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UWorld > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How can you differentiate Type 1 DM from steroid-induced DM in a patient started on steroids 6 months ago for suspected primary adrenal insufficiency?

A

Steroid-induced DM will not show ketoacidosis (T1DM will show ketoacidosis); Addison’s disease is usually treated with physiologic doses of steroids (not enough to cause steroid-induced DM)

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2
Q

MOA of Pioglitazone?

A

PPARg agonist

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3
Q

Pioglitazone belongs to class of …

A

Thiazolidinediones

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4
Q

Major AE of Pioglitazone?

A

Pulmonary edema

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5
Q

Which type of patient is at greatest risk of developing pulmonary edema during Pioglitazone use?

A

CHF

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6
Q

HbA1c at which patients should be started on insulin (especially if they have symptoms of hyperglycemia)?

A

A1c > 9.0

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7
Q

Benefit of basal insulin vs. NPH insulin?

A

Basal insulin has lower risk of hypoglycemia

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8
Q

4 aspects of clinical presentation for MELAS?

A

Seizures, Hearing loss, Lactic acidosis, Stroke-like episodes

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9
Q

Myasthenia gravis represents a disease of …

A

Neuromuscular junction

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10
Q

Characteristic of muscle weakness seen in Myasthenia gravis?

A

Muscle weakness worsens as the day progresses

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11
Q

2 most common aspects of clinical presentation for Myasthenia gravis?

A

Double vision, Ptosis

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12
Q

What accounts for Double vision, Ptosis seen in setting of Myasthenia gravis?

A

Weakness of extraocular muscles

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13
Q

2nd most common aspect of clinical presentation for Myasthenia gravis?

A

Dysphagia

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14
Q

What accounts for Dysphagia seen in setting of Myasthenia gravis?

A

Weakness of bulbar muscles

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15
Q

Etiology of Myasthenia gravis?

A

Ig against ACH-R

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16
Q

Strong association exists between Myasthenia gravis and …

A

Thymoma

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17
Q

2 DOCs for Raynaud syndrome?

A

Nifedipine, Amlodipine

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18
Q

Nifedipine, Amlodipine belong to which class of medication?

A

DHP CCBs

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19
Q

Best management of retrosternal, multinodular goiter in patient presenting with dysphagia?

A

Surgical excision

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20
Q

29 yo female presents with asymptomatic hypercalcemia (due to primary hyper-parathyroidism); HX of stomach ulcers; FHX of pituitary tumors – diagnosis?

A

MEN1 syndrome

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21
Q

3 hallmarks of MEN1 syndrome?

A

3 P’s … Pituitary, Parathyroid, Pancreas

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22
Q

Best management of MEN1 syndrome in patient < 50 yo?

A

Parathyroidectomy

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23
Q

Most common extracranial tumor of childhood?

A

Neuroblastoma

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24
Q

Most common sites of origin for Neuroblastoma?

A

Adrenal medulla, Sympathetic chain ganglia

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25
Q

Clinical presentation for Neuroblastoma?

A

Painless abdominal mass, flushing, sweating

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26
Q

What accounts for HTN in setting of Neuroblastoma?

A

Mass compression of renal artery … activation of RAS … HTN

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27
Q

What accounts for flushing, sweating in setting of Neuroblastoma?

A

Catecholamine surge

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28
Q

Levels of PTH seen in familial hypocalciuric hypercalcemia?

A

Increased

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29
Q

How can you distinguish familial hypocalciuric hypercalcemia from primary hyperparathyroidism?

A

Check urinary Ca2+ … low in familial hypocalciuric hypercalcemia, high in primary hyperparathyroidism

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30
Q

First step of evaluation for familial hypocalciuric hypercalcemia?

A

Serum PTH

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31
Q

Clinical presentation of familial hypocalciuric hypercalcemia?

A

Asymptomatic hypercalcemia

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32
Q

Inheritance pattern of familial hypocalciuric hypercalcemia?

A

AD

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33
Q

Etiology of familial hypocalciuric hypercalcemia?

A

Mutation in calcium-sensing receptor

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34
Q

Clinical presentation of hyperglycemic hyperosmotic nonketotic state (HHS)?

