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Step2CK > Endo Uworld > Flashcards

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

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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

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3
Q

what drug can bring out adrenal crisis during surgery

A

etomidate

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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

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5
Q

what to check for primary amenorrhea

A

prolactin TSH and FSH after checking pregnancy

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6
Q

primary amenorrhea with increased FSH

A

premature ovarian failure

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7
Q

primary amenorrhea with increased TSH

A

hypothyroid

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8
Q

Euthyroid sick syndrome

A

fall in T3 levels. normal T4 and TSH

during acute sick illness

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9
Q

why do heavy women have milder post menopasual Sx

A

conversion of adrenal androgens to estrogens by adipose tissue

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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
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11
Q

what releases PTHrp usually

A 
squamous cell lung!
renal
bladder
breast
ovarian
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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

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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)

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14
Q

dosing levothyroxine with pregnancy

A

increase dose when pregnant

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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

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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

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17
Q

generalized bone pain. just had bowel resection for crohns. has pseudofractures and proximal muscle weakness

A

osteomalacia

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18
Q

labs of osteomalacia

A

decreased Ca, decreased phosphorus.

increased PTH

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19
Q

C peptide reflects what

A

natural insulin by product

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20
Q

how to Dx primary polydipsia

A

if urinary omsolality increases after water deprivation test

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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

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22
Q

untreated hyperthyroidism is greatest risk for

A

bone loss

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23
Q

signs hyperthyroid with painless nodule and decreased uptake

A

painless thyroiditis

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24
Q

what DM med is helpgul to reduce weight and control BP

A

GLP-1 agonist

exenatide or lireglutide

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25
Q

side effect of GLP-1 agonists for dM

A

pancreatitis

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26
Q

DM with decreased appetite nausea and abdominal bloating. gets early satiety and low glucose right after meals

A

delayed gastric emptying (gastroparesis)

Tx with metoclompramide or small frequent meals

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27
Q

signs hyperthyrdoi and thyroid exam show 2 nodules on scan only uptake in one of them and no uptake anywhere else

A

toxi adenoma

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28
Q

what dugs can precipitate hyperosmolar hyperglycemic states in DM

A

thiazides because volume deplete and dec GFR more which activates hormones to counter regulate

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29
Q

comorbidities with PCOS

A 
overweight/obesity
glucose intolerance/DM
dyslipidemia
OSA
endometrial hyperplasia/cancer
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30
Q

best step in manageing diabetic nephropathy

A

BP control

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31
Q

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

A

measure thyroid hormones because hypothyroid can cause myopathy

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32
Q

signs hyperthyroid. on diet, has diffuse decrease uptake on scan

A

low TBG level due to exogenous thyroid supplements

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33
Q

what CA is associated with hashimoto

A

lymphoma of thyroid

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34
Q

decreaseing HbA1c to less than 6.5% helps prevent what

A

retinopathy

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35
Q 
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
A

VIPoma

achlorhydria from dec gastric acid secretion

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36
Q

lab findings in VIPoma

A

hypokalemia
hypercalcemia
hyperglycemia

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37
Q

first line for DM neuropathy

A

TCA

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38
Q

high TSH T3 T4

A

TSH secreting pituitary adenoma

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39
Q

causes of proximal muscle myopathy

A 
polymyosistis dermatomyositis
hypo or hyper thyroid
cushings
lambert eaton
myasthenia gravis
steroids
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40
Q

HTn and hypokalemia

A

check plasma aldosterone/renin ratio

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41
Q

what do you check if suspect acromegaly

A

IGF-1 if high then do glucose suppression test. if does not suppress GH = acromegaly

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42
Q

low and high dose DXM does not suppress cortisol

A

ectopic ACTH production

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43
Q

calcification of both adrenal glands

from mexico

A

TB causing adrenocortical insufficiency

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44
Q

what is the main difference between primary adrenal insufficiency and secondary from chronic glucocorticoid

A

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

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45
Q

why does TSH decrease in pregnancy

A

bhcg causes inc T4 in first trimester then suppressing TSH

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46
Q

change in thyroid hormones in pregnancy

A

increase total T4
increase free T4
decrease TSH

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47
Q

best markers fr resolution of ketoacidosis

A

serum anion gap and beta hydroxybutyrate

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48
Q

best immediate therapy for Sx hyperthyroid

A

propranolol

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49
Q

low Ca with high PTH

A

vit D deficiency
chronic kidney disease
pancreatitis or sepsis
tumor lysis

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50
Q

prussian blue stain

A

presence hemosiderin

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51
Q

underlying path in G6PD def

A

oxidative stress

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52
Q

heinz bodies

A

G6PD def

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53
Q

in glucagon world what gets converted to pyruvate

A

lactate, alanine and otehr aa

54
Q

unique property of collicular carcinoma of thyroid

A

encapsulated. so invasion of tumor capsule and blood vessels

55
Q

when is oral glucose testing done in pregnancy

A

24-28 weeks

56
Q

what organ is responsible for precocious sexual development

A

adrenal androgen release

57
Q

isolated premature adrenarche

A

PCOS, MD 2 or metabolic syndrome

58
Q

management of prolactinoma in premenopausal with no mass effects

A

cabergoline or bromocriptine

59
Q

How does steatorrhea affect Calcium

aka celiacs

A

disrupts absorption vit D. so get vit d deficiency with low Ca, phosphorus and high PTH

60
Q

signs of thyroid storm

A 
high fever!
tachy cardia and hypternsion
arrhythmias
agitation, delirium
goiter, lid lag, tremor
warm and moist skin
n/v/d and jaundice
61
Q

how does prolactinoma cause hypogonadism

A

suppress gnRH hormone

62
Q

what cancer most commonly produces PTHrp

A

metastatic breast cancer

63
Q

clinical manifestations carcinoid

A 
skin flushing, telangiectasias
GI diarrhea and cramping
valvular lesions in heart
bronchospams
niacin deficiency
64
Q

Dx carcinoid

A

increased 5HIAA
CT MRI abdomen and pelvis
octreoscan to see mets
echo

65
Q

deficiency in carcinoid

A

niacin and tryptophan

66
Q

niacin def

A

dermatitis, diarrhea dementia (pellagra)

67
Q

sheehan

A

pituitary infarction- ischemic necrosis

68
Q

signs primary adrenal insufficiency (addison)

A

fatigue, hyperpigmentation, low BP, eosinophilia, low sodium and hyperkalemia

69
Q

what are the tests for adrenal insufficiency

A

basal early morning cortisol, ACTH and cosyntropin test

70
Q

what is cosyntropin test

A

ACTH synthetic analogue

serum cortisol usually increases after administration cosyntropin unless have adrenal insufficiency

71
Q

low basal cortisol in morning with low ACTH

A

central adrenal insufficiency (pituitary or hypothalamus)

72
Q

central adrenal insufficiency is synonymous with

A

secondary or tertiary

73
Q

signs of refeeding syndrome

A

arrhythmia
CHF
seizures
wernicke encephalopathy

74
Q

what causes refeeding syndrome

A

the release of insulin causing uptake phosphorus, K and Mg

fast refeeding can cause cardiopulmonary failure

75
Q

what is hyperCa of immobilization

A

increased osteoclastic bone reabsorption

need hydration and bisphosphonates

76
Q

what causes neonatal thyrotoxicosis

A 
transplacental passage materna anti TSH R Ab
causing warm moist skin
tachy cardia
poor feeding, poor weight gain
low birth weight
77
Q

what is T for neonatal thyrotoxicosis

A

self resolves once Ab disappears

give methimazole and beta blocker for Sx

78
Q

what will happen if give betablocker to pheo exacerbation

A

BP will increase rapidly from unnopposed alpha

79
Q

why can large tranfusion cause hypocalcemia

A

patient has to have liver impairment usually

citrate in tranfused blood binds the active ionized Ca

80
Q

side effects of antithyroid drugs

A

agranulocytosis
methimazole is 1st trimester teratogen
propylthiouracil cause hepatic failure and ANCA assoc vasculitis

81
Q

most common cause death in acromegaly

A

CHF

82
Q

signs of glucocorticoid deficiency

A

fatigue, loss of appetite, hypoglycemia, hyponatremia and eosinophilia

83
Q

what is not affected in pan hypopituitarism

A

aldosterone

remember it is central adrenal insufficiency or secondary.

84
Q

what sex hormone is primarily made in adrenals

A

DHEA-S

85
Q

overproduction DHEA-S

A

gets converted to testosterone, hirsutism!

86
Q

most common cause primary adrenal insufficiency

A

autoimmune

87
Q

most common malignant thyroid carcinoma

A

papillary from epithelial-thyroid follicular cells)

88
Q

definition constitutional growth delay

A

delayed growth spurt
delayed puberty
delayed BONE AGE!!!!

89
Q

chronic kidney disease cause what imbalance in electrolytes

A

secondary hyperPTH from low Ca from low Vit D conversion

also holds onto phosphorus which also stimualtes PTH

90
Q

TSH and LH values in prolactinoma

A

low LH

normal TSH

91
Q

target blood glucose for gestational DM

A

fasting

92
Q

what is next step if diet modification is not good enough for Gestational DM

A

insulin

93
Q

what are complications of late maternal hyperglycemia for neonate

A

polycythemia from inc metabolic demand
organomegaly
macrosomia shoulder dystocia
neonatal hypoglycemia

94
Q

MEN 1

A

pituitary adenoma
primary hyper PTH
pncrease/GI gastrinoma

95
Q

best initial therapy for primary hyperaldosteronism

A

eplerenone

96
Q

side effects spironolactone

A

decreased libido and gynecomastia in men

breast tenderness and menstural irregularities in women

97
Q

best management in young girl with PCOS no intention of getting pregnant

A

combined OCP

98
Q

which treatment for graves will worsen eyes temporarily

A

radioactive iodine pre treat with glucocorticoids to decrease effects

99
Q

nephrotic syndrome. what is causing low serum Ca

A

low albumin

100
Q

what metabolic abnormalities occur with hypothyroid

A

hyperlipidemia and hyponatremia

sometimes aSx elevations CPK and increased AST ALT

101
Q

hypercortisolism

A

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
Q

hyperCa, metabolic alkalosis and renal failure

A

milk alkali syndrome

PTH will be suppressed.

103
Q

HTn with undetectable renin activity

A

primary hyperaldosteronism

104
Q

how do kidneys escape excess Na with hyperaldosteronism

A

increase renal blood flow and GFR and atrial natriuretic peptide is relased all to promote Na excretion

105
Q

thyroid nodule. next step

A

TSH and U/S

106
Q

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

A

17-hydroxyprogesterone from a deficiency in 21 hydroxylase

salt wasting!!!

107
Q

best IV fluid for hyperosmolar hyperglycemic state

A

normal saline

108
Q

patient with hypothyroid taking levothyroxine. now going on estrogen. what is going to happen

A

need more leveothyroxine because TBG increases

109
Q

osteomalacia

A

impaired osteoid matrix mineralization from vit D def

110
Q

if this electrolyte is low can cause hypoCa

A

Mg because induces resistance to PTH and decrease PTH secretion

111
Q

how does PE affect Ca

A

increase Ca bound to albumin so decrease serum Ca

because respiratory alkalosis causes H to dissociate from albumin freeing up space for Ca

112
Q

respiratory alkalosis effect on Ca

A

causes H to dissociate albumin freeing space to bind Ca

so decrease serum Ca

113
Q

preferred Tx for graves

A

radioactive iodine therapy unless severe opthamology or pregnant

114
Q

advanced bone age, precocious puberty but LH and after gnRH still is low

A

peripheral cause– CAH

115
Q

15 weight gain with muscle weakness proximally and HTN

glucose is elevated and CXR show right hilar mass and lymphadenopathy

A

cushings from small cell cancer creating ACTH

116
Q

hyperandrogenism in adult female occuring rapidly

A

check DHEA-S and testosterone

117
Q

elevated testosterone and normal DHEA-S in female

A

ovarian source

118
Q

elevated DHEA-S and normal testosterone

A

adrenal source

119
Q

most common testicular sex cord stromal tumor

A

leydig cell tumor

120
Q

what do leydig cell tumors produce

A

testosterone and estrogen from increased aromatase activity

secondary inhibition LH and FSH

121
Q

skin hyperpigmentation

A

primary adrenal insufficiency!!!!! not secondary!!!!!!!!!!

122
Q

what causes HTN in thyrotoxicosis

A

increased myocardial contractility

123
Q

MEN2B

A

marfinoid!!!
Pheo
medullary thyroid carcinoma
mucosal neuromas

124
Q

Men2A

A

PTH
Pheo
medullary thyroid

125
Q

fever and sore throat after starting anti thyroid

A

stop meds! agranulocytosis

126
Q

glucagonoma Sx signs

A 
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
Q

DM patient with rash and has lost a lot of weight

A

glucagonoma

128
Q

when do ulcers require amputation

A

gangrene

129
Q

when to hospitalize for foot ulcer

A

cellulitis and abscess formation or osteomyelitis

gangrene

130
Q

risk factors for graves opthamology

A

SMOKING
female se
advancing age

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