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ABIM > Endocrine 1 > Flashcards

Endocrine 1 Flashcards

1
Q

Pt presents with anemia, diarrhea, necrotic migratory erythema, weightloss, chelosis. Dx? Test? Rx?

A

Glaucognoma. Check gucagon levels > 500. Resect

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2
Q

Single most common cause of hypothyroidism?

Test?

What antibodies to check and why?

Rx?

A

Hashimoto’s Thyroiditis.

Measure TSH and FT4.
Can check TPO antibodies ONLY if Diagnosis is Unclear

Rx: Thyroxine.

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3
Q

Pt presents with EPISODIC/Paroxsymal Hypertension, HA, sweating, palpitations, tremors.

Dx?
1. First step in diagnosis?
2. 2nd Step?
3. When to do MIBG?
4. Rx?

A

Pheochromocytoma.

  1. 24 hr Urinary fractionated Metanephrine and Catecholamines or Plasma Metanephrines
  2. CT or MRI of abdomen to look for tumor
  3. When CT or MRI is negative
  4. Alpha blockers (Phenoxybenzamine) for 2 weeks before surgery
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4
Q

Severe Hypothyroidism, AMS, Puffy face, Hands and Enlarge Tongue, Hypothermia.

Dx?

What to give first and why?

A

Myxedema Coma

Admit to ICU

Give IV Hydrocortisone before IV T3 and T4.
( They usually have concomitant Adrenal Insufficiency. Avoid Adrenal Crisis)

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5
Q

Hyperthyroidism with Proptosis and Exopthalmus and Myxedema.

  1. Dx?
  2. Best initial test?
  3. Definitive Test?
  4. Rx (3)?
  5. Side effect of Drug?
  6. Which treatment is good for pregnant patients?
  7. What medication will patients need after?
A
  1. Graves Disease
  2. LOW TSH and HIGH T4
  3. RAUI (Evidence of Diffuse Increased uptake)
    • Radioactive Iodide Ablation Therapy ( Do not use in Pregnant
      Patients)
    • 1st Propranolol and Methamizole (1st Line) -
      Can be definitive RX for 50% patients OR
      given in preparation for Thyroidectomy
    • Thyroidectomy
  5. Agrangulocytosis
  6. PTU during 1st trimester, Also given in Thyroid Storm
  7. Synthroid after Ablation
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6
Q

Hyperthyroid with Tender Thyroid.
Pt was sick previously with URI and fever.

  1. Dx?
  2. Best initial test?
  3. Most accurate test?
  4. Where is the Scan presentation also seen in?
  5. Rx for Mild and Severe Cases?
A
  1. Subacute Granulomatosis Thyroiditis, (Dequarveins Thyroiditis)
    - Occurs POSTVIRAL infection.
  2. Transient: Low TSH and High T4, Then High TSH and low T4 (HYPERthyroid to HYPOthyroid) - the gland burns out
  3. RAUI decreased uptake (due to Destruction of Gland No synthesis done).
  4. Also Seen in Postpartum, Silent, Iodine Induced Thyroiditis.
  5. NSAID for mild pain. Steroids For sever Pain. BB for tachycardia.
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7
Q

Like DKA for the Hyperthyroid. Pt presents with Coma, Delirium, Tachycardia, Restlessness, Emesis, Jaundice and Diarrhea.
Dx?
Management?

A

Thyroid Storm (Brought on by trauma, stress, infection, surgery)

IVF
IV PTU
IV Propanolol,
IV Dexamethasone (Prevents Conversion of T3 to T4 & Adrenal Support)

Iodine-Postassium Solutions (to inhibit hormone release)

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8
Q

Pt presents with delirium, been on ventilator, has had mutiple surgeries Low TSH, T4 and T3. Dx?

A

Sick Euthyroid State

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9
Q

Old lady with a hx of Goiter. Now presents with Palpitations. BP 142/92, HR 97 and 2 large nodules felt on examination.