A

Very high BG, AMS, No ketoacidosis

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35
Q

Initial management of hyperglycemic hyperosmotic nonketotic state (HHS)?

A

IV fluids, IV insulin, K+ replacement

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36
Q

Best treatment for patients with hyperglycemic hyperosmotic nonketotic state (HHS) once BG has been corrected to < 200?

A

Subcutaneous insulin (basal-bolus regimen)

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37
Q

Change to mineralcorticoids in setting of 21-hydroxylase CAH?

A

Decreased

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38
Q

Change to glucocorticoids in setting of 21-hydroxylase CAH?

A

Decreased

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39
Q

Change to androgens in setting of 21-hydroxylase CAH?

A

Increased

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40
Q

Symptoms seen in setting of 21-hydroxylase CAH?

A

Ambiguous genitalia in girls, Precocious puberty in males

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41
Q

Change to K+ in setting of 21-hydroxylase CAH?

A

Increased

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42
Q

Change to Na+ in setting of 21-hydroxylase CAH?

A

Decreased

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43
Q

Change to BP in setting of 21-hydroxylase CAH?

A

Decreased

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44
Q

Change to mineralcorticoids in setting of 11-hydroxylase CAH?

A

Increased

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45
Q

Change to glucocorticoids in setting of 11-hydroxylase CAH?

A

Decreased

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46
Q

Change to androgens in setting of 11-hydroxylase CAH?

A

Increased

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47
Q

Symptoms seen in setting of 11-hydroxylase CAH?

A

Ambiguous genitalia in girls

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48
Q

Change to K+ in setting of 11-hydroxylase CAH?

A

Decreased

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49
Q

Change to BP in setting of 11-hydroxylase CAH?

A

Increased

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50
Q

Change to mineralcorticoids in setting of 17-hydroxylase CAH?

A

Increased

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51
Q

Change to glucocorticoids in setting of 17-hydroxylase CAH?

A

Increased

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52
Q

Change to androgens in setting of 17-hydroxylase CAH?

A

Decreased

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53
Q

Symptoms seen in setting of 17-hydroxylase CAH?

A

Ambiguous genitalia in males; Absent puberty

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54
Q

Change to K+ in setting of 17-hydroxylase CAH?

A

Decreased

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55
Q

Change to BP in setting of 17-hydroxylase CAH?

A

Increased

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56
Q

Inheritance pattern of 21-hydroxylase CAH?

A

AR

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57
Q

Diagnostic test for 21-hydroxylase CAH?

A

Elevated levels of 17-hydroxyprogesterone

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58
Q

Best management of 21-hydroxylase CAH?

A

Chronic replacement of glucocorticoids + mineralocorticoids; Genital reconstruction for females

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59
Q

4 aspects of clinical presentation for pheochromocytoma?

A

Episodic HA, palpitations, sweating; Resistant HTN

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60
Q

Genetic syndrome associated with pheochromocytoma?

A

MEN2

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61
Q

Best screening test for pheochromocytoma?

A

24-hour fractionated urinary metanephrine + catecholamine excretion

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62
Q

After biologic confirmation, what is the next step of workup for pheochromocytoma?

A

Abdominal imaging with CT, MRI

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63
Q

Most common location of pheochromocytoma?

A

Adrenal glands

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64
Q

Patient with high clinical suspicion for pheochromocytoma, but (-) MRI/CT – what is next step?

A

MIBG scan

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65
Q

Preoperative management of pheochromocytoma?

A

10-14 days of alpha blocker for BP control, then b blocker

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66
Q

Common intraoperative complication of pheochromocytoma?

A

Hypotension

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67
Q

What accounts for hypotension as intraoperative complication of pheochromocytoma?

A

Decreased catecholamine levels in circulation after tumor removal

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68
Q

Best management of intraoperative hypotension during removal of pheochromocytoma?

A

NML saline bolus

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69
Q

Best management of intraoperative HTN during removal of pheochromocytoma?

A

Phentolamine

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70
Q

Typical change to thyroid hormone seen in the setting of amiodarone use?

A

Decreased peripheral conversion of T4  T3 … (high T4, low T3)

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71
Q

How can amiodarone also lead to hypothyroidism?

