Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Boards > Endo 2 > Flashcards

Endo 2 Flashcards

1
Q

Subacute thyroiditis clinical features + RAI result

A
  • precipitated by viral URI commonly
  • tender or painful thyroid
  • suppressed TSH (inflammation causes leakage of stored thyroid hormone)
  • low RAI (due to leakage of stored thyroid hormone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Graves clinical features + lab features

A
  • pathognomic clinical features but some patients don’t have thyromegaly or extra thyroidal manifestations
  • Elevated RAI uptake + elevated thyroglobulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathognomic clinical features of Graves

A
  • thyroid bruit
  • eye disease
  • dermopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Physical exam for toxic adenoma and multi nodular goiter

A

palpable thyroid nodules

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

Clinical features of subclinical Cushing syndrome

A
  • cortisol greater than 5 from 1 mg overnight dexamethasone suppression test
  • no specific features of Cushing syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal plasma aldosterone-plasma renin ratio

A

Less than 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Next step after determining patient has adrenal insufficiency

A

21-hydroxylase antibody (most common cause of primary adrenal insufficiency in the US is autoimmune adrenalitis)

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

What is secondary adrenal insufficiency?

A
  • adrenal insufficiency due to hypopituitarism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lab features of secondary adrenal insufficiency

A
  • low serum cortisol + low or inappropriately normal serum ACTH levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of a large, indeterminate adrenal mass

A
  • Adrenalectomy (never biopsy, adrenocortical carcinoma can be missed due to sampling error)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why patients with primary adrenal failure require both glucocorticoid and mineralocorticoid replacement

A

Destruction of adrenal cortex causes decreased synthesis of both cortisol and aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why you monitor urinary calcium in chronic hypoparathyroidism

A

Without PTH, urinary calcium excretion is higher than normal for any given serum calcium level

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

Workup of suspected hypercalcemia from granulomatous disease (Sarcoidosis)

A

1,25-dihydroxyvitamin D level (macrophages convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D)

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

Lab profile hypercalcemia from granulomatous disease (Sarcoidosis)

A
  • hypercalcemic

- suppressed PTH

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

Diagnosis of diabetes insipidus

A
  • urine and serum osmolality

- NOT desmopressin challenge or water deprivation test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of toxic adenoma

A

Radioactive iodine

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

Goal A1c in older adults

A

7.5-8.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hypothalamic-pituitary-adrenal gland axis

A

CRH release from hypothalamus –> acts on pituitary to release ACTH –> ACTH acts on adrenal gland to release cortisol

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

Thyroid axis

A

TRH relapse from hypothalamus –> acts on pituitary to please TSH –> TSH acts on thyroid to release T3 and T4

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

Hypothalamic-pituitary-gonadal axis

A

GnRH from hypothalamus –> acts on anterior pituitary to release LH, FSH –> LH, FSH act on ovaries and testes to release testosterone and progesterone

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

RAI uptake in toxic adenoma

A

increased (it is hyperplasia of follicular cells)

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

Postpartum thyroiditis clinical features + lab features

A

Painless + within 1-6 months after delivery

- increased serum thyroglobulin + low RAI take

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

Mixed cryoglobulinemia disease associations

A
  • chronic HCV, HIV

- SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Type 1 cryoglobulinemia disease associatoins

A

Lymphoproliferative or multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mixed cryoglobulinemia clinical features

A
  • fatigue, arthralgias
  • glomerulonephritis, HTN
  • pulmonary: dyspnea, pleurisy
  • palpable purpura, LCV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Type 1 cryoglobulinemia clinical features

A
  • often asymptomatic
  • hyper viscosity (blurry visino), VTE
  • livedo reticularis, purpura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complement levels in Type 1 cryoglobulinemia

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antiphospholipid antibody syndrome clinical features

A
  • anemia, thrombocytopenia, livedo reticularis, glomerulonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Next step in type 1 cryoglobulinemia

A

bone marrow biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

other lab presentation of primary hyperparathyroidism

A
  • calcium can be normal or high-normal in setting of vitamin d deficiency (vitamin d deficiency and primary hyperparathyroidism often coexist)
  • once vitamin D is repleted, patient becomes hypercalcemic + inappropriately elevated PTH level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Calcium, phos, PTH, vitamin d in secondary hyperparathyroidism from renal failure

A
  • calcium = normal to low
  • phos = normal to high
  • 25 hydroxyvitamin D = normal
    1,25 hydroxivitamin D = normal to low
  • PTH is high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of subclinical hypothyroidism

A

IF TSH greater than 10 –> treat with synthroid

IF TSH less than 10 –> obtain anti-thyroid peroxidase antibody + treat if meeting indication for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Indications for treatment with subclinical hypothyroidism

A
  • goiter
  • symptomatic (**convincing symptoms not vague fatigue or constipation)
  • pregnant
  • ovulatory dysfunction with infertility
  • **elevated anti-TPO titer
  • hypercholesterolemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Differential for hyperprolactinemia

A

1) **CKD (increased release and decreased clearance of prolactin)
2) meds (antipsychotics)
3) untreated primary hypothyroidism
4) pituitary adenomas
5) following a seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Meds causing hyperprolactinemia

