Endo

Question 1

most common cause of primary hypothyroidism in the US

Answer 1

Hashimoto disease

Question 2

MC cause of primary hypothyroidism in the world

Answer 2

iodine deficiency

Question 3

subclinical hypothyroidism

Answer 3

normal T4 level and high TSH

Question 4

how often should pts have TSH checked when initiating therapy for hypothyroidism

Answer 4

every 6 weeks after initiating treatment or changing levothyroxine doses

Question 5

tx for pts who have impaired conversion of T4 to T3 in hypothyroidism

Answer 5

liothyronine therapy in addition to levothyroxine

Question 6

primary adrenal insufficiency is also called

Answer 6

Addison disease

Question 7

what is Addison disease

Answer 7

rare condition in which the adrenal cortex is unable to produce enough glucocorticoids and mineralocorticoids

Question 8

what is Addison disease caused by

Answer 8

dysfunction or destruction of the adrenal cortex, which is located superior to the kidneys

Question 9

MC cause of Addison disease

Answer 9

autoimmune adrenalitis

Question 10

sx chronic Addison disease

Answer 10

weakness, fatigue, loss of appetite, a variety of gastrointestinal symptoms, weight loss, dizziness, and hypotension. Hyperpigmentation of the skin is the most characteristic physical finding of the disease and is typically generalized over the whole body.

Question 11

sx acute Addison disease (crisis)

Answer 11

result of trauma, infection, surgery, fluid depletion, or noncompliance with medications. Patients in crisis present with severe symptoms, including high fever, nausea, vomiting, and altered mental status, and with abdominal symptoms characteristic of an acute abdomen

Question 12

dx Addison disease

Answer 12

morning serum cortisol level and rapid adrenocorticotropic hormone stimulation test

High levels of ACTH and low levels of cortisol indicate primary adrenal insufficiency, while low levels of both ACTH and cortisol indicate secondary adrenal insufficiency

Question 13

electrolyte issues in Addison disease

Answer 13

Hyponatremia in primary adrenal insufficiency is caused by mineralocorticoid and cortisol deficiencies and hyperkalemia is due to decreased mineralocorticoids

hypoglycemia
hypercalcemia

Question 14

tx Addison disease

Answer 14

lifelong with a combination of glucocorticoids and mineralocorticoids.
Glucocorticoids include prednisone, hydrocortisone, and dexamethasone. Mineralocorticoid replacement is typically with fludrocortisone.

Question 15

tx acute adrenal crisis

Answer 15

immediate hydrocortisone, intravenous fluids, vasopressors, broad-spectrum antibiotics, and correction of electrolyte abnormalities and hypoglycemia

Question 16

MC cause of hyperthyroidism

Answer 16

Graves disease

Question 17

other causes of hyperthyroidism

Answer 17

toxic multinodular goiters, toxic adenomas, amiodarone-induced thyrotoxicosis, and iodine-induced hyperthyroidism

Question 18

eye stuff seen in graves dz

Answer 18

exophthalmos

Question 19

tests besides T3, T4, TSH for hyperthyroidism

Answer 19

anti-thyrotropin receptor antibody and a thyroid-stimulating immunoglobulin test
If both are positive, it would be significant for Graves disease

Question 20

tx hyperthyroidism

Answer 20

methimazole or propylthiouracil

Question 21

preferred tx hyperthyroidism in pregnancy

Answer 21

propylthiouracil

Question 22

Cushing disease is caused by

Answer 22

adrenocorticotropic hormone (ACTH)-secreting tumors found in the pituitary gland (most commonly an adenoma and rarely a carcinoma), causing an excess of corticosteroids in the body

Question 23

sx Cushing syndrome

Answer 23

central obesity, moon face, buffalo hump, supraclavicular fat pads, protuberant abdomen, purple striae (around the thighs, breasts, and abdomen), and thin extremities due to muscle atrophy. Other symptoms include hypertension, osteoporosis

Opportunistic bacterial or fungal infections are common, as well as impaired wound healing and easy bruising

Question 24

dx cushing syndrome

Answer 24

The diagnosis of Cushing syndrome requires the establishment of hypercortisolism in the serum or urine.
Typically, cortisol levels are lower in the evening, so a late-night salivary cortisol test that shows consistently high levels is sensitive and specific for Cushing syndrome.
An overnight (low-dose) dexamethasone suppression test uses the functionality of the hypothalamic-pituitary-adrenal (HPA) axis. When dexamethasone is given, a persistently elevated cortisol level in the morning points to Cushing syndrome (normally the HPA axis would be suppressed)

A 24-hour urinary free cortisol that is three times the upper limit of normal is suggestive of Cushing syndrome

Question 25

when you confirm hypercortisolism (those initial few tests) for Cushing, what should be next

Answer 25

a plasma ACTH

Question 26

plasma ACTH Cushing syndrome

Answer 26

A high ACTH level suggests a pituitary or other ectopic ACTH-secreting tumor. A low level indicates an adrenal tumor (because a glucocorticoid-producing tumor is suppressing the HPA axis). Patients with elevated ACTH levels should undergo further testing to delineate whether the source is the pituitary or an ectopic ACTH-secreting tumor. A high-dose dexamethasone suppression test can be performed. In Cushing disease, over 50% suppression will occur since pituitary adenomas are only partially resistant to negative feedback by glucocorticoids. In ectopic ACTH-secreting tumors, cortisol suppression does not occur with high doses of dexamethasone.

Question 27

tx Cushing syndrome

Answer 27

taper of corticosteroids
Pituitary Cushing disease is treated by transsphenoidal selective resection of the pituitary adenoma

Cabergoline, ketoconazole, and metyrapone can be used to reduce levels of cortisol - if not surgical candidates

Question 28

dx DM

Answer 28

random plasma glucose ≥ 200 mg/dL in a patient who is symptomatic, fasting plasma glucose ≥ 126 mg/dL on two separate occasions, glucose level ≥ 200 mg/dL 2 hours after oral glucose tolerance test in the serum or plasma, or hemoglobin A1C (HbA1C) > 6.5%.

Question 29

Metformin should not be prescribed if pt has what GFR

Answer 29

under 30 mL/min/1.73 m2

Question 30

vaccinations DM

Answer 30

yearly influenza vaccination, the pneumococcal vaccine, and the hepatitis B vaccine if previously unvaccinated. The pneumococcal vaccine should be given to patients under 65 years of age, either pneumococcal conjugate vaccine 15 or 20 may be used. If pneumococcal conjugate vaccine 15 (PCV 15) is used, then pneumococcal polysaccharide vaccine 23 (PPSV 23) should be given, where an interval ≥ 8 weeks from vaccination with PCV 15 can be considered. Current guidelines for the tetanus and diphtheria vaccinations and the herpes zoster vaccine should also be followed.

Question 31

A1C goal DM

Answer 31

A1C goal of ≤ 7.0%