Endo Uworld Flashcards
1
Q
pins and needles sensation and mucle cramps. no PMH or FMH
has low Ca and high phosphorus and BUN 10 Cr 0.8
A
hypoparathyroid- primary
2
Q
post hysteretomy patient develops nausea vomiting and acute abdomenal pain
has Hx SLE and takes prednisone
BP 70/40 pulse 110 and BP increases slightly after 4 L fluid
A
adrenal insufficiency having acute adrenal crisis
3
Q
what drug can bring out adrenal crisis during surgery
A
etomidate
4
Q
16 year old with facial hair, irregular menstrual cycles, and normal external genitalia
LH and FSH inc
17 hydroxyprogesterone inc
serum testosterone inc and DHEA inc
A
CAH from 21 a hydroxylase deficiency
5
Q
what to check for primary amenorrhea
A
prolactin TSH and FSH after checking pregnancy
6
Q
primary amenorrhea with increased FSH
A
premature ovarian failure
7
Q
primary amenorrhea with increased TSH
A
hypothyroid
8
Q
Euthyroid sick syndrome
A
fall in T3 levels. normal T4 and TSH
during acute sick illness
9
Q
why do heavy women have milder post menopasual Sx
A
conversion of adrenal androgens to estrogens by adipose tissue
10
Q
2 months fatigue and nausea vomiting, polyuria and polydipsia with constipation
smoking and drinking Hx
normal vitals
mucous membranes dry
Ca elevated, albumin norm. PTH low. Cr 1.9 BUN 54 glucose 180 and mildly low activated Vit D
A
hypercalcemia of malignancy
- osteolytic mets
- PTHrp
- inc tumor production activated Vit D (lymphoma)
- inc IL6 levels in MM
11
Q
what releases PTHrp usually
A
squamous cell lung! renal bladder breast ovarian
12
Q
signs of precocious puberty next step
A
check bone age
if advanced then check basal LH
if normal then isolated development- no further testing
13
Q
what does basal LH tell you in precocious puberty
A
if low then do GnRH stimulation and if still low it is peripheral precocious (gonadotropin independent)
if high- central (gonadotropin-dependent)
14
Q
dosing levothyroxine with pregnancy
A
increase dose when pregnant
15
Q
6 mo history fatigue, HA, decreased libitdo
decreased testicular volume
low LH, low Testosterone, low TSH and T4 and mildly elevated prolactin
A
hypopituitarism
pituitary adenoma
16
Q
DKA presentation
A
15 year old in ED with confusion, rapid breathing, abdominal pain. cold 3 days ago. has urinary frequency and progressive fatigue and somnolence
mucous membranes dry
K is high in serum Na normal bicarb very low
17
Q
generalized bone pain. just had bowel resection for crohns. has pseudofractures and proximal muscle weakness
A
osteomalacia
18
Q
labs of osteomalacia
A
decreased Ca, decreased phosphorus.
increased PTH
19
Q
C peptide reflects what
A
natural insulin by product
20
Q
how to Dx primary polydipsia
A
if urinary omsolality increases after water deprivation test
21
Q
how to Dx central vs nephrogenic DI
A
central will get better with vasopressin
nephrogenic barely has a response to vasopressin in increasing urine osmolality
22
Q
untreated hyperthyroidism is greatest risk for
A
bone loss
23
Q
signs hyperthyroid with painless nodule and decreased uptake
A
painless thyroiditis
24
Q
what DM med is helpgul to reduce weight and control BP
A
GLP-1 agonist
exenatide or lireglutide
25
side effect of GLP-1 agonists for dM
pancreatitis
26
DM with decreased appetite nausea and abdominal bloating. gets early satiety and low glucose right after meals
delayed gastric emptying (gastroparesis)
| Tx with metoclompramide or small frequent meals
27
signs hyperthyrdoi and thyroid exam show 2 nodules on scan only uptake in one of them and no uptake anywhere else
toxi adenoma
28
what dugs can precipitate hyperosmolar hyperglycemic states in DM
thiazides because volume deplete and dec GFR more which activates hormones to counter regulate
29
comorbidities with PCOS
```
overweight/obesity
glucose intolerance/DM
dyslipidemia
OSA
endometrial hyperplasia/cancer
```
30
best step in manageing diabetic nephropathy
BP control
31
fatigue myalgias and muscle weakness in both elgs for a month. difficult standing up out of a chair. weakness and cramping in legs
decreased strength in proximal mm in LE and sluggish ankle jerks
normal ESR and elevated CPK
electrolytes normal
enxt step
measure thyroid hormones because hypothyroid can cause myopathy
32
signs hyperthyroid. on diet, has diffuse decrease uptake on scan
low TBG level due to exogenous thyroid supplements
33
what CA is associated with hashimoto
lymphoma of thyroid
34
decreaseing HbA1c to less than 6.5% helps prevent what
retinopathy
35
```
progressive watery diarrhea. cramps and feels dehydrated. stools are tea colored and has episodic flushing of face
no traveling
normal vitals
normal abdominal exam
mass on pancreatic tail on imaging
```
VIPoma
| achlorhydria from dec gastric acid secretion
36
