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ENDOCRINOLOGY step 2 C/S > E2 > Flashcards

E2 Flashcards

1
Q

Benefits of pharmacologic intervention for adequate blood glucose control?

A

Reduce microvascular(retinophaty,nephrophaty and nurophaty) complication

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2
Q

What about macrovascular complications and mortality?

A

show no benefit

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3
Q

What factors reduce Macrovascular complications?

A

smocking sensation
Lipid level control
Exercise
BP. control

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4
Q

Indication for treatment in prolactinoma?

A

Macroprolactinoma(>10 mm )
Symptomatic macroprolactinoma
Treat with a dopamine agonist(Capergolin,bromocriptine)

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5
Q

surgery indication?

A

Sise > 3 cm

Enlargement during treatment

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6
Q

Antithyroid drug S/E?

A

Allergic rxn(MC)
Agranulocytosis(rare,do CBC if patient have infection symptom)
MTZ:1st TM teratogenic(aplasia cuitis),cholestasis
PTU:Hepatic failure,ANCA associated vasculitis

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7
Q

Osteomalacia symptoms?

A 
maybe asymptomatic
bone pain
muscle weakness
muscle cramp
difficulty of walking
waddling gait
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8
Q

Diagnosis?

A 
Inc.ALP and PTH
Dec.Ca, P,
Low urinary ca
low VIT D
thining of bone cortex and decrease density
bilateral symmetric psudo#
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9
Q

pathophysiology?

A

Vitamin D deficiency

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10
Q

Cause of diabetic foot ulcer?

A

Neuropathic (MCC)
Previous DFU
Vascular insuficiency
Foot deformity

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11
Q

Neuropathic ulcer?

A

Mainly affect plantar bony prominence area

Punched out ulcer with undermined border

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12
Q

diagnosis?

A

test with monofilament

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13
Q

PAD and diabetic foot ulcer?

A

AKI assess macrovascular obstruction

But diabetic foot ulcer is related to microvascular lesion

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14
Q

Arterial ulcer cmon location?

A

Tip of toe

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15
Q

Confirmatory Diagnosis of PAD?

A

Adrenal suppression test after normal saline
But adrenal venous sampling is important to assess which adrenal is hypersecretory(The mass is not always an indicator of the hypersecreting adrenal)

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16
Q

Managment?

A

For unilateral
Surgery
Aldosterone antagonist for refusing or non-candidates for surgery
For bilateral
Aldosterone antagonist(eplerenone–selective)

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17
Q

What form of estrogen can not affect TBG level?

A

Transdermal estrogen pach(bypass liver)

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18
Q

In Hashimoto thyroiditis which complication can happen even in a subclinical state with high TPO titer?

A 
Recurrent miscarriage
This patient(HTPO) is also at high risk for progression to clinical hypothyroidism. So Levetyroxin Tx is recomended
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19
Q

Initial test to assess the cause of PAI?

A

8-AM cortisol and ACTH

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20
Q

If low cortizole<5ug/dl and high TSH?

A

Confirmatory for PAI

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21
Q

If High cortizole>15ug/dl ?

A

Rule out PAI

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22
Q

If Cortisol 5-15?

A 
Non-confirmatory
Do cosyntropin(HM ACTH) test
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23
Q

If low cortisone and High ACTH after CT?

A

PAI

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24
Q

Low Cortisol and Low ACTH after the test?

A

Therithery/secondary AI(will have blunted response due to adrenal athrophy)

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25
Q

The normal response after CT >20?

A

rule out PAI

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26
Q

Indeterminate?

A

Asses pituitary

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27
Q

the first test to do in hypercalcemia?

A

PTH level

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28
Q

If have low PTH?

A

PTHrP

Vit D level

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29
Q

The first test to do in thyroid nodule in patients with low risk and non-suggestive PE for ca?

A

TSH and U/S

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30
Q

Indication for FNAC?

A

Noncystic >2 cm

malignancy feacher in U/S with size > 1cm

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31
Q

malignancy feature?

A

microcalcification
internal vascularity
irregular margin

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32
Q

other feature for malignancy?

A

Low TSH with low RIU relative to surrounding tissue

33
Q

First-line Tx for DN?

A

TCA(amitriptyline)–Inhibit pain signaling
SNRI(Duloxetine)—Inhibit pain signaling
AC(Pregabaline, Gabapentine)–Central NS inhibition

34
Q

TCA C/I?

A

Age > 65

Underling cardiac disease

35
Q

What to rule out in hyperprolactinemia?

A

Hypothyroidism

RF(Cr)

36
Q

AT drug indication In graves?

A 
Mild symptoms
Low Anti TSHR Ab
In old age
pregnants
small goiter
37
Q

surgery and Radiation?

A

Moderate and severe symptoms

w/o above mentiond list

38
Q

Diabetic Gastropathy pathogenesis?

A

Long-standing DM(T1)
Enteric nerve damage
Failure of fundal relaxation
Uncoordinated peristelisis

39
Q

Diagnosis?

A

nuclear gastric emptying study

40
Q

Managment?

A

Metoclopramide

Erythromycin

41
Q

CM?

A

Postprandial bloating and vomiting
Early satiety
Impaired nutrition
Wight loss

42
Q

GI S/E of DM?

A

Gastroparesis
esophageal dysmotility
Intestinal disorder(diharoa,constipation and incontinence)

43
Q

VIPoma Syndrome CM?