A
  • antipsychotics (haldol, risperdol)
  • antidepressants (amitriptyline, sertraline)
  • reglan
  • opiates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Clinical features of adrenal insufficiency

A
  • fatigue + hypotension + hypoglycemia + hyponatremia + high or NORMAL potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

initial evaluation of clinically-suspected adrenal insufficiency

A
  • 8 AM serum cortisol
  • plasma ACTH
  • ACTH stim test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Typical clinical course of subacute thyroiditis

A

hyperthyroidism then euthyroidism then hypothyroidism then recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Treatment of subacute thyroiditis

A

beta-blocker + NSAIDS

IF no improvement with NSAIDS, then prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

other term for subacute thyroiditis

A

Subacute granulomatous thyroiditis (de Quervains)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Common cause of hypogonadism

A

DM2 and obesity

42
Q

management of hypogonadism in DM2

A

**IF markedly low serum testosterone (below 200) or low or *inappropriately normal pituitary hormones or mass effect symptoms– pituitary MRI

43
Q

Latent autoimmune diabetes of adulthood (LADA) presentation

A

Type 1 DM + manifesting later in life + commonly FH of autoimmune disease

44
Q

Diagnosis of LADA

A

Anti-islet cell + glutamic acid decarboxylase antibodies

45
Q

Hyperglycemia management in ICU + goal

A
  • put patient on insulin drip

- goal 140-180

46
Q

What are the meglitinides + examples

A
  • short-acting non-sulfonylurea insulin secretagogues

- repaglinide

47
Q

What are the thiazolidinediones?

A
  • Pioglitazone
  • rosiglitazone
  • lobeglitazone
48
Q

Examples of alpha-glucosidase inhibitors + clinical use

A
  • acarbose, miglitol

- used to control post-prandial glucose excursions

49
Q

What are the DPP-4 inhibitors? clinical utility?

A
  • linagliptin, sitagliptin, saxagliptin

- CKD patients with intermittent hypoglycemia

50
Q

GLP-1 agonists

A
  • liraglutide

- exenatide

51
Q

presentation of myxedema coma

A
  • AMS
  • hypothermia
  • swelling of the extremities, face, and tongue
  • *hypoventilation
52
Q

What is central hypothyroidism

A

(another term for secondary hypothyroidism)

Hypothyroidism due to pituitary deficiency

53
Q

Synthroid management in central hypothyroidism

A

Base on serum free TF (TSH may not rise due to absence of normal pituitary function)

54
Q

Management of primary hyperaldosteronism from adrenal hyperplasia

A

medical therapy (spironolactone, eplerenone)

55
Q

How to titrate synthroid in hypothyroidism + frequency of dose adjustments

A

1) based on TSH, NOT T4
2) increase dose every 6 weeks until TSH is within normal range
3) monitor TSH every 6 to 12 months

56
Q

Initial dose of synthroid in hypothyroidism

A

IF elderly or CHF – low- dose (25-50)

*75 otherwise

57
Q

Management of subclinical hypothyroidism if no indication for treatment

A
  • periodically monitor thyroid function studies for progression to overt hypothyroidism
58
Q

common clinical presentation of hypothyroidism

A

weight gain + edema

59
Q

Initial step in workup of Cushings

A

ACTH

60
Q

Next step after thyroid ultrasound and TSH obtained

A

IF normal or elevated TSH + greater than 1 cm – FNA (regardless of findings on US, normal TSH or high suggests increased risk for cancer)
IF low TSH – iodine 123 scintigraphy (likely hyperfunctioning)

61
Q

Next step after iodine 123 scintigraphy of thyroid nodule

A
  • if hyper functioning – treat (hot nodule)

- if cold or indeterminate – biopsy with FNA

62
Q

Antithyroid drug therapy of choice for Graves

A

Methimazole

PTU only if pregnant (methimazole is teratogenic and PTU is hepatotoxic so methimazole is generally preferred)

63
Q

Goal blood sugars within

A
  • Fasting below 95
  • 1 hour postprandial less than 140
  • A1c isn’t that helpful (tend to be lower in pregnant women)
  • hyperglycemia is associated with adverse fetal outcomes. Gestational DM2 requires tight glycemic control to prevent complications so glycemic targets are lower than in non pregnant patients.
64
Q

First and second line for gestational DM2

A

Dietary modification

IF blood sugar uncontrolled at follow-up – insulin

65
Q

LH and FSH in secondary hypogonadism due to hereditary hemochromatosis

A
  • supressed (it is secondary hypogonadism due to iron accumulation in the pituitary gonadotrophs)
66
Q

Androgen-secreting ovarian tumors vs. congenital adrenal hyperplasia

A
  • androgen-secreting ovarian tumor = postmenopausal women, very high testosterone level (greater than 150) + rapidly progressive
  • CAH = younger women + mild elevation in testosterone
67
Q

