Endo

Question 1

Treatment for Cushing’s syndrome, which inhibits cortisol synthesis at the level of 11-hydroxylase?

Answer 1

Metyrapone

Question 2

Treatment for Cushing’s syndrome, which inhibits early steps of steroidogenesis?

Answer 2

Ketoconazole

Question 3

Treatment for Cushing’s syndrome, which is an adrenolytic agent that is also effective for reducing cortisol in adrenocortical carcinoma?

Answer 3

Mitotane

Question 4

Treatment for Cushing’s syndrome, which block 11B-hydroxylase, usually used for severe cases of cortisol exscess?

Answer 4

Etomidate

Question 5

What must be done after successful removal of an ACTH or cortisol producing tumor until HPA axis RESUMES its normal axis?

Answer 5

Physiologic hydrocortisone replacement

Question 6

OHAs that can increase risk of bladder cancer? (2)

Answer 6

Pioglitazone and Dapagliflozine

Question 7

Most common cause of Mineralocorticoid excess

Answer 7

Primary hyperaldosteronism
Bilateral (micro nodular) adrenal hyperplasia (60%) > Adrenal (Conn’s) Adenoma (40%)

Question 8

Clinical hallmark of primary hyper aldosteronism

Answer 8

Hypokalemic hypertension

Others: increase Na retention, aldosterone excess

Question 9

Diagnostic of Primary aldosteronism

Answer 9

Saline infusion test (IV administration of 2L NSS over 4h:
Positive: failure of aldosterone to suppress below 140pmol/L (5ng/dL)

Screening
Endo wise: ARR (aldosterone-renin ratio) > 750pmol/L + high normal or increase aldosterone

Cardio wise: PA:PRA ratio > 30:1

Question 10

Treatment for GRA (glucocorticoid-remediable hyperaldosteronism)

Answer 10

Low dose Dexa that controls BP

Question 11

Adrenal carcinoma-like CT scan characteristics

Answer 11

=/> 4cm
> 20 HU

Benign: </=20 HU

Question 12

WEISS Score for ACC (atleast 3 elements for suggest ACC)

Answer 12

High Nuclear grade
Atypical mitosis
Diffuse architecture
Mitotic rate (>5/hpf)
<25% clear cells
+ necrosis, venous invasion, invasijb of sinusoid and tumors

Question 13

What is the Adjuvant treatment given post removal of ACC with high risk recurrence ?

Answer 13

Mitotane >= 2yrs

High risk: tumor size> 8cm, vascular capsule invasion or violation, Ki67 proliferation index >/= 10%

Question 14

Most common cause of adrenal insufficiency

Answer 14

Autoimmune adrenalitis

Question 15

Hallmark of Proliferative diabetic retinopathy and what is the ultimate effect of proliferative stage

Answer 15

Neovascularization
Retinal hypoxia

Question 16

Treatment for adrenal crisis

Answer 16

Rehydration 1L/hr with continuous cardiac monitoring + Hydrocortisone 100mg IV bolus then 200 mg over 24h

Question 17

Treatment for chronic adrenal insufficiency

Answer 17

Hydrocortisone physiologic doses: HYdrocortisone PO 15-25 mg in2-3 divided doses, half of dose taken in morning
However not preferred for replacement: longacting (prednisolone, dexamethasone)

Question 18

Assay that can predict both fetal and neonatal thyrotoxicosis

Answer 18

TRAb

Question 19

Increased Serum Tg in all types of thyrotoxicosis except for:

Answer 19

Thyrotoxicosis factitia

Question 20

On thyroid scan what characteristics describes a highly malignant nodule?

Answer 20

Hypoechoic, solid, with infiltrative borders, microcalcifications

“Cold nodule”

Question 21

What medicationcan induce secondary hypothyroidism?

Answer 21

Bexarotene treatment
Amiodarone

Question 22

Represent end stage of Hashimoto’s thyroiditis, almost completely absent thyroid cells

Answer 22

Atrophic thyroiditis

Question 23

What condition in hypothyroidism due to increase dermal glycosamoniglycan content which traps water giving rise to non pitting edema

Answer 23

Myxedema

Question 24

How long would you test TFTs after instituting LT4 treatment

Answer 24

2 months

Question 25

Subclinical hypothyroidism (High tsh normal t3t4) which patient would you RECOMMEND to treat with LT4

Answer 25

Woman who wishes to conceive or is pregnant TSH level >10miu/L Start with low dose of levothyroxine25-50 ug/d

Question 26

Consideration for treatment OF LT4 in Hypothyroidism

Answer 26

+ suggestive symptoms of hypothyroidism Positive TPO ab Any evidence of heart disease

Question 27

Prior to conception, in hypothyroidism what is the target Tsh on lt4 therapy

Answer 27

<2.5

Question 28

Elderly patient require __% less thyroxine than young patient

Answer 28

20%

Question 29

Treatment for myxedema

Answer 29

LT4 administered single IV bolus 200-400mcg loading dose, followed by oral dose of 1.6mcg/kg/day, reduced by 25 % if administered IV. Since T4 to T3 is impaired there is rationale for adding liothyronin (T3) IV: initial dose 5-20 micrograms followed by 2.5-10mcg every 8 hours . 
Parenteral hydrocortisone 50mg IV every 6 hours

Question 30

Non inflamed indurated plaque with deep pink or purple color abd and orange skin, mimis elephantiasis

Answer 30

Thyroid dermopathy

Question 31

Form of clubbinf foun in <1% of patient in Graves disease

Answer 31

Thyroid acropachy

Question 32

LOW TSH normal T4 normal t3

Answer 32

Subclinical hyperthyroidism

Question 33

How to avoid thyrotoxic crisis before RAI

Answer 33

Pretreatment with antithyrpid drugs for atleast 1 month before RAI STOP metimazole or carbumaxole 2-3 dats before RAI restart 3-7days after RAI If with opthalmopathy give prednisone 30mg/dat at the time of RAI tapered over 6-8 weeks

Question 34

Treatment for thyroid storm

Answer 34

DOC: PTU 500-1000mg loading dose and 250 mg every 4h. Alt Methimazole 20mgq6 Then SSKI 5 drops q6 Propnaloo 60-80mg PO q4 Others: GC (hydrocortisone 300mg IV bolus then 100mg q8

Question 35

Which thyroid Ca has + Hurthle cell histology

Answer 35

follicular (FTC)