Endo

Question 1

Increased thirst, urinary frequency, dilute urine (Osm<300), Desmopressin increases urine Osm to 450

Answer 1

Central DI: deficiency in ADH leads to decreased water reabsorption in the kidney, hypernatremia and increased volumes of dilute urine.

Question 2

Primary Amonorrhea w/o secondary sexual characteristics, anosomia

Answer 2

Kallmann’s syndrome: disorder of GnRH synthesis

Question 3

Hypothyroid in pt w/ chronic afib, med SE?

Answer 3

Amiodarone, inhibits production of triiodothyronine, toxic to follicular cells

Question 4

HTN, hyperreflexia, weakness, hypernatremia, hypokalemia, met alkalosis (high bicarb), decreased renin, unilateral abd mass on CT

Answer 4

primary hyperaldosteronism: adrenal adenoma hypersecreting mineralocorticoids.

Question 5

hypercalcemia pt w/ sarcoidosis, other lab finding?

Answer 5

elevation in angiotensin-converting enzyme (ACE), hypercalcemia via increased production of 1,25 (OH)2 vitamin D by macrophages within the granulomas.

Question 6

Pt p/w fever, tachycardia, tender anterior neck, increased TSH and thyroxine; dx? Rx?

Answer 6

subacute (de Quervain’s) thyroiditis; rx: NSAIDS

Question 7

Hormone levels in pt w/ high androgen state (virilization), enlarged ovaries, irregular menstuation?

Answer 7

polycystic ovarian syndrome: increased levels of androgens lead to high estrogen levels, which suppress FSH and lead to increased LH levels.

Question 8

Drugs that can cause secondary hypocalcemia

Answer 8

Carbamazepine, phenytoin, rifampin, and theophylline activate cytochrome P450 in the liver that inactivate vitamin D.

Question 9

Pt p/w HTN, tachycardia, headache, palpitations, and tremor, suprarenal mass, high serum calcium and glucose

Answer 9

pheochromocytoma (w/elevated urinary catecholamine) rx: α-adrenergic blocker such as prazosin; resection

Question 10

Pt p/w recent flushing, diarrhea, hypotension, systolic murmur accentuated by inspiration, JVD

Answer 10

Carcinoid syndrome w/ increased urine 5-HIAA, a by-product of serotonin, tricuspid regurge via fibrous deposits, right-sided heart failure

Question 11

Newborn p/w constipation, prolonged jaundice secondary to delayed maturation of glucuronide conjugation, failure to thrive, and open fontanelles, umbilical hernias, genital swelling

Answer 11

Congenital hypothyroidism

Question 12

Child p/w abn facies, cleft palate, congenital heart defects, thymic aplasia, and parathyroid hypoplasia with hypocalcemia

Answer 12

DiGeorge’s syndrome, with deletion of chromosome 22q11

Question 13

Hypotensive w/ skin pigmentation, wt loss and fatigue, eosinophilia, hyponatremia, hyperkalemia, non AG met acidosis/ hyperchloremic acidosis work up? Dx? Rx?

Answer 13

primary adrenal insuf/ Addison’s dz; low morning cortisolACTH (central), Cosyntropin 250ug (ACTH) stimulation (cortisol normally rises >20 w/in 30-60min)

Question 14

Hypotensive, wt loss, fever, cough, hyponatremia, hyperkalemia, adrenal gland calcification? Dx? PH?

Answer 14

primary adrenal insuf from TB inf; Hypoaldosteronism causes non AG metabolic acidosis

Question 15

Glucose>600, no/low ketones, normal AG, serum Osm>320, bicarb>18

Answer 15

Hyperosmolar Hyperglycemic State, p/w more confusion, usually in elderly w/ DMT2

Question 16

Glucose 200-500, ketonuria, AG acidosis, serum Osm<320, bicarb<18

Answer 16

Diabetic Ketoacidosis, p/w abd pain, hyperventilation, lethargy, ususally in youger w/ DMT1

Question 17

HTN, hyperreflexia, weakness, hypernatremia, hypokalemia, met alkalosis (high bicarb), increased renin and aldosterone; etiology

Answer 17

Secondary hyperalsdosteronism: renovascular HTN, malignant HTN, renin tumor, diuretic use

Question 18

Hypoglycemia, hyponatremia, constipation, cold intolerence, bradycardia, erectile dysfunction and low libido, fatigue, delayed DTR; dx?

Answer 18

Panhypopituitarism, w/ hypogonadotropins, glucocorticoid deficiency, hypothyroidism, but normal aldosterone and potassium (Renin/angiotensin dependent)

Question 19

Antibodies in Hashimoto’s thyroiditis?

Answer 19

Anti-TPO (thyroid peroxidase) and anti-thyroglobulin

Question 20

Best indicators of resolution of ketonemia (DKA)?

Answer 20

Mesured AG and beta-hydroxybutyrate

Question 21

Smoker p/w HTN, hypokalemia, metabolic alkalosis, proximal muscle weakness, skin pigmentation; dx?

Answer 21

Ectopic ACTH via Small cell lung cancer;

Question 22

Recent weightloss, diarrhea, DM, hyperglycemia, (erythamous plaques with eroded borders& central clearing) necrolytic migratory erythema, normocytic normochromic anemia; dx?

Answer 22

Pancreatic Glucagonoma, glucagon>500

Question 23

Rubbery goiter w/ anti-TPO (thyroid peroxidase) ab; dx?

Answer 23

Hashimoto’s thyroiditis; confirm w/ Core needle bx; increased risk of Lymphoma of the thyroid

Question 24

Metabolic sx dx? (4/5)

Answer 24

1. abd obesity waist>40M,35W; 2. fasting glucose>100-110; 3. BP>130/80; 4. triglycerides>150; 5. HDL<40M,50W

Question 25

Ambiguos genitalia in girls w/ salt wasting, hopnatremia, hyperkalemia, vomiting, hypotension, elevated testosterone, decreased cortisol and aldosterone; dx? Elevated steroid?

Answer 25

CAH w/ 21-hydroxylase deficiency, elevated 17-hydroxyprogesterone

Question 26

Ambiguos genitalia in girls w/ HTN, fluid and salt retention, elevated testosterone, decreased cortisol and aldosterone; dx? Elevated steroid?

Answer 26

CAH w/ 11-beta-hydroxylase deficiency, w/ elevated 11-deoxycorticosteone (weak mineralcorticoid)

Question 27

All pts phenotypically female, decreased cortisol and testosterone, elevated mineralcorticoids, hypokalemia, HTN, fluid and salt retention; dx?

Answer 27

CAH w/ 17-alpha-hydroxylase deficiency

Question 28

Diabetic, recent URI, p/w headaches, confusion, glucose in urine, dehydration signs, blurred vision, no ketones, hyperglycemia; dx?

Answer 28

Non-Ketotic Hyperosmolar syndrome (NKHS)