Nonclassic 21-hydroxylase deficiency clinical features

A
  • similar to PCOS
68
Q

Nonclassic 21-hydroxylase deficiency diagnosis

A
  • elevated serum 17-hydroxyprogesterone
69
Q

Etiology of hypercalcemia + high normal PTH

A
  • primary hyperparathyroidism (high normal or borderline in some patients. Normally even mild hypercalcemia suppresses PTH to very low levels. Therefore, hypercalcemia associated with a non suppressed PTH level suggests inappropriate PTH secretion due to Primary hyperparathyroidism)
70
Q

mechanism by which sulfonylureas cause hypoglycemia

A
  • accumulate in CKD or with AKI or following bactrim treatment for UTI
71
Q

Healthcare maintenance for GCA

A
  • osteoporosis screening when starting steroids

- yearly chest x rays (rule out thoracic aortic aneurysms)

72
Q

indication for with carotid stenosis

A
  • carotidendarterectomy if symptomatic + greater than 70% stenosis
  • statin + ASA otherwise + bp control
73
Q

management of thyroid function after radioactive iodine therapy

A
  • measure T3 and T4 (TSH may remain suppressed for months after treatment even if patient is hypothyroid. Some patients develop hypothyroidism after treatment and need synthroid)
74
Q

Situation commonly precipitating unmasking of pheochromocytoma

A

anesthesia induction

75
Q

Next step after elevated IGF-1 suggesting acromegaly

A
  • confirmatory testing with oral glucose suppression test
76
Q

lab features of chronic opioid use leading to hypogonadism

A
  • low FSH and LH (leads to decreased GnRH secretion)
77
Q

hungry bone syndrome labs

A
  • low calcium
  • low phos (also reabsorbed with calcium)
  • low mag (also reabsorbed with calcium)
  • normal (or high) PTH
78
Q

central hypothyroidism clinical features

A
  • low TSH + low T4

- typically evidence of other hormone deficiencies

79
Q

workup of central hypothyroidism

A
  • neuroimaging

- pituitary hormone testing (need to rule out associated adrenal insufficiency)

80
Q

euthyroid sick syndrome lab features

A
  • normal to decreased TSH, T4, and T3

- increased reverse T3

81
Q

Sheehans syndrome clinical features

A
  • following pregnancy –> failure to lactate, lethargy, weight loss, loss of hair, hypothyroidism
82
Q

Treatment of milk alkali syndrome

A
  • standard hypercalcemia treatment (normal saline, lasix)
83
Q

First and second line treatment of hyperhidrosis

A

First line: topical aluminum chloride solution

Second line: botox injections

84
Q

preferred prophylaxis of chronic cluster headaches

A

verapamil

85
Q

Diabetic amyotrophy clinical features

A
  • acute, asymmetric, focal lower extremity weakness, followed by pain + atrophy + areflexia + autonomic dysfunction + weight loss
  • it’s a lumbosacral plexopathy affecting lumbosacral nerve roots and peripheral nerves
86
Q

Treatment of diabetic amyotrophy

A
  • symptomatic (PT, pain control, BS control)
87
Q

contraindications to HPV vaccination

A
  • pregnancy (unclear safety profile)
88
Q

First line treatment of OCD

A
  • SSRIs

- CBT

89
Q

Inpatient management of DM2 per boards

A
  • basal, bolus insulin, NOT sliding scale
90
Q

Management of DKA patient with blood glucose less than 200

A

switch to D5- half normal with ***KCL (only time you should give maintenance fluids without KCL is if K is greater than 5.2)

91
Q

Management of amiodarone-induced hypothyroidism

A
  • continue Amio + start synthroid (hypothyroidism is easily corrected by synthroid and patients typically need Amio)
92
Q

Initial management of amiodarone-induced hyperthyroidism

A
  • RAI scan + thyroid US
93
Q

painless thyroiditis clinical features

A
  • typically 1 year post pregnancy (but can also occur in non postpartum women and men)
  • 1-2 months of mild hyperthyroid symptoms, followed by hypothyroid symptoms
94
Q

Management of painless thyroiditis

A

symptomatic (beta blockers)

95
Q

Painless thyroiditis vs Graves disease

A
  • RAI scan (markedly decreased uptake in painless thyroiditis due to release of preformed thyroid hormone)
96
Q

Next step after thyroid nodule with TSH and US obtained

A

IF TSH normal or elevated – consider FNA based on US
IF TSH low – thyroid scintigraphy (this will differentiate between cold and hot nodules, which is impt because hot nodules are rarely malignant. Cold nodules are and require FNA based on size, US findings and pt characteristics)

97
Q

what is a cold and hot nodule

A

low RAI uptake or high RAI uptake

98
Q

SE of spironolactone

A
  • anti-androgenic effects due to testosterone receptor blockade (not just gynecomastia but also low libido, and fatigue)
  • hyperkalemia
99
Q

MEN Type 1 disorders

A
  • primary hyperparathyroidism
  • pituitary tumors
  • pancreatic tumors
100
Q

MEN Type 2A disorders

A
  • medullary thyroid cancer
  • pheochromocytoma
  • parathyroid hyperplasia
101
Q

MEN Type 2B disorders

A
  • medullary thyroid cancer
  • pheochromocytoma
  • marfanoid habitus
  • mucosal and intestinal neuromas

Boards (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions