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Step 2 > Endo > Flashcards

Endo Flashcards

1
Q

Causes of panhypopituitarism

A 
Tumors
Trauma 
Radiation 
Hemochromatosis
Sarcoidosis
Histocytosis X 
Infection: TB, fungus, parasite
Autoimmune infiltration
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2
Q 
Amenorrhea
Decrease libido 
Decreased secondary sex characteristics 
Erectile dysfunction 
Decreased muscle mass
A

LH/FSH deficiency

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3
Q

Pediatric short stature

A

GH deficiency

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4
Q

Central Obesity
Increased LDL and cholesterol
Reduced lean muscle mass

A

GH deficiency

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5
Q

Diagnosing secondary hypothyroidism?

A

Initial: low TSH & fT4
Diagnostic: TRH stim- fails to increase TSH

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6
Q

Diagnosing hypogonadotropic hypogonadism?

A

Measure LH/FSH (low) and testosterone (low)

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7
Q

Hypogonadotropic hypogonadism
Anosmia
50% renal agenesis

A

Kallman Syndrome

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8
Q

Diagnosing growth hormone deficiency?

A

Initial: Measure Igf-1 (somatostatin)
Diagnostic:
No response to arginine infusion (should stimulate GH)
No response to GHRH

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9
Q

Metyrapone test

A

Inhibits 11-beta-hydroxylase to decrease adrenal output.

Normally cause increase in ACTH levels.

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10
Q

Insulin stimulation test

A

Decrease in glucose should stim GH.

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11
Q

Central DI Etiology

A

50% idiopathic
trauma, stroke, tumor
infiltration from sarcoidosis/infection

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12
Q

Nephrogenic DI Etiology

A 
Lithium 
Hypercalcemia 
Hypokalemia
Chronic pyelonephritis 
Amyloidosis 
Myeloma
Sickle Cell Disease
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13
Q

High volume urine
Excessive thirst
Hypernatremia: neuro symptoms

A

DI

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14
Q

Diagnose DI

A

Water deprivation test:
Restrict water and measure Urine Osm every hour until normalize.
Administer desmopression and remeasure urine Osm in 1 hour

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15
Q

Central DI treatment

A

Long term vasopressin

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16
Q

Nephrogenic DI

A

Treat underlying cause or remove causative agent

Use thiazide diuretic, amiloride, or NSAIDs

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17
Q

Acromegaly Etiology

A

ALWAYS pituitary adenoma

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18
Q

Diagnose acromegaly

A

Elevated glucose
Hyperlipidemia
Test prolactin-cosecretion

Measure IGF-1
Glucose supression test

MRI

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19
Q

Treatment of acromegaly

A

Transphenoidal resection

Cabergoline-dopamine inhibit GH
Octreotide/lanreotide- somatostatin inhibit GH
Pegvisomant- GH receptor antagonist

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20
Q

Hyperprolactinemia etiology

A 
Cosecreted with GH 
Hypothyroidism- Increase TRH stim prolactin 
Pregnancy 
Intense exercise 
Nipple stim 
Pituitary adenoma
Renal insufficiency 
Antipsychotics 
Methyldopa
Metoclopramide 
TCA 
Opioids 
Verapamil
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21
Q

Diagnose hyperprolactinemia

A

Thyroid function
Pregnancy test
BUN/Cr
Liver function

If all normal: MRI

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22
Q

Treat prolactinoma

A

Dopamine agonist- Cabergoline/bromocriptine

Transphenoidal resection

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23
Q

Hypothyroidism eitology

A

Almost always Hashimoto’s thyroiditis burnout

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24
Q 
Bradycardia
Constipation 
Weight gain 
Fatigue, lethargy, coma
Decreased reflexes
Cold intolerance 
Hypothermia 
Hair loss 
Edema
A

Hypothyroidism

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25
Q

Hypothyroid diagnosis

A
  1. Measure TSH
  2. Measure fT4

If TSH double normal- treat
If TSH elevated, but less than double- anti-TPO Ab

26
Q 
Tachycardia, palpitations, a.fib 
Diarrhea
Weight loss 
Anxiety 
Hyperreflexia 
Heat intolerance 
Fever
A

Hyperthyroid

27
Q

Hyperthyroid + eye and skin changes

A

Graves Disease

28
Q

Hyperthyroid + tender thyroid

A

Subacute thyroiditis

29
Q

Hyperthyroid + normal exam

A

Painless thyroiditis

30
Q

Hyperthyroid + involuted non-palpable gland

A

Exogenous thyroid hormone use

31
Q

Hyperthyroid + elevated TSH

A

Pituitary adenoma

32
Q

High TSH

RAIU- elevated

A

Graves Disease

33
Q

Low TSH

RAIU- decreased

A

Subacute thyroidits, painless thyroiditis, exogenous thyroid hormone
**correlate with exam