A

High iodine content in amiodarone inhibits synthesis of thyroid hormone

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72
Q

Which b blocker is used in thyrotoxic emergencies, due to its ability to decrease peripheral conversion of T4  T3?

A

Propranolol

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73
Q

Of all the b blockers, why does Propranolol have the ability to decrease peripheral conversion of T4  T3?

A

Propranolol is a non-cardioselective b blocker

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74
Q

Prognosis for amiodarone-associated changes in thyroid hormone?

A

Will see changes to thyroid hormones during first 3 months … then thyroid hormone abnormalities will resolve after 3 months

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75
Q

3 aspects of clinical presentation for alcoholic ketoacidosis?

A

AMS, ketonuria, mild hyperglycemia

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76
Q

Change to anion gap in alcoholic ketoacidosis?

A

Increased

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77
Q

Typical BG in DKA?

A

BG > 250

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78
Q

Best management of alcoholic ketoacidosis?

A

IV dextrose, NML saline, thiamine … (insulin not necessary)

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79
Q

Most common cause of obesity?

A

Imbalance of caloric intake / energy expenditure … overeating

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80
Q

60 yo female presents after MVA; States that she did not see other car approaching from side; Reports HX of bilateral adrenalectomy for treatment of Cushing’s disease; PE shows bitemporal hemianopsial – diagnosis?

A

Nelson syndrome

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81
Q

What is Nelson’s Syndrome?

A

Tumor of pituitary gland

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82
Q

Etiology of Nelson’s Syndrome?

A

Loss of negative feedback of adrenal glucocorticoids following bilateral adrenalectomy

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83
Q

Clinical presentation of Nelson’s Syndrome?

A

Bitemporal hemianopsia, hyperpigmentation

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84
Q

Diagnostic tests for Nelson’s Syndrome?

A

MRI showing pituitary enlargement, elevated ACTH levels

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85
Q

Best management of Nelson’s Syndrome?

A

Pituitary tumor is aggressive … so treat with surgery + radiation of pituitary gland

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86
Q

Possible strategy for prevention of Nelson’s Syndrome after bilateral adrenalectomy?

A

Pituitary radiation

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87
Q

Disadvantage of Pituitary radiation for prevention of Nelson’s Syndrome after bilateral adrenalectomy?

A

Increased risk of hypopituitarism

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88
Q

What is now the preferred treatment for Cushing Syndrome (no longer bilateral adrenalectomy)?

A

Transsphenoidal pituitary surgery

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89
Q

How does amiodarone cause hyperthyroidism?

A

Increases thyroid hormone synthesis

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90
Q

How does amiodarone cause hypothyroidism?

A

Large iodine load in amiodarone suppresses synthesis of thyroid hormone; Directly inhibits peripheral conversion of T4  T3

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91
Q

Electrolyte abnormality associated with hypothyroidism?

A

Hyponatremia

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92
Q

Additional testing that all patients placed on amiodarone should undergo?

A

TSH every 3-4 months

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93
Q

35 yo female presents with uncontrolled HTN; Reports mood swings, recent DX of DM; PE shows no abdominal bruit, full peripheral pulse; CXR shows vertebral osteopenia – diagnosis?

A

Cushing syndrome

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94
Q

2 lab values associated with Cushing syndrome?

A

Hypokalemia, metabolic alkalosis

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95
Q

2 screening test options for Cushing syndrome?

A

24-hour urinary free cortisol, Dexamethasone suppression test

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96
Q

Normal response to Dexamethasone suppression test?

A

Serum cortisol is suppressed after administration of dexamethasone

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97
Q

2 greatest risks of mortality in patients with acromegaly?

A

Cardiovascular disease, Colon CA

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98
Q

How does acromegaly lead to Cardiovascular disease?

A

Asymmetric septal hypertrophy, conduction defects, myocardial fibrosis

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99
Q

Clinical presentation of Cystic Fibrosis?

A

Chronic productive cough, fatigue, weight loss, recurrent respiratory infection

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100
Q

Inheritance pattern of Cystic Fibrosis?

