ENDO

Question 1

Graves disease (diffuse toxic goiter):
pathophys/presentation?
dx?
tx?

Answer 1

autoimmune dz due to TSI (anti-TSH) → hyperthyroid sx, exophthalmos, thyroid bruits, pretibial myxedema

Dx ↓TSH, ↑free T4

Tx PTU (pregnant), methimazole (not pregnant), oral radioiodine (can become hypothyroid), subtotal thyroidectomy (permanent)

Question 2

Plummer disease (toxic multinodular goiter):
dx?
tx?

Answer 2

multiple hyperfunctioning areas in thyroid → hyperthyroid sx

Dx ↓TSH, ↑free T4 + patchy uptake on T3 scan

Tx oral radioiodine (2 cm)

Question 3

Toxic adenoma:
dx?
tx?

Answer 3

Dx ↓TSH, ↑free T4 + hot nodule on T3 scan

Tx oral radioiodine (2 cm)


Question 4

Thyroid storm:
presentation?
tx?

Answer 4

precipitating factor (stress, infx) → hyperthyroidism exacerbation → marked fever, tachycardia, agitation, GI sx

β-blockers + antithyroid drugs

Question 5

Hashimoto thyroiditis:
pathophys/presentation?
dx?
tx?

Answer 5

autoimmune dz w/ lymphocytic infiltration → hypothyroid sx

Dx ↑TSH, ↓/nl free T4

Tx Synthroid

Question 6

De Quervain thyroiditis:
presentation?
dx?
tx?

Answer 6

painful granulomatous inflammation following viral URI → hypo- thyroid sx

Dx ↑TSH, ↓/nl free T4

Tx NSAIDs + observation (will self-resolve)

Question 7

Acute thyroiditis:
presentation?
dx?
tx?

Answer 7

painful, swollen, tender thyroid mass due to Staph/Strep infx → hypothyroid sx

Dx ↑TSH, ↓/nl free T4

Tx I+D

Question 8

Riedel thyroiditis:

presentation?

Answer 8

firm, painless thyroid → hypothyroid sx

Question 9

Myxedema coma:
presentation?
tx?

Answer 9

precipitating factor (stress, infx) → hypothyroidism exacerbation → marked hypothermia, ∆MS, respiratory depression

Tx IV thyroxine + hydrocortisone + supportive care

Question 10

Management of Thyroid nodules?

Answer 10

1. TSH, if normal…
2. FNA
3. If malignant, remove; if benign, observe; if indeterminant, thyroid scan –> cold = malig

Question 11

Papillary thyroid cancer:
spread?
pathology?
prognosis?
tx?

Answer 11

lymphatic

Psamomma bodies w/ Orphan Annie nuclei

best px

total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
*f/u thyroglobulin levels

Question 12

Follicular thyroid cancer:
spread?
MC population?
tx?

Answer 12

hematogenous spread

endemic to iodine deficient areas

Tx hemilobectomy + frozen bx → total thyroidectomy if bx shows carcinoma
*f/u thyroglobulin levels

Question 13

Medullary thyroid cancer:
spread?
pathology?
tx?
f/u on...

Answer 13

lymphatic and hematogenous spread

amyloid deposits

total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN

f/u calcitonin levels + 24-hr urinary VMA (MEN2 syndrome also has pheos)

Question 14

Anaplastic thyroid cancer:
px?
tx?

Answer 14

worst px

tx palliative care

Question 15

Hurthle cell cancer:

tx?

Answer 15

Tx total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN; f/u thyroglobulin levels

Question 16

Hypocalcemia sx =

Answer 16

neuromuscular irritability (tingling, tetany), prolonged QT, arrhythmias

Question 17

Hypercalcemia sx =

Answer 17

stones (kidney)
bones (bone pain, osteitis fibrosa cystica)
groans (peptic ulcers, pancreatitis)
psychic overtones (depression, anxiety, ∆MS)

Question 18

Hypoparathyroidism:
labs?
tx?
Chvostek sign = 
Trousseau sign =

Answer 18

↓PTH, ↓Ca, ↑P

vit D and Ca

Chvostek sign: tapping on Cheek causes muscle contractions

Trousseau sign: inflating BP cuff causes carpal muscle spasms

Question 19

Pseudohypoparathyroidism =
labs?
tx?
PE finding?

Answer 19

end-organ resistance to PTH

↑PTH, ↓Ca, ↑P

vit D + Ca

Knuckle-knuckle-dimple-dimple sign: hand morphology seen w/ pseudohypoparathyroidism

Question 20

Primary hyperparathyroidism:

labs?

Answer 20

↑PTH, ↑Ca, ↓P + Cl:P ratio >33:1

Question 21

Secondary hyperparathyroidism:
pathophys?
labs?

Answer 21

renal failure → ↓1α-hydroxylase → ↓vit D → ↓Ca → compensatory ↑PTH

↑↑PTH, ↓Ca, ↑P

Question 22

Prolactinoma:
presentation?
dx?
tx?

Answer 22

galactorrhea, amenorrhea, infertility, ↓libido

Dx ↑PRL + β-HCG/TSH (r/o 2° causes)

Tx bromocriptine or cabergoline (<1 cm), transsphenoid hypophysectomy (≥1 cm)

Question 23

Acromegaly: 
presentation?
MCC death?
dx?
tx?

Answer 23

↑GH → overgrowth of brow, jaw, hands, and feet

MCC death is CV disease

Dx oral glucose test

Tx transsphenoid hypophysectomy + octreotide (suppress GH)

Question 24

Pituitary Cushing:
presentation?
dx?
tx?

Answer 24

↑ACTH → truncal obesity, abd striae, buffalo hump, hyperglycemia, osteoporosis, HTN, immunosuppression

Dx ↑ACTH + dexa suppression test (pituitary Cushing is suppressable)

Tx transsphenoid hypophysectomy

Question 25

Hypopituitarism is a/w ↓ levels of which hormones?

Answer 25

↓FSH/LH, ↓ACTH, ↓TSH, ↓PRL, ↓GH

Question 26

Craniopharyngioma:
presentation?
dx?
tx?

Answer 26

embryological remnant of Rathke pouch → bitemporal hemianopsia (◐◑), headache, papilledema, ∆MS

MRI (supracellar calcified cysts)

Tx transsphenoid hypophysectomy

Question 27

Central vs nephrogenic diabetes insipidus?

tx?

Answer 27

Central DI: ↓ADH secretion from posterior pituitary; tx = DDAVP

Nephrogenic DI: normal ADH but kidneys don’t respond; tx = HCTZ

Question 28

SIADH:
presentation?
dx?
tx?

Answer 28

↑ADH secretion from posterior pituitary → volume expansion, hyponatremia (coma/sz/death if acute, asx if chronic)

Dx Na <270

Tx water restriction