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Clin Med II > Endo Diagnosis > Flashcards

Endo Diagnosis Flashcards

1
Q

Elevated plasma LDL
Elevated plasma triglyceride
Premature atherosclerosis, thus elevated cardiovascular morbidity
Mild obesity (inc fat mass)

A

GH deficiency

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2
Q

Excessive & sustained GH release even in daytime

A

acromegaly

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3
Q

When GH is in excess in children of growing ages what occurs?

A

gigantism

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4
Q

Frontal bossing
increased base of nose
thickening of naso-labial sulcus and lips
parotid hypertrophy
loss of oval features
thickened tongue and skin, increased skin folds, enlarged visceral organs (can lead to HTN due to cardiomegaly)

A

acromegaly

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5
Q

If acromegaly is due to enlarged anterior pituitary what sx would you expect to see?

A

HA, peripheral vision loss and double vision

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6
Q

How do you diagnosis acromegaly?

A

measure IGF-I levels and if elevated test glucose intolerance test and GH measure and if inadequately suppressed then do pituitary MRI to find mass if none then do chest and abd CT to find extrapituitary cayse

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7
Q

What tests would you use to assess adrenal fn?

A

Measure urinary hormone or degradation products- 24 hour collection

Dexamethasone suppression test (corsitol levels should decrease if HPA is normal and ectopic ACTH tumors do not respond)

Metyrapone Stimulation Test (inhibits cortisol via inhibition of 11-beta hydroxylase)

CRH Stimulation Test (excessive rise in ACTH in corticotroph tumors but not in ectopic ACTH producing tumors)

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8
Q

K+ depletion
Na+ retention
Hypertension

A

Hyperaldosteronism

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9
Q

What is conn symdrome

A

primary aldosteronism

excess secretion of aldosterone due to adrenal disease

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10
Q

What is Secondary hyperaldosteronism- renin dependent?

A

High plasma renin activity often due to cirrhosis, heart failure or nephrosis

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11
Q

What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) excess?

A

Cortisol: ↑

CRH: ↓

ACTH: ↓

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12
Q

What happens to cortisol, CRH and ACTH when a patient has Secondary (pituitary) excess?

A

Cortisol: ↑

CRH: ↓

ACTH: ↑

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13
Q

What happens to cortisol, CRH and ACTH when a patient has Primary (adrenal) deficiency?

A

Cortisol: ↓

CRH: ↑

ACTH: ↑

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14
Q

What happens to cortisol, CRH and ACTH when a patient has Secondary deficiency?

A

Cortisol: ↓

CRH: ↑

ACTH: ↓

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15
Q

Hypersecretion of epinephrine and norepinephrine

A

Pheochromocytoma

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16
Q

Effect of Pheochromocytoma

A

sustained HTN
glycosuria
increased urinary excretion of catecholamine metabolites

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17
Q

What type of thyroid cancer has the best outcome?

A

Papillary thyroid cancers

95% 10 yr survival

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18
Q

What is the best test for Cushing’s?

A

24 hr urine or midnight salivary cortisol

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19
Q

How do you test for adrenal crisis?

A

ACTH stim test is the Gold standard

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20
Q

If patient presents with cushings symptoms and ACTH is high what is the most likely cause?

A

Pituitary (primary) cushings or ectopic cushing’s

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21
Q

Sodium levels with SIADH

A

low

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22
Q

Sodium levels with central diabetes insipidus

A

high

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23
Q

high BP and low K+

A

hyperaldosteronism

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24
Q

episodic HA, tachycardia, sweating, feeling of impending doom

A

Pheochromocytoma

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25
Q

Best initial screening test for pheochromocytoma?

A

plasma metanephrines

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26
Q

What test should you order if you suspect hyperaldosteronism?

A

renin aldosterone levels

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27
Q

Parathyroid adenoma
Pituitary adenoma
Pancreatic islet cell tumor

A

MEN type 1

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28
Q

Pheochromocytoma
Medullary carcinoma of thyroid
Parathyroid hyperplasia

A

MEN type 2A

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29
Q

Pheychromocytoma
Medullary carcinoma of thyroid
Marfanoid habitus with mucosal and visceral ganglioneuromas

A

MEN type 2B

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30
Q

What test do you order if you suspect Hashimodos?

A

TPO

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31
Q

What antibodies are associated with graves?

A

TSI and TRAB

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32
Q

Low TSH and high free T4

A

Graves disease

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33
Q

Patient is unsure if he has type 1 or type 2 diabetes what test should you order?

A

GAD ab because 90% of type 1 are positive for GAD

34
Q

What is goal fasting blood sugar level for diabetic patients?

A

<110-112

35
Q

What are preprandial blood sugar level goals for diabetic patients?

A

80-130

36
Q

Patient has FH of hypoglycemia and thinks she is hypoglycemic as well. What test do you order?

A

serum glucose test when she is symptomatic because insulin levels will be high even though blood glucose is low

37
Q

Whipple’s triad

A

hypoglycemia sx, low blood glucose, reversal of sx when blood glucose normalized

=hypoglycemic

38
Q

What is the MC cause of Addison’s Disease in the US?

A

autoimmune adrenalitis-

thyroid disease is MC

39
Q

What is the MC cause worldwide of primary adrenal insufficiency?