A

AR

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101
Q

2 most common pathogens responsible for recurrent respiratory infection in cystic fibrosis?

A

Staph aureus, Pseudomonas

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102
Q

CXR finding that suggests Cystic Fibrosis?

A

Bronchiectasis … (several parallel linear opacities in lung parenchyma)

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103
Q

Gold standard diagnostic test for Cystic Fibrosis?

A

Sweat chloride test

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104
Q

22 yo female presents to initial OCP use; Reports HX of hypothyroidism, currently taking levothyroxine – relationship between starting OCP and patient’s hypothyroidism?

A

Levothyroxine will likely need to be increased due to effects of OCP

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105
Q

In addition to starting OCP, what are 2 other circumstances that may warrant increase in levothyroxine dose for patient?

A

Pregnancy, Acute hepatis

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106
Q

Why do pregnancy, acute hepatitis, and OCP use warrant increased dose of levothyroxine?

A

Increased estrogen level increases the amount of Thyroxine-Binding Globulin (TBG) in circulation … decreases levels of free circulating thyroid hormone (T3,T4)

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107
Q

In addition to increasing levothyroxine dose in patients who are pregnant OR using OCPs, what other screening should be performed on regular basis?

A

TSH measurements

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108
Q

42 yo female presents with GI symptoms consistent with IBS; CT abdomen shows 2cm adrenal mass – next step of workup?

A

Workup for hormone hypersecretion/malignancy

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109
Q

5 essential lab studies for patient with incidental adrenal mass?

A

Serum electrolytes, Dexamethasone suppression test, 24-hour urine catecholamines, metanephrine + VMA, 17-ketosteroid

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110
Q

3 characteristics of adrenal incidentalomas that require surgical excision?

A

Malignant tumors, Size > 4cm, Functional tumor

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111
Q

Best management of adrenal incidental tumors that do not have suspicious characteristics?

A

Observation with serial abdominal imaging; Removal if increasing in size

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112
Q

Initial step of workup for patient with high clinical suspicion for diabetic neuropathy?

A

Tuning fork screening test

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113
Q

3 first-line DOCs for management of diabetic neuropathy?

A

SNRIs, Pregabalin, TCAs

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114
Q

Example of SNRIs used in treatment of diabetic neuropathy?

A

Duloxetine

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115
Q

35 yo male presents with excessive daytime sleepiness; BMI = 36; HX of HTN – diagnosis?

A

Obstructive Sleep Apnea

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116
Q

Next step of workup for patient with high-clinical suspicion for Obstructive Sleep Apnea?

A

Polysomnography

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117
Q

41 yo female presents with amenorrhea, dyspareunia, blurred vision; Labs show prolactin = 50, undetectable LH and FSH; a subunit is increased – diagnosis?

A

Pituitary adenoma

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118
Q

Primary treatment for Pituitary adenoma?

A

Trans-sphenoidal surgery

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119
Q

3 test results that are DIAGNOSTIC for T2DM?

A

HbA1c > 6.5%, Fasting BG > 126, Random BG > 200, Oral glucose tolerance BG > 200

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120
Q

A1c that corresponds to pre-DM?

A

5.7-6.4%

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121
Q

Fasting BG that corresponds to pre-DM?

A

100-125

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122
Q

Random BG that corresponds to pre-DM?

A

140-199

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123
Q

Oral glucose tolerance BG that corresponds to pre-DM?

A

140-199

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124
Q

What is the most sensitive test for diagnosis of T2DM?

A

Oral glucose tolerance test

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125
Q

Effect of intensive BG control in T2DM on macrovascular complications (MI, CVA)?

A

No change

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126
Q

Effect of intensive BG control in T2DM on microvascular complications (neuropathy, nephropathy, retinopathy)?

A

Improvement

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127
Q

Effect of intensive BG control in T2DM on mortality?

A

No change / Increased

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128
Q

2 classes of oral DM medications that carry risk of hypoglycemia?

A

Sulfonylureas, Meglitinides

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129
Q

2 examples of Sulfonylureas?

A

Glyburide, Glipizide

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130
Q

Suffix of Meglitinides?

A

“-glinides”

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131
Q

Suffix of GLP-1 mimetics?

