Endo

Question 1

Painless thyroiditis consists of

Answer 1

Hyperthy followed by hypothy and then recovery. May have high anti-Peroxidase ab even in postpartum thyroiditis. Similar to hashimoto with DECR RAIU (radioactive iodine intake)
Assoc with HCV interferon tx, lithium tx
Self limited dz and can consider b blocker for symp and to prevent afib

Question 2

Chvostek sign

Answer 2

Facial twitch when facial n tapped due to HYPOca

Vs HYPERca may present weak, constipated

Question 3

Exogenous hyperthyroid has what pattern for Tg (thyroglobulin) and radioactive uptake?

Answer 3

BOTH low
If both high- graves
Low TG RAIU but high TG means thyroiditis
High TG alone can be thyroid cancer

Question 4

Match the following-
Sglt2 (sodium gluc transporter) - candidiasis
Ddp4-pancreatitis
Biguanide-gi side effects
Alpha glucosidase inh- gi side effects

Answer 4

Metformin is biguanide

Acarbose is alpha glucosidase

Question 5

How does amiodarone affect thyroid levels?

Answer 5

Decr conversion of t4 to t3 meaning incr t4. Decr t3.

Normal or borderline high tsh if clinically euthyroid. Amio usually causes hypothyroidism

Just rpt tfts in 3 months

Question 6

Ct head with thick calvari and cotton wool appearance of skull is

Answer 6

Pagets disease- asymp

Check ca is normal but ALP is high.
Next get bone scan.
Tx is bisphosphonate

Question 7

Common symptom of advanced pagets disease?

Answer 7

Hearing loss

U tx with calcitonin and bisphosphonate but wont reverse damage

Question 8

Elevated calcium. Next labs?

Answer 8

pth. If high pth, check urine calcium excretion. High urine calcium means 1 or 3 hyperpara. Low urine excretion means familial hyperca hypocalcuria.

Low pth then measure pthrp (most likely cause), 25 vit d and 1,25 vit dz

Question 9

Rapidly enlarging prior small goiter that now causes facial plethora with arm raised and esophageal obstruction with tfts looking like hashimotos is due to

Answer 9

Thyroid lymphoma. Risk factor is hashimotos

Question 10

Tx of diabetic neuropathy besides pregabalin, tca?

Answer 10

snri loke duloxetine!!!!

Often spontaneously resolve in 1 yr and can dc meds

Question 11

Msk pain, insomnia, fatigue should get what lab workup?

Answer 11

Fibromyalgia - get cbc (anemia), cpk (ro myositis) vs esr va tsh (hypothy)

Question 12

Lithium induced hypothyroidism (symptomatic). Next step is

Answer 12

Add synthroid

B4 start lithium need to check tfta and also monitor tfts q6m

Question 13

Medullary thyroid cancer that is resected but still elevated calcitonin means you need to perform what test next?

Answer 13

Ct neck and chest to eval for residual cancer

Medullary thy cancer is malign of parafollicular cells and DO not uptake iodine and thus rai doesnt work

Question 14

Advantage of long acting insulin over mixed insulin (short plus long)

Answer 14

Less risk hypoglycemia

Question 15

Thyroid nodule >1 cm with normal tfts should get what next?

Answer 15

Fna

If tsh low then get radionuclide thyroid scan

Question 16

Fna shows medullary thyroid cancer. Need to rule out MEN with what tests?

Answer 16

RET oncogene mutation, calcitonin lvl, CEA, calcium/pth

Need to eval for men2a- med thyroid cancer, pheo, hyperparathyroidism bc cant procede with thyroidectomy wo first ro pheo due to OR risks

Men2b has neuromas, marfanoid

Question 17

What is risk of type 1 dm in kid of mother w type1? Of father?

Answer 17

3%, 6%

Question 18

Fever, heat intolerance, enlaeged thyroid very tender with tfts showing hyperthyroidism is due to
What do u find on RAI???!!!

What is tx???

Answer 18

Subacute thyroiditis
Decr uptake!!!!!!!!!!!

Tx is supportive bc dz is self limited!!! Nsaids and bblocker!!
Vs in graves u have incr uptake

Question 19

Pt w hx of gastric ulcer, now w high serum calcium level and high pth and low phos. What is next step in management?

Answer 19

Refer for parathyroidectomy

men1 syndrome- 3p’s parathyroidism, pancreatic tumor (gastrinoma), pituitary tumor (prolactinoma)

Dont need to check calcitonin and metaneprines which are part of men2

Question 20

Type 1 dm2 who now is often hypoglycemic, hyperk, hypotens, arf my have

Answer 20

Addisons and should get cosyntropin test

May also see eosinophilia

Question 21

Loss of cremaster reflex in someone w recent mva, hx of dm2 neuropathy w the ed, normal motor and sensory is due to
Injury to spinal cord at L1-2
Dm2 neuropathy

Answer 21

Dm2!!

L1-2 injury would also cause hip flexion and adduction prob

Question 22

Can you continue oral med and start insulin?

Answer 22

Yes! Check for met acidosis by calculating and if there is stop metformin! If kidney injury stop gly buride bc metabolized that way

Can continue pioglitazone, acarbose, repaglinide which metabolized by liver

Question 23

Pt w hx of adrenalectomy or abd procedure and w hyperpigmentation and cushings and bitemporal hemianopsia has

Answer 23

Nelsons syndrome - check mri and high acth

Vs prolactinoma does not have incr pigmentation

Question 24

Pt w hx if thyroida sp thyroidectomy on synthroid w high normal tsh. Should u change synthroid dose?

Answer 24

Yes incr for goal tsh low botmal

Question 25

Tx of graves w RAI should be given w

Answer 25

Steroids to prevent complications w existing opthalmopahy

Question 26

Sp RAI for graves, and pt asymp. What test to use to monitor?

Answer 26

T3 t4!!! Bc tsh may be suppresses for wks after

Question 27

Pt w primary hypoparathyroidism should be tx with what? Means low ca and vit d.

What if check urine calcium is high and serum calcium levels are low?

Answer 27

Tx w calcium and high dose vit d

Urine calcium high should tx w THIAZide bc hypercalcemia causing

Question 28

Dka - if on ivf and insulin and glc

Answer 28

Half insulin and add dextrose to fluid to prevent hypoglycemia!!!!!

not continue same regimen

Question 29

Asymp hypothy w normal t4 and dunno t3, next lab?

Answer 29

Antithyroid ab, lipid panel

If those abn then tx