lab findings in VIPoma
hypokalemia
hypercalcemia
hyperglycemia
37
first line for DM neuropathy
TCA
38
high TSH T3 T4
TSH secreting pituitary adenoma
39
causes of proximal muscle myopathy
```
polymyosistis dermatomyositis
hypo or hyper thyroid
cushings
lambert eaton
myasthenia gravis
steroids
```
40
HTn and hypokalemia
check plasma aldosterone/renin ratio
41
what do you check if suspect acromegaly
IGF-1 if high then do glucose suppression test. if does not suppress GH = acromegaly
42
low and high dose DXM does not suppress cortisol
ectopic ACTH production
43
calcification of both adrenal glands
| from mexico
TB causing adrenocortical insufficiency
44
what is the main difference between primary adrenal insufficiency and secondary from chronic glucocorticoid
secondary does not affect aldosterone. only decrease in cortisol and ACTH because aldosterone is primarly regulated by RAAS
secondary do not get hyperg\pigementation or hyperkalemia
45
why does TSH decrease in pregnancy
bhcg causes inc T4 in first trimester then suppressing TSH
46
change in thyroid hormones in pregnancy
increase total T4
increase free T4
decrease TSH
47
best markers fr resolution of ketoacidosis
serum anion gap and beta hydroxybutyrate
48
best immediate therapy for Sx hyperthyroid
propranolol
49
low Ca with high PTH
vit D deficiency
chronic kidney disease
pancreatitis or sepsis
tumor lysis
50
prussian blue stain
presence hemosiderin
51
underlying path in G6PD def
oxidative stress
52
heinz bodies
G6PD def
53
in glucagon world what gets converted to pyruvate
lactate, alanine and otehr aa
54
unique property of collicular carcinoma of thyroid
encapsulated. so invasion of tumor capsule and blood vessels
55
when is oral glucose testing done in pregnancy
24-28 weeks
56
what organ is responsible for precocious sexual development
adrenal androgen release
57
isolated premature adrenarche
PCOS, MD 2 or metabolic syndrome
58
management of prolactinoma in premenopausal with no mass effects
cabergoline or bromocriptine
59
How does steatorrhea affect Calcium
| aka celiacs
disrupts absorption vit D. so get vit d deficiency with low Ca, phosphorus and high PTH
60
signs of thyroid storm
```
high fever!
tachy cardia and hypternsion
arrhythmias
agitation, delirium
goiter, lid lag, tremor
warm and moist skin
n/v/d and jaundice
```
61
how does prolactinoma cause hypogonadism
suppress gnRH hormone
62
what cancer most commonly produces PTHrp
metastatic breast cancer
63
clinical manifestations carcinoid
```
skin flushing, telangiectasias
GI diarrhea and cramping
valvular lesions in heart
bronchospams
niacin deficiency
```
64
Dx carcinoid
increased 5HIAA
CT MRI abdomen and pelvis
octreoscan to see mets
echo
65
deficiency in carcinoid
niacin and tryptophan
66
niacin def
dermatitis, diarrhea dementia (pellagra)
67
sheehan
pituitary infarction- ischemic necrosis
68
signs primary adrenal insufficiency (addison)
fatigue, hyperpigmentation, low BP, eosinophilia, low sodium and hyperkalemia
69
what are the tests for adrenal insufficiency
basal early morning cortisol, ACTH and cosyntropin test
70
what is cosyntropin test
ACTH synthetic analogue
| serum cortisol usually increases after administration cosyntropin unless have adrenal insufficiency
71
low basal cortisol in morning with low ACTH
central adrenal insufficiency (pituitary or hypothalamus)
72
central adrenal insufficiency is synonymous with
secondary or tertiary
73
signs of refeeding syndrome
arrhythmia
CHF
seizures
wernicke encephalopathy
74
what causes refeeding syndrome
the release of insulin causing uptake phosphorus, K and Mg
| fast refeeding can cause cardiopulmonary failure
75
what is hyperCa of immobilization
increased osteoclastic bone reabsorption
| need hydration and bisphosphonates
76
what causes neonatal thyrotoxicosis
```
transplacental passage materna anti TSH R Ab
causing warm moist skin
tachy cardia
poor feeding, poor weight gain
low birth weight
```
77
what is T for neonatal thyrotoxicosis
self resolves once Ab disappears
| give methimazole and beta blocker for Sx
78
what will happen if give betablocker to pheo exacerbation
BP will increase rapidly from unnopposed alpha
79
why can large tranfusion cause hypocalcemia
patient has to have liver impairment usually
| citrate in tranfused blood binds the active ionized Ca
80
side effects of antithyroid drugs
agranulocytosis
methimazole is 1st trimester teratogen
propylthiouracil cause hepatic failure and ANCA assoc vasculitis
81
most common cause death in acromegaly
CHF
82
signs of glucocorticoid deficiency
fatigue, loss of appetite, hypoglycemia, hyponatremia and eosinophilia
83
what is not affected in pan hypopituitarism
aldosterone
| remember it is central adrenal insufficiency or secondary.
