Diagnosis

Question 1

The occurance of a low-trauma fracture without alternative eplanation is diagonstic of?

Answer 1

osteoporosis

NO matter wat the bone denstity test shows

Question 2

what is the mainstay of diagnosing and monitoring osteoporosis?

Answer 2

Duel-energy X-ray absorptiometry (DXA)

Question 3

what does the T score mean

Answer 3

states how many standard deviations that a pts BMD is from the mean of a population of sex-matched young, healthy controls

Question 4

what does a Z score mean

Answer 4

it is the same thing as a T score, except the reference population is age matched

Question 5

What should be kept in mind when diagnosing a young patient with osteoporosis?

Answer 5

the diagnosis of osteoporosis in young patients should be reserved for those with fragility fractures and should not be made on DXA Alone

Question 6

a T score of -2.5 or lower?

Answer 6

osteoporosis

Question 7

a T score of -1.0 to -2.4

Answer 7

osteopenia

Question 8

For the purpose of diagnosis, what site is used for scoring?

Answer 8

The site that shows an individual’s lowest score

Question 9

What score is used in both premenopausal women and young men?

Answer 9

Z-scores

Question 10

A Z-score less than -2.0 in premenopausal women and young men?

Answer 10

lower than expeced bone density for age

Question 11

useful for accurately determining size of gland and nodules- can also evaluate texture of gland

Answer 11

thyroid ultrasound

Question 12

when do you perform fine needle aspiration?

Answer 12

nodules must be 1cm to biopsy

Question 13

limitation to fine needle aspiration?

Answer 13

cannot differentiate follicular adenoma from follicular carcinoma

Question 14

what do you obtain if TSH is low or FNA shows evidence of follicular neooplasia?

Answer 14

thyroid scan

Question 15

what results could come back for thyroid scan?

Answer 15

Cold: nonfunctioning (5-10% risk of malignancy)
Warm: Functioning (5-10% risk of malignancy)
Hot: hyperfunctioning, rarely malingant

Question 16

diagnosis of cushing’s syndrome

Answer 16

24 hour urine cortisol (at least 2 tests)
dexmethasone supression testing (negative feedback- supressibility) (excess steroid should shut off ACTH if it doesn’t thats supporting)
midnight salivary cortisol x 2-3 (Circadian rhythm)

Question 17

Dexmethasone supression test

Answer 17

1mg of dex taken at midnight- cortisol levels taken in the AM.
Less than 1.8 ug/dL excludes cushing’s
*make sure patient isn’t on OCPs)

Question 18

How do you distingush between ACTH-dependent and independent causes by ordering AM plasma ACTH? what levels would you expect? what would be important to look at?

Answer 18

• plasma ACTH undetectable would be ACTH independent form of cushings- look at adrenals
• Plasma ACTH normal or elevated - ACTH dependent form of cushing’s- look at pituitary gland or ectopic source

Question 19

Imaging studies for cushing’s syndrome?

Answer 19

Pituitary MRI (Cushing’s disease)- depenent ACTH
CT of Adrenals- (Independent ACTH)
CT of thorax (if MRI doesn’t show anything)

Question 20

what is first line treatment for cushing’s syndrome

Answer 20

pituitary surgery is the first-line treatment of cushing’s disease

Question 20

what is first line treatment for cushing’s syndrome

Answer 20

pituitary surgery is the first-line treatment of cushing’s disease

Question 21

how do you confirm the diagnosis of primary aldosteronism?
what is a normal result? what is hyperaldosteronism?

Answer 21

• IV normal saline suppression test: 2-3 liters infused over 4-6 hours
• normal= aldosterone after IV NS<6ng/dl
• Hyperaldosteronism confirmed if PA> 10ng

Question 22

how do you diagnose pheochromocytoma?

Answer 22

measure metanephrines and catecholamines in urine and blood

Question 23

24 hour urine for a phechromocytoma workup measures? (98% sensitive, 98% specific)

Answer 23

fractionated metenephrines
fractionated catecholamines

Question 24

how do you diagnose primary aldosteronism

Answer 24

1. plasma aldosterone/renin ratio (must be off spironolactone or epelerone for 6 weeks- other HTN meds ok)- replace K if low (it will inhibit aldosterone)- Ratio >30 aldosteronism likely
2. confirming diagnosis- Is it suppressible
   * IV NS suppression tes
   * hyperaldosteronism confirmed if PA > 10ng
   * oral salt loading can also be done

Question 25

how do you diagnose myexedma coma?

Answer 25

based on clinical presentaton
* TSH, free T4, T3 not helpful

cortisol/ACTH stimulation
additional labratory values: elevated cholesterol, hyponatremia, elevated CK

Question 26

Types of thyroid cancer

Answer 26

papillary
follicular
medullary
lymphoma
metastatic from breast, lung, kidney, melanoma
anaplastic