: - goal A1C? - Oral meds max A1C reduction - insulins max A1c reduction - What A1C to start insulin?
goal <7% oral: -3 insulin: -7 start insulin at A1C of 9
46
T2DM treatment approach
1. lifestyle + Metformin 2. if 3 mo not at goal, add 2nd agent, based on comorbidities 3. if 3 mo again, not at goal, start insulin.
47
metformin | -contraindications (3 to know)
CKD (Cr >1.5 males, 1.4 females) CHF Liver dz
48
side effects and contraindications: metformin sulfonylureas TZDs
- diarrhea (goes away) - CKD (lactic acidosis), CHF - hypoglyc - reduced dose in CKD (b/c hypoglyc risk) - weight gain, CHF risk - CHF
49
T2DM uncommon med classes - class names - ex brand names - side effects
1. DPP4-i (sitagliptin) 2. GLP-i (exenatide) 3. acarbose 4. SGLT2-i (canagloflozin) 1. weight neutral 2. weight loss 3. diarrhea, flatulence 4. DKA risk
50
Outpt insulin regimens | -what are the 2
- basal-bolus | - mixed ('idiot insulin'): 2x/daily 70/30 humulin or novolin
51
Inpatient diabetes | -how to do it the right way
Basal bolus (+Sliding scale). Remove oral meds. 1. Calculate TDI (total daily insulin) = 0.5U/kg unless Cr high. If TDI
52
1. Somogyi effect, vs 2. Dawn phenomena - how to diff
1. (rebound hyperglyc) too much insulin at night, high AM glucose. Body responded by making more glucose, then insulin wore off by AM. 2. to little insulin at night, high AM glucose. Check 3AM glucose to diff! If high, then Dawn If low, then Somogyi
53
DKA management: | -describe main steps to discharge
1. start NS, check e-lytes 2. If K <4.0, give KCl and don't give insulin yet 3. K good, Give insulin. 4. keep giving insulin until AG closes. If hypoglyc, switch to D5 1/2NS 5. once AG closed, stop insulin drip and bridge with long-acting SQ insulin. Have pt eat. If AG still closed, go home.
54
Young adult, no hx diabetes, comes to ED for polydipsia, polyuria, fatigue. Suspect what, check what labs
Could be DKA vs HHS Glu: 300-500 BMP: AG ABG: acidosis ketones (serum, urine): + Glu: 800-1000 BMP: no AG, but possible contraction alkalosis! Also pseudohypoNa. ABG: no acidosis ketones: - HHS: could see metabolic alkalosis (contraction) causing slow breathing, leading to hypoxia and hypercapnia (intubate!). Coma, unresponsive.
55
Diabetes pts | -what things to check routine, how (3)
1. eyes. q1yr eye exam 2. peripheral neuro. monofilament exam 3. renal: microalb/Cr ratio

STEP 2CK Review (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions