Endocrine 1

Question 1

plasma aldosterone to renin is greater than 20… dx is

next step

Answer 1

primary hyperaldosteronism

adrenal suppression testing (give salt load). if positive, do adrenal imaging with CT

Question 2

differential for low RAIU in hyperthyroid patient, and how to differentiate

Answer 2

release of preformed thyroid hormone (thyroiditis)
exogenous intake of thyroid hormone
distinguish w/ thyroglobulin (high in endogenous thyroid release, low in exogenous intake)

Question 3

elevated alpha subunit to TSH - dx?

Answer 3

pituitary adenoma

Question 4

what do you see in secondary adrenal insufficiency caused by chronic steroid use

Answer 4

decr ACTH
decr cortisol
normal aldosterone

Question 5

what do you see in primary adrenal insufficiency

Answer 5

incr ACTH
decr cortisol
decr aldosterone

Question 6

prolactin is stimulated by

Answer 6

TRH

serotonin

Question 7

effects of low cortisol

Answer 7

low glucose
hyponatremia
eosinophilia

Question 8

ADR of both methimazole and PTU

Answer 8

agranulocytosis

Question 9

methimazole ADRs

Answer 9

cholestasis
1st trimester teratogen
agranulocytosis

Question 10

PTU ADRs

Answer 10

hepatic failure
ANCA associated vasculitis
agranulocytosis

Question 11

low T3 only

Answer 11

euthyroid sick syndrome

Question 12

high TSH, normal T3 and T3, no sxs

Answer 12

subclinical hypothyroidism

Question 13

labs suggestive of primary hyperaldosteronism

Answer 13

PAR greater than 20

and plasma aldosterone greater than 15

Question 14

tx of primary hyperaldosteronism, unilateral vs bilateral adrenal adenoma

Answer 14

unilateral: surgery preferred over aldosterone antagonist
bilateral: aldosterone antagonist

Question 15

hyperandrogenism

- labs to order, and interpretation

Answer 15

testosterone and DHEAS
if T high and DHEAS normal: ovarian source
if T NL and DHEAS high: adrenal source

Question 16

sxs of severe diabetic retinopathy

Answer 16

poor night vision
curtain falling from vitreous bleed
floaters during resolution of vitreous bleed

Question 17

first step in hyperosmolar hyperglycemic state, and next step

Answer 17

IVF (NS initially, then switch to half NS if sodium normal or high)
monitor K, give K if 3.3-5.3

Question 18

low LH, low FSH, low testosterone.. possible cause

Answer 18

prolactinoma (suppresses GnRH)

Question 19

Hashimoto’s thyroiditis prone to what cancer

Answer 19

thyroid lymphoma

Question 20

when to add D5 in DKA

Answer 20

when glucose less than 200

Question 21

treatments for SIADH

Answer 21

water restriction to less than 800 mL
if urine osmol at least twice serum osmol, do loop diuretics
hypertonic saline until sodium at least 120

Question 22

common causes of elevated PTH

Answer 22

CKD

Vit D deficiency

Question 23

patient has HPA axis suppression with high dose corticosteroid (greater than 20 mg)… anesthesiologist should avoid

Answer 23

etomidate

Question 24

patient taking intermediate level of corticosteroid (between 5 and 20).. how to measure risk of HPA axis suppression

Answer 24

early morning cortisol

Question 25

primary polydipsia labs

Answer 25

low Na
serum osm greater than 290
urine osm less than 100

Question 26

diabetic… best med for weight loss and mechanism

Answer 26

exenatide (byetta)

GLP-1 agonist

Question 27

T2DM and on metformin. when should you add insulin?

Answer 27

Hb A1c greater than 8.5

Question 28

congenital aromatase deficiency

• sxs
• labs

Answer 28

maternal virilism
virilization of XX babies
xx have normal internal, but virilized external genitalia

high FSH/LH
low estrogen

Question 29

hyperthyroid and decreased thyroid uptake

Answer 29

painless / silent thyroiditis
struma ovarii
De Quervain / subacute thyroiditis

Question 30

prolactin level of prolactinoma

Answer 30

at least 200