A

“-tide”

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132
Q

Suffix of DPP-4 inhibitors?

A

“-gliptin”

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133
Q

Clinical presentation of subclinical hypothyroidism?

A

Elevation in TSH, with normal free T4 levels

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134
Q

Next step of work-up for patient with subclinical hypothyroidism?

A

Order Anti-TPO Ig

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135
Q

4 situations in which subclinical hypothyroidism warrants treatment?

A

Symptoms of hypothyroidism, Anti-TPO Ig, Abnormal lipid profile, Ovulatory + menstrual dysfunction

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136
Q

Best management of DKA?

A

IV normal saline, Continuous IV insulin

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137
Q

Additional treatment for DKA?

A

K+

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138
Q

At what point should K+ be administered to a patient with DKA?

A

If K+ levels are < 5.2

139
Q

Equation for calculating anion gap?

A

Na – (Cl + HCO3)

140
Q

While managing a patient with DKA – at what point should IV insulin infusion be replaced by subcutaneous insulin treatment?

A

Subcutaneous insulin when … Anion Gap has returned to NML; HCO3- is < 15; pH > 7.30

141
Q

Patient is admitted for DKA; BG has improved from 320 to 154; Anion gap remains elevated, HCO3- remains > 15 – what is best step of management?

A

IV insulin should be continued … but rate of IV insulin infusion should be halved, and dextrose should be added to IV fluids (to prevent hypoglycemia)

142
Q

When replacing IV insulin infusion with subcutaneous insulin in a patient with DKA – how should that replacement be done?

A

Subcutaneous long-acting insulin takes a while to go into effect … IV insulin should be continued for 1-2 hour after subcutaneous insulin is started … (prevents rebound ketoacidosis)

143
Q

Normal fasting BG?

A

70-100

144
Q

BG that constitutes hypoglycemia?

A

BG < 60

145
Q

3 aspects of Whipple’s Triad (suggestive of true hypoglycemia)?

A

Low BG, Symptoms of hypo-BG, Symptoms resolve when patient is given glucose

146
Q

2 methods of basal insulin administration in patients with T1D?

A

Glargine (lantus) QD; NPH BID

147
Q

If a patient becomes hypoglycemic before dinnertime, how should insulin regimen be adjusted?

A

Decrease dose of AM long-acting insulin (or NPH)

148
Q

Change to C-peptide in patient with exogenous insulin use?

A

Low

149
Q

Change to C-peptide in patient with oral hypoglycemic agents?

A

High

150
Q

Change to C-peptide in patient with insulinoma?

A

High

151
Q

40 yo male presents with symptoms of hypoglycemia; Labs show elevated serum insulin, elevated C-peptide, elevated proinsulin – next step of diagnosis?

A

Screen for oral hypoglycemic agents … need to distinguish between insulinoma vs. oral hypoglycemic agent use

152
Q

Appearance of Graves Disease on thyroid scan?

A

Diffuse uptake

153
Q

Best management of symptomatic Graves Disease?

A

b blocker + anti-thyroid drug

154
Q

2 examples of anti-thyroid drugs?

A

PTU, MMZ

155
Q

When is PTU preferred to MMZ?

A

1st trimester pregnancy

156
Q

2 alternatives to anti-thyroid drugs?

A

Radioactive iodine, Thyroidectomy

157
Q

Which lab test should be performed 4-6 weeks after initiating anti-thyroid drugs in a patient with Graves Disease?

A

Total T3 + free T4

158
Q

Definition of Euthyroid Sick Syndrome?

A

Low T3, NML T4, NML TSH … in an asymptomatic patient

159
Q

Etiology of Euthyroid Sick Syndrome?

A

Decreased peripheral conversion of T4  T3

160
Q

Best management of Euthyroid Sick Syndrome?

A

Observation in acute patient … reassess T3/T4/TSH levels when back to baseline health

161
Q

1st step of workup for patient with newly discovered hypercalcemia?

A

Serum PTH levels

162
Q

Effect of severe hypercalcemia due to malignancy on PTH levels?

A

Suppressed

163
Q

What causes suppression of PTH in the setting of hypercalcemia of malignancy?