34
Q

Graves treatment

A

Radioactive iodine

35
Q

Subacute thyroiditis treatment

A

Aspirin

36
Q

Painless thyroiditis

A

No treatment

37
Q

Treatment for acute hyperthyroidism

A
  1. Propanolol-blocks target organ, prevents peripheral conversion
  2. Thiourea- blocks hormone production
  3. Iodinated contrast material- block peripheral conversion, blocks hormone release
  4. Hydrocortisone
  5. Radioactive iodine
38
Q

Treatment for Graves opthalmopathy

A

First line: steroids
Radiation for non-responders
Decompressive surgery last resort

39
Q

Hypercalcemia etiology

A 
***Primary hyperparathyroidism 
Osteolytic cancer 
Hypercalcemia of malignancy 
Vit D intoxication 
Sarcoidosis 
Thiazide diuretics 
Hyperthyroidism
40
Q 
Confusion 
Stupor 
Constipation 
Short QT syndrome 
HTN 
Osteoporosis 
Nephrolithiasis 
DI 
Renal insufficiency
A

Hypercalcemia

41
Q

Treat acute hypercalcemia

A
  1. IVF
  2. Bisphosphonates
  3. Calcitonin
    (If sarcoid treat with steroids)
42
Q

Hyperparathyroid etiology

A

Solitary adenoma
Hyperplasia
Malignancy

43
Q

Diagnose hyperparathyroidism

A 
High Ca
High PTH 
Low Phos 
Urine Ca > 250 
High Cl 
ECG- short QT
44
Q

Surgical candidates for parathyroidectomy

A 
Symptomatic 
Asx and:
- Ca at least 1 above upper limit 
- Age less than 50 
- Bone density < T -2.5
- Reduced renal function
45
Q

Treatment for hyperparathyroidism and not surgical candidate

A

Cinacalet

46
Q

Hypocalcemia etiology

A 
Thyroidectomy 
Hypomagnesemia 
Renal failure 
Vit D deficiency 
DiGeorge syndrome 
Fat Malabsorption 
Low albumin (not symptomatic!!)
47
Q 
Chvostek sign 
Carpopedal spasm 
Perioral numbness
Mental irritability 
Seizures 
Trousseau sign
A

Hypocalcemia

48
Q

Diagnose hypocalcemia

A

EKG- long QT

Slit lamp- cataracts

49
Q

Etiology of Cushing syndrome

A

Pituitary overproduction
ACTH production from carcinoid/cancer
Overproduction of cortisol from adrenals
Iatrogenic

50
Q 
Striae
Easy bruising 
Decreased wound healing 
Osteoporosis
HTN
Menstrual disorder 
Erectile dysfunction 
Cognitive disturbance 
Polyuria
A

Hypercortisolism

51
Q

Lab findings in hypercortisolism

A 
Hyperglycemia
Hyperlipidemia
Hypokalemia
Metabolic alkalosis
Leukocytosis
52
Q

Establish presence of hypercortisolism

A

Best initial test: 24-hour urine coritsol (more specific)

1mg overnight dexamethasone suppression test- false positives:
depression, alcoholism, obesity

53
Q

Establish cause of hypertcortisolism

A

Measure ACTH
ACTH elevated- pituitary or ectopic
ACTH depressed- adrenal

54
Q

Establish source of ACTH

A

High dose dexamethasone suppression test

55
Q

Evaluate adrenal incidentaloma

A
  1. measure urine metanephrines- rule out pheo
  2. Measure renin and aldosterone
  3. 1mg overnight dexamethasone suppression test
56
Q

Etiology of Addison’s disease

A

**Autoimmune destruction
**TB
Adrenoleukodystrophy
Cancer to adrenals

57
Q 
Weakness
Fatigue 
Altered mental status 
N/V
Anorexia 
Hypotension 
Hyponatremia
Hyperkalemia
A

Hypoadrenalism

58
Q

Profound hypertension
Fever
Confusion
Coma

A

Acute adrenal crisis

59
Q

Lab findings in hypoadrenalism

A 
Hypoglycemia 
Hyperkalemia 
Hyponatremia 
Metabolic acidosis 
High BUN
60
Q

Diagnose hypoadrenalism

A

Cosyntropin (synthetic ACTH) stim test

61
Q

Treatment of Addision’s

A

Replace steroid with hydrocortisone

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