RAIU shows patchy uptake.

Dx?

Rx?

A

Multinodular Toxic Goiter.

(Patchy uptake on RAIU) as oppose to ONE Toxic Adenoma which has a LOCALIZED uptake on RAIU.

Rx With Radioactive Ablation Therapy or Thyroidectomy

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10
Q

24 yo med student presents with Weightloss, Tremors, Palpitations, Non painful thyroid gland, NO nodules, NO myxedema, NO proptosis. She states she takes no meds.

TSH Low and T4 High.
RAIU Low. Not Uptake Seen.

Dx?

Next step in management?

A

Exogenous/Surreptitious Thyroid Use.

Check Thyroid Globulin levels

(These are ELEVATED in ENDOgenous Thyroid Hormone Production and SUPPRESSED in EXOgenous USE)

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11
Q

Male presents with Gynecomastia, Lack of Labido, Small Testes, Sterility, Thin Wrinkly Skin and Mental Retardation.

Dx?
Test?
Rx?

A

Kinefelter Syndrome
(Most common pRimary Developmental Abnormality causing Hypogonadism)
47, XXY (Barr Body never lef.)

There is HIGH LH, FSH, Estradiol levels with LOW Urinary 12-ketosteroid and LOW testosterone levels.

Testosterone replacement

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12
Q

HTN diagnosed under 30 or above 60, HTN not controlled on 2 medications, associated with polyuria, polydipsia, hypokalemia.

  1. Dx?
  2. Best initial test?
  3. Definitive test?
  4. What test can be done if the first 2 test are equivocal?
  5. Rx for Adenoma?
  6. Rx for Hyperplasia?
A

Hyperaldosteronism (Conn Syndrome.)
Hypernatremia, Hypokalemia

  1. Best initial test is PAC/PRA ratio > 20
    (Tells the difference between Primary and Secondary).
  2. Definitive test Aldosterone Suppression Test
    • (Oral Saline) should suppress Aldosterone
  3. Can Check Venous Sampling if Aldosterone Suppression is Equivocal.

CT scan can be done after biochemical testing. to check for tumor/hyperplasia

  1. Adenoma - Rx with Laparotomy
  2. Bilateral Hyperplasia Rx with - Eleprenone/ Sprinolactone
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13
Q
  1. Next step in management after discovering a firm tender thyroid on physical exam?
  2. When is FNA indicated?
  3. When will you do a I-123 Synctigraphy?
A
  1. TSH and US of Thyroid Gland
  2. FNA is indicated when TSH is NORMAL
    - Cold Nodule/ Hypofunctioning/ Normal TSH
    - Family Hx of Thyroid cancer (MEN)
    - Suspicious Findings on US (Hypoechoic,
    >1cm)
  3. When the US and Lab are Equivocal Test
    -the Synctigraphy will tell if the nodule us
    HYPO or HYPER then you will do FNA
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14
Q
  1. Name 1 cause of Primary Hyperaldosteronism, Renin and Aldosterone Levels?
  2. Name 2 causes for Secondary Hyperaldosteronism, Renin and Aldosterone Levels?
  3. Name 3 causes for Exogenous or NON- Hyperaldosteronism, Renin and Aldosterone Levels?
A
  1. Adenoma/Hyperplasia
    (Decrease Renin, increase Aldosterone)
  2. Malignant HTN, Reno-vascular Artery Stenosis (Increase Renin, Increase Aldosterone)
  3. Cushings Dz, Congenital Adrenal Hyperplasia Exogenous Mineralocorticoid use (Low Renin, Low Aldosterone)
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15
Q

Name the laboratory findings of Osteitis Deformans (Pagets Disease)

A

Normal Ca and Phosphate

Elevated Alk Phos Levels, Urinary Hydroxyproline, N- Telopeptide, C-Telopeptide

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16
Q

Pt has hx of Hashimotos with now Rapidly Growing Thyroid gland causing Obstructing Symptoms. Dx?