A

Secretion of PTH-related protein

164
Q

Approach to urgent surgery in a patient with hypothyroidism (newly-diagnosed via labs)?

A

Surgery may proceed if no symptoms of myxedema coma

165
Q

AE of starting levothyroxine in a patient about to undergo surgery?

A

Risk of MI in patients with existing CAD

166
Q

___ refers to an atypical presentation of hyperthyroidism in elderly patients that is characterized by lethargy, confusion, depression

A

Apathetic thyrotoxicosis

167
Q

Apathetic thyrotoxicosis is often misdiagnosed as …

A

Dementia

168
Q

MOA of SGLT-2 inhibitors?

A

Promotes glucose excretion at level of proximal renal tubule

169
Q

3 AEs of SGLT-2 inhibitors?

A

Vulvovaginal candidiasis, UTI, polyuria

170
Q

Most common cause of subclinical hypothyroidism?

A

Chronic lymphocytic thyroiditis (Hashimoto’s)

171
Q

Lab value that suggests increased likelihood of subclinical hypothyroidism progressing to Chronic lymphocytic thyroiditis (Hashimoto’s)?

A

High levels of anti-TPO antibodies

172
Q

Change to TSH in subclinical hypothyroidism?

A

Elevated

173
Q

Change to T4 in subclinical hypothyroidism?

A

NML

174
Q

Complication of subclinical hypothyroidism?

A

Recurrent miscarriage

175
Q

Clinical presentation of subacute thyroiditis?

A

Hyperthyroidism, fever, neck PAIN

176
Q

2 alternate names for subacute thyroiditis?

A

De Quervain thyroiditis, Subacute granulomatous thyroiditis

177
Q

Subacute thyroiditis is typically preceded by …

A

URI

178
Q

What accounts for hyperthyroidism symptoms in subacute thyroiditis?

A

Release of stored thyroid hormone due to follicular injury

179
Q

Appearance of thyroid scan in subacute thyroiditis?

A

Very low radioactive iodine uptake

180
Q

2 additional conditions in which low radioactive iodine uptake is seen on thyroid scan?

A

Post-partum thyroiditis, Surreptitious thyroid hormone use

181
Q

Clinical prognosis for subacute thyroiditis?

A

Spontaneous resolution

182
Q

Best management of subacute thyroiditis?

A

Supportive care

183
Q

2 medications that can be used in supportive care of subacute thyroiditis?

A

NSAIDs, b blockers

184
Q

Role of b blockers in management of subacute thyroiditis?

A

Minimize hyperadrenergic symptoms (sweating, palpitations)

185
Q

Does subacute thyroiditis cause a hyper- or hypothyroid state?

A

Hyperthyroid phase, then followed by hypothyroid phase

186
Q

Epidemiology of tertiary hyperparathyroidism?

A

CKD patients

187
Q

Change to Ca2+ levels in tertiary hyperparathyroidism?

A

High

188
Q

Change to PO3- levels in tertiary hyperparathyroidism?

A

High

189
Q

Change to PTH levels in tertiary hyperparathyroidism?

A

High

190
Q

Best management of tertiary hyperparathyroidism?

A

Parathyroidectomy

191
Q

Clinical presentation of tertiary hyperparathyroidism?

A

Bone pain

192
Q

Additional lab value seen in setting of tertiary hyperparathyroidism?

A

Elevated alkaline phosphatase

193
Q

What accounts for elevated levels of alkaline phosphatase in tertiary hyperparathyroidism?

A

High bone turnover

194
Q

45 yo male is on escalating doses of levothyroxine; Despite therapy, he continues to have elevated TSH levels – diagnosis?

A

Levothyroxine malabsorption

195
Q

2 conditions that might require escalating doses of levothyroxine?

A

Malabsorption (celiac disease), Pregnancy

196
Q

2 drugs that might require escalating doses of levothyroxine?

A

Iron, Calcium

197
Q

3 drugs that might interfere with thyroxine metabolism, requiring escalating doses of levothyroxine?

A

Carbamazepine, rifampin, phenytoin

198
Q

70 yo female presents with symptoms of hyperthyroidism; She was recently diagnosed with CAD via coronary angiogram, with stent placement – diagnosis?