A 
W.Diarrhea--secretory(low stool OG<50)
Hypokalemia Sx--Due to GI loss
Metabolic Alkalosis---GI BC loss
Hypo/ achlorhydria---Decrease GA production
Nausea, Vomiting, and flushing
Hyperglycemia---Glycogenolysis
Maybe Ass. with MEN1
44
Q

Diagnosis?

A

VIP>75 pg/ml

CT: Mass at Tail

45
Q

Management?

A

Rehydration
Octreotide
SUrgery if have hepatic metastasis

46
Q

Hyperthyroid bone disease?

A

High thyroid–Activate osteoclast—B.Reasorbition-D.Bone density/I.# risk—Hypercalcemia–I.PTH–Dec R.Ca and L.Vit D–Renal loss of ca despite hypercalcemia

47
Q

euthyroid sick syndrome?

A

Thyroid hormonal abnormality due to pheripherial T4 to T3 conversion in acute illnes.

48
Q

Cxs?

A

Low T3
Normal T4 and TSH
High rT3
a patient will have no CM

49
Q

Causes ESS?

A

Inc. endogenous glucocorticoid
Inflammatory cytokine(TNF)
Starvation
Drug(amiodarone,CS,BB )

50
Q

How to d/t primary (testicular) male hypogonadism from Secondary(P/H) disorder?

A

PH: High LH/FSH
SH: Normal/Low LH/FSH

51
Q

Is a test next to do?

A

SH: Prolactine and Transferrin saturation +-MRI
PH: karyotype and based on risk

52
Q

Ovarian androgen?

A

Testosterone
Androstenedione
DHEA

53
Q

Adrenal Androgen?

A

All three ovarian A.

DHEA sulfate

54
Q

The first test to do in an old patient with hirsutism with no other disease manifestation like Cushing?

A

Testosterone and DHEAS level

55
Q

Cause of Hypoglycemia in non-diabetics?

A

B cell tumor(high C-P,>20% of insulin C)
surreptitious insulin usage(low C-p)
ILGFII producing mesenchymal tumor (Low I and C.P)
D/T using C-Peptide level

56
Q

CM of Cushing?

A 
Central obesity
Skin atrophy
wide purplish stria
proximal muscle weakness
HTN
Glucose intolerance
Skin Hyperpigmentasion
Depression and anxiety
Hirsutism
57
Q

Diagnosis?

A

2 of these 3 criteria positive
1-24-hour urinary cortisol level
2-Late-night salivary cortisol assay
3-Low dose DEXA supresion test

58
Q

Next to do?

A

TSH level

59
Q

MEN 1 genetic?

A

Autosomal dominant

Due to

60
Q

CXS?

A

3 P tumor

1) pituitary(mainly prolactinoma)
2) P.Hyperparathyroidism
3) Pancras/Gi tumor
- –Gastrinoma(recurrent, resistant PUD)
- –Insulinoma
- –VIP oma
- –Glucagonoma

61
Q

Comorbidity can occur in PCOS?

A

Metabolic syndrome(DM,HTN)
OSA
Non-alcoholic liver disease
Endometrial hyperplasia

62
Q

The best test to diagnose DM in PCOS?

A

Oral glucose tolerance test

63
Q

the precipitating factor for HHS?

A

Acute illness(MI) and trauma
Infection
Insulin therapy interruption
Medication impacts CH metabolism(GC, thiazide, and atypical antipsycotic)

64
Q

things should do before measuring PAC/Renin ratio?

A

Stop drugs that alter aldosterone mechanisms like spironolactone, el, tr, and amiloride.

65
Q

Hypercalcemia of malignancy cause?

A 
Squamous Ca(high PTHrP, Low PTH, and Low P)
Bone metastasi(Low PTH and PTHrP)
66
Q

Treatment for hyperthyroidism due to thyroid distruction?

A

Propranolol

67
Q

What about prednisolone?

A

In dequrivian thyroiditis not respond to NSAID

Amidadron induced destructive thyrotioxicosis

68
Q

Hormonal abnormality in primary hypothyroidism?

A

Hign TSH
HIGH TRH(lead to high prolactin )
Low FSH/LH(due to high prolactin)

69
Q

Large fiber neuropathy in DM manifestation?

A

pressure, proprioception, and balance loss
numbness and poor balance
diminished /absent AR
Reduced/absent VIB,LT, and proprioception

70
Q

small fiber neuropathy in DM manifestation?

A

pain and temprature loss
numbness and poor balance
reduced pinprick
Ankle reflex preserved

71
Q

The first test to do in hypocalcemia?

A

Serum Mg level(low mg cause PTH resistance and low production)

72
Q

the major cause of milk-alkali syndrome?

A

excessive intake of CaCo3

73
Q

Cause of hypercalcemia with low PTH?

A 
Hypercalcemia of malignancy
Vit D toxicity
Granulomatous disease
Drug-induced(thiazide)
Milk alkali syndrome
Thyrotoxicosis
Vitamin A toxicity
Immobility
74
Q

MEN2A?

A

Medullary thyroid ca(calcitonin)
Pheochromocytoma
parathyroid adenoma

75
Q

why we should screen for pheochromocytoma before resectioning of MTca?

A

prevent catecholamine surge(pheochromocytoma should be first resected)

76
Q

how to screen?

A

Plasma fractionated metanephrine assay

77
Q

NA level in three types of DI?

A

Central–High
Nephrogenic–Normal
Psychogenic–Low

78
Q

Is hypocalcemia secondary to RF feature?

A

High PTH
High P
Low Ca
Low Vit D

ENDOCRINOLOGY step 2 C/S (4 decks)

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