A

Thyroid lymphoma

17
Q

Seen in pituitary apoplexy or Sheehan Syndrome:
Name the deficiency:
1. Amenorrhea, loss of libido, erectile dysfunction?
2. Fatigue, nausea, vomiting, weight loss, abdominal pain?
3.Cold intolerance, weight gain, constipation?
4. Loss of Muscle Mass?
5. Polydipsia, Polyuria, Nocturia?

Test? Rx?

A
  1. FSH/LH deficiency
  2. ACTH deficiency
  3. TSH deficiency
  4. GH deficiency
  5. ADH deficiency.

Check for target-organ Hormone deficiency then MRI.

Hydrocortisone, Androgen, GH.

T4 is indicated only after HypoAdrenalism has been ruled out or treated. (Prevent Adrenal Crisis)

18
Q

Common incidental finding on CT/MRI where NO Pituitary Gland is visualized or Small but pts have NORMAL Functional Endocrine Hormones Dx?

A

Empty sella syndrome.

19
Q

Pituitary adenomas: What to Order for Each?

  1. Galactorrhea, Amenorrhea
  2. Enlargement of Hands, Feet, Nose, Lips, Tongue, Increase spacing of teeth?
  3. Proximal Muscle weakness, Facial rounding, centripetal obesity, purple striae, diabetes, hypertension ?
A
  1. Prolactin level (prolactinoma)
  2. IGF-1 (Acromegaly)
  3. 24 hr Urinary Cortisol,
    Overnight 1mg dexamethasone Suppression
    Test
    Late Night Salivary Cortisol Elevated (Cushing
    dz)
20
Q

Management of Adrenal incidentaloma?

A

Order 24 hr Urinary fractionated Metanephrines and Catecholamines & Low Dose 1mg Dexamethasone Suppression test

21
Q

Pt presents with Weakness, Hypotension, Weightloss, Hyperpigmentation, loss of pubic and axillary hair, Neutropenia.

  1. Dx?
  2. What are the metabolic derangement?
  3. Test?
  4. Rx?
  5. Rx for persistent hypotension and hyponatremia?
A
  1. Adrenal Insufficiency
    (Autoimmune, Tumor, TB/Sarcoid/
    Hemachromatosis, Infarction, Surgery)
  2. Hyponatermia, Hyperkalemia, Metabolic Acidosis, Hypoglycemia.
  3. AM Serum Cortsiol and AM Serum ACTH levels.
    If cortisol is < 3 and ACTH is elevated then you
    can stop there.
    If cortisol is btw 3-15 then do Cosynotropin
    Stimulation test (ACTH Stimulation test)
  4. Rx: IVF + HC
  5. ADD FC for persistent hypotension, Hyponatremia
22
Q

Pt presents with Galactorrhea, Amenorrhea and Infertility.

Men experience Erectile Dysfunction and Decreased Libido

Dx?

What to R/O?

Test?

What is the First Line Treatment ?

What is the 2nd Line Treatment?

A

Hyperprolactinemia.
1. Check levels: 200 means pituitary

  1. Rule out other causes
    Beta HCG, TRH,
    - BUN/CR (Renal failure can lead to elevated
    prolactin levels)
  2. Order MRI

Rx: 1. Dopamine Agonist (Cabergoline/Bromocriptine)

  1. Transphenoidal surgery
    • 2nd line because most Prolactinomas shrink
      with D2 agonist
23
Q

Recent head trauma, neurosurgery, pituitary mass lesion, infiltrative disorder, kidney dz, lithium use.
Urine osm < 200.

  1. Dx?
  2. What Should be R/o?
  3. Test?
  4. How to differentiate Nephrogenic from Central DI?
  5. Treatment:
    a. DI after surgery?
    b. Chronic central DI?
    c. Lithium induced nephrogenic DI?
    d. Non-drug induced nephrogenic DI?
A
  1. SIADH
  2. R/o Diabetes and HYPERcalcemia
  3. Water deprivation test
  4. Desmopressin challenge test (Give ADH)
     If POSITIVE (urine concentrates OK) do MRI. 

  If NEGATIVE (urine remains dilute kidney 
  NOT OK) do 
   kidney US

5 a. 5% dextrose, 0.45% sodium chloride
IV Desmopressin

b. Intranasal or Oral desmopressin

c. Stop lithium

d. Thiazide and Salt restriction

24
Q

Pt had Thyroid Surgery and now presents with Chovstek, Tetany, QT Prolongation, Hypotension, Circumoral Tingling of the hands and feet.

  1. Dx?
  2. What are the other 2 common reasons?
  3. Labs ?
  4. What does Respiratory Alkalosis do?
  5. Treatment?
A
  1. Hypocalcemia
    Primary hypoparathyroidism from post neck surgery ie thyroidectomy.
    • Hypomagnesemia (Mag stimulates Parathyroid Gland, low levels lead to Ca loss in urine)
    • Renal Failure (cant activate Vit D)
  3. Check Ionized/Free and Total Ca level AND Albumin level (for every 1 pt decrease albumin the total Ca will decrease by .8)
    0.8 (4 - pt albumin) + serumCa

Check, PTH, Vit D, Mag

  1. Respiratory Alkalaosis causes more binding of Ca to Albumin which would lower the Ionized Calcium as well
  2. Rx: Treat the underlying disorder.
    Replace Mag, Calcium, Vitamin D
25
Q

What is the Difference btw Primary Hyperparathyroidism and Familial Hypocalciuric Hypercalcemia?

Rx for FHH Rx for PPTH?

A

Both have elevated PTH

FHH has MILD HYperCalcemia with NO symptoms.

-Urine Ca <200

  • Urine Calcium/Urine Creatinine ratio < 1.0 in FHH because mutation in Calcium Sensing Receptor in Kidney which causes inability to excrete Ca INTO Urine.

PPTH has Urine Ca > 200 and UC/CR >2.0
All the elevated CA is able to excreted into Urine

Rx for FHH is reassurance.

PPTH is parathyroidectomy if symptomatic.

26
Q

27 yo F presents with Poor Sleep, Palpitations, Hand Tremors, Sweaty Hands, Heat Intolerance for the last 2-3 weeks. She has mild Diffuse Thyroid Enlargement with NO Tenderness, Nodules or Bruit. She has lid lag without exophthalmos.
TSH < 0.03, T3 230, Thyroglobulin 126. RAIU is 2%.

Dx?
Next Step in management ?

A

Painless Thyroiditis (Preformed Thyroid Hormone Release. (Occurs in Women > 1 year post Pregnancy.)

Self limited treatment
Beta Blocker therapy if needed

27
Q

Young patient who presents with Osteoporosis and Recurrent Fractures despite Bisphosphonate Therapy.

Next step in Management?

A

Evaluate for Secondary Causes of Osteoporosis.

(Cushing Syndrome, TSH, Hyperparathyroidism, GI (UC/Crohns) Meds)

28
Q

63 yo M with hx of Radiation due to Nasopharngyeal Cancer 10 years ago.
Presents with Fatigue, Lethargy, Dry Skin, loss of libido and Cold Intolerance.

Cortisol is 6
TSH 0.4
T3 88
Testosterone 279

Next Step in Management?

A

Cosyntropin Stimulation Test for evaluation of Adrenal insufficiency.

Pt has Central Hypothyroidism

29
Q
  1. Initial Test for Acromegaly?
  2. Definitive test
  3. Treatment?
A
  1. IGF1 ( has no fluctuations like GH)
  2. Oral Glucose Suppression Test
    • Give glucose and it suppresses GH (Negative
      Test)
    • Does not Suppress GH (Positive)

ABIM (45 decks)

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