A

TB or fungal infection

40
Q

Adrenals enlarged with granulomas and caseation

A

TB causing primary adrenal insufficiency

41
Q

ACTH high

Cortisol low

A

primary adrenal insufficiency

42
Q

What should you be concerned about in a patient with primary AI who has a major infection and is subjected to major stress?

A

Adrenal crisis

43
Q

AM cortisol <3

A

Adrenal insufficiency

44
Q

What is the Cosyntropin Stimulation Test?

A

Inject cosyntropin → measure basal, 30 min and 60 min cortisol

Nrml resp: max cortisol >18 ug/dl

adresses adrenal reserve but not direct pituitary/hypothal fn

45
Q

What is MC cause of Secondary Adrenal Insufficiency

A

exogenous steroid use

46
Q

ACTH Low

Cortisol Low

A

Secondary Adrenal Insufficiency

47
Q

What medications must be avoided when testing a patient for primary aldosteronism?

A

spironolactone and eplernone

48
Q

Elevated aldosteronism, normal or elevated renin

With hypertension: renal artery stenosis, malignant hypertension, renin-secreting tumor

A

Secondary hyperaldosteronism with HTN

49
Q

Decreaseeffectivecentralvascularvolume

Hypovolemia, CHF, cirrhosis, nephrotic syndrome

A

Secondary hyperaldosteronism without HTN

50
Q

What is the Best Screening Test for Primary Aldosteronism?

A

Aldosterone and renin

51
Q

How do you determined if ACTH dependent Cushing’s syndrome is primary or ectopic?

A

High dose dexamethasone suppression test

Pituitary will have partial suppression which Ectopic ACTH will have no suppression

or CRH stimulation test
Ectopic ACTH will not stimulate cortisol while pituitary will

52
Q

What tumors are MC associated with ectopic ACTH production?

A

Small cell lung cancer

Bronchial carcinoid

53
Q

What ate the MC causes of hirsuitism?

A

PCOS
Idiopathic
CAH

54
Q

What is the MC cause of Congenital Adrenal Hyperplasia?

A

21-hydroxylase deficiency

55
Q

a dry, waxy type of swelling (nonpitting edema) with abnormal deposits of mucin in the skin (mucinosis) and other tissues, associated with hypothyroidism
facial changes are distinctive, with swollen lips and thickened nose

A

Myxedema

56
Q

If hypothyroid and thyroid responds to dose of TSH where is the problem?

A

pituitary or hypothal

57
Q

If hypothyroid and TSH rises in response to TRH where is the problem?

A

hypothalamus

58
Q

TSH increased but TH is declining
Thyroid hypertrophies and develops goiter
What is the cause?

A

Iodine deficiency goiter

59
Q

What is TH resistance?

A

very rare receptor mutation where thyroid hormone levels are normal but body does not respond because receptor is mutated

60
Q

Dwarfism
Mental retardation
Growth retardation
Short limbs

A

Cretinism

congenital iodine deficiency syndrome

61
Q

What drugs MC cause hypoglycemia?

A

Insulin

Sulfonylureas

62
Q

Whipple’s Triad

A

sx consistent with hypoglycemia, documented low blood glucose + sx, prompt relief of sx when blood sugar normalized

63
Q

Suspected humoral agent with Flushing

A

Bradykinin, 5- hydroxytryptophan, prostaglandins

64
Q

Suspected humoral agent with Diarrhea

A

Serotonin, prostaglandins

65
Q

Suspected humoral agent with Cardiac lesions

A

Serotonin

66
Q

Suspected humoral agent with Bronchospasm

A

Bradykinin, histamine, prostaglandins

67
Q

Suspected humoral agent with Skin lesions

A

Niacin deficiency

68
Q

If adrenal hyperplasia is due to excess ACTH what zone is affected?

A

zona fasciculata and

zona reticularis

69
Q

If adrenal hyperplasia is ACTH independent what zone is affected?

A

zona glomerulosa

70
Q

Paraganglioma

A

Extraadrenal pheochromocytoma

71
Q

What finding in Neuroblastoma would indicate poor prognosis?

A

N-myc amplification

72
Q

What are some major complications of diabetes?

A

CV dz, renal failure, blindness, amputation, nerve damage

73
Q

What causes type 1 DM?

A

Autoimmune destruction of insulin-producing pancreatic β cells

74
Q

Impaired cellular responses to the physiological effects of insulin

A

insulin resistance

75
Q

Impaired cellular responses to the physiological effects of insulin

A

insulin resistance

76
Q

MC cause of hypercalcemia

A

primary hyperparathyroidism due to enlarged adenoma

77
Q

TSH is normal but free T4 is low what is most likely diagnosis?

A

central (or secondary) hypothyroidism

78
Q

Low TSH

Low FT4

A

central hypothyroidism

OR

use of T3 product- won’t need FT4 or TSH so they will be low

79
Q

Recent infection AMS, resp failure, carcinogenic shock, CK, defective thermoregulation

A

Myxedema Coma

80
Q

nrml FT4 and low TSH

A

thyroid storm or resolving postpartum thyroiditis

81
Q

What diagnosis is consistent with US for goiter or possible nodule showing heterogeneous thyroid?

A

Hashimotos thyroiditis

82
Q

What diagnosis is consistent with US for goiter or possible nodule showing heterogeneous thyroid?

A

Hashimotos thyroiditis

Clin Med II (19 decks)

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