84
what sex hormone is primarily made in adrenals
DHEA-S
85
overproduction DHEA-S
gets converted to testosterone, hirsutism!
86
most common cause primary adrenal insufficiency
autoimmune
87
most common malignant thyroid carcinoma
papillary from epithelial-thyroid follicular cells)
88
definition constitutional growth delay
delayed growth spurt
delayed puberty
delayed BONE AGE!!!!
89
chronic kidney disease cause what imbalance in electrolytes
secondary hyperPTH from low Ca from low Vit D conversion
| also holds onto phosphorus which also stimualtes PTH
90
TSH and LH values in prolactinoma
low LH
| normal TSH
91
target blood glucose for gestational DM
fasting
92
what is next step if diet modification is not good enough for Gestational DM
insulin
93
what are complications of late maternal hyperglycemia for neonate
polycythemia from inc metabolic demand
organomegaly
macrosomia shoulder dystocia
neonatal hypoglycemia
94
MEN 1
pituitary adenoma
primary hyper PTH
pncrease/GI gastrinoma
95
best initial therapy for primary hyperaldosteronism
eplerenone
96
side effects spironolactone
decreased libido and gynecomastia in men
| breast tenderness and menstural irregularities in women
97
best management in young girl with PCOS no intention of getting pregnant
combined OCP
98
which treatment for graves will worsen eyes temporarily
radioactive iodine pre treat with glucocorticoids to decrease effects
99
nephrotic syndrome. what is causing low serum Ca
low albumin
100
what metabolic abnormalities occur with hypothyroid
hyperlipidemia and hyponatremia
| sometimes aSx elevations CPK and increased AST ALT
101
hypercortisolism
glucose HTN and weight gain. cushings.
can cause proximal wekaness, central adiposity and abdominal striae
HA
usually exogenic. can be small cell lung cancer making ACTH
or ACTH porducing pituitary adenomas (cushing diseasE)
102
hyperCa, metabolic alkalosis and renal failure
milk alkali syndrome
| PTH will be suppressed.
103
HTn with undetectable renin activity
primary hyperaldosteronism
104
how do kidneys escape excess Na with hyperaldosteronism
increase renal blood flow and GFR and atrial natriuretic peptide is relased all to promote Na excretion
105
thyroid nodule. next step
TSH and U/S
106
46 XX with vomiting, poor feeding, dry mucous membranes, skin turgor decreased, enlargement clitoris and fusion labioscrotal folds with no palpable gonads
Na is low and K is high
what is increased
17-hydroxyprogesterone from a deficiency in 21 hydroxylase
| salt wasting!!!
107
best IV fluid for hyperosmolar hyperglycemic state
normal saline
108
patient with hypothyroid taking levothyroxine. now going on estrogen. what is going to happen
need more leveothyroxine because TBG increases
109
osteomalacia
impaired osteoid matrix mineralization from vit D def
110
if this electrolyte is low can cause hypoCa
Mg because induces resistance to PTH and decrease PTH secretion
111
how does PE affect Ca
increase Ca bound to albumin so decrease serum Ca
| because respiratory alkalosis causes H to dissociate from albumin freeing up space for Ca
112
respiratory alkalosis effect on Ca
causes H to dissociate albumin freeing space to bind Ca
| so decrease serum Ca
113
preferred Tx for graves
radioactive iodine therapy unless severe opthamology or pregnant
114
advanced bone age, precocious puberty but LH and after gnRH still is low
peripheral cause-- CAH
115
15 weight gain with muscle weakness proximally and HTN
| glucose is elevated and CXR show right hilar mass and lymphadenopathy
cushings from small cell cancer creating ACTH
116
hyperandrogenism in adult female occuring rapidly
check DHEA-S and testosterone
117
elevated testosterone and normal DHEA-S in female
ovarian source
118
elevated DHEA-S and normal testosterone
adrenal source
119
most common testicular sex cord stromal tumor
leydig cell tumor
120
what do leydig cell tumors produce
testosterone and estrogen from increased aromatase activity
| secondary inhibition LH and FSH
121
skin hyperpigmentation
primary adrenal insufficiency!!!!! not secondary!!!!!!!!!!
122
what causes HTN in thyrotoxicosis
increased myocardial contractility
123
MEN2B
marfinoid!!!
Pheo
medullary thyroid carcinoma
mucosal neuromas
124
Men2A
PTH
Pheo
medullary thyroid
125
fever and sore throat after starting anti thyroid
stop meds! agranulocytosis
126
glucagonoma Sx signs
```
necrolytic migratory erythema- erythematous plaques on face, perineum enalarge and coalesce
DM - mild hyperlycemis
diarrhea, anorexia, abdominal pain
weight loss
ataxia, dementia, proximal mm wekaness
```
127
DM patient with rash and has lost a lot of weight
glucagonoma
128
when do ulcers require amputation
gangrene
129
when to hospitalize for foot ulcer
cellulitis and abscess formation or osteomyelitis
| gangrene
130
risk factors for graves opthamology
SMOKING
female se
advancing age