A

Iodine-induced hyperthyroidism (from iodine contrast)

199
Q

Additional etiology of Iodine-induced hyperthyroidism?

A

Amiodarone

200
Q

Clinical prognosis of Iodine-induced hyperthyroidism?

A

Self-limited

201
Q

Best initial treatment of Iodine-induced hyperthyroidism?

A

b blockers

202
Q

Additional treatment of Iodine-induced hyperthyroidism?

A

MMZ

203
Q

68 yo female presents with hypoglycemia in setting of suspected sulfonylurea overdose; In addition to dextrose-50, which medication should be administered?

A

Octreotide

204
Q

Rationale for administering octreotide to patients with hypoglycemia in setting of suspected sulfonylurea overdose?

A

Dextrose administration can cause transient hyperglycemia, which may elicit an even higher level of insulin secretion + subsequent rebound hypoglycemia … Octreotide is a somatostatin analogue that decreases insulin secretion to prevent rebound hypoglycemia

205
Q

2 lab values seen in congenital hypothyroidism?

A

High TSH, Low T4

206
Q

Best management of congenital hypothyroidism?

A

Start levothyroxine immediately, Thyroid US

207
Q

Clinical prognosis for congenital hypothyroidism?

A

Excellent prognosis with treatment; Risk for permanent neurological defects without treatment

208
Q

Most common etiology of congenital hypothyroidism?

A

Thyroid dysgenesis

209
Q

36 yo female presents with palpitations, irregular menstrual cycle; PE shows HTN, lid lag, warm skin, hand tremor; Labs show elevated TSH, T3, T4, a subunit – diagnosis?

A

TSH-secreting pituitary adenoma

210
Q

Change to TSH, T3, T4, a subunit in thyroid hormone resistance?

A

TSH, T3, T4 = elevated; a subunit = NML

211
Q

Change to TSH, T3, T4, a subunit in pregnancy?

A

TBG = elevated; TSH = NML; T3, T4 = elevated

212
Q

Change to TSH, T3, T4, a subunit in surreptitious thyroid hormone use?

A

T3, T4 = elevated; TSH = low

213
Q

28 yo male presents with polyuria, polydipsia; BP 160/94; Labs show hypokalemia – diagnosis?

A

Primary hyperaldosteronism (Conn Syndrome)

214
Q

Best screening test for Primary hyperaldosteronism?

A

Plasma Aldosterone/Renin ratio

215
Q

What accounts for polyuria in the setting of Primary hyperaldosteronism?

A

Hypokalemia … causes an impaired urinary concentrating state

216
Q

Normal fasting BG level?

A

< 126

217
Q

Patients with impaired fasting BG (109-126) are at increased risk for …

A

CAD

218
Q

Duration of glucocorticoids that necessitates a tapering dose to prevent suppression of the HPA axis (causing adrenal insufficiency)?

A

Duration > 3 weeks requires a taper; Duration < 3 weeks can be stopped abruptly

219
Q

Effect of intensive BG control in patients with T2DM on macrovascular complications (MI, CVA)?

A

No change

220
Q

Effect of intensive BG control in patients with T2DM on microvascular complications (neuropathy, nephropathy, retinopathy)?

A

Improved

221
Q

Effect of intensive BG control in patients with T2DM on overall mortality?

A

No change

222
Q

Clinical presentation of anabolic steroid abuse?

A

Changes in mood, worsened acne, hirsutism

223
Q

Change to lipid levels in anabolic steroid abuse?

A

Decreased HDL

224
Q

Change to CBC in anabolic steroid abuse?

A

Increased hemoglobin and hematocrit

225
Q

Change to testes in anabolic steroid abuse?

A

Decreased testicular size + sperm count; Gynecomastia

226
Q

3 aspects of clinical presentation for Hereditary Hemochromatosis?

A

Secondary hypogonadism, skin hyperpigmentation, DM

227
Q

8 yo male presents after 3 days of NV, fever; T103, HR 176, BP 70/30, RR 34; Labs show Na 128, BG 290; UA shows (+) ketones, glucose - what is explanation for patient’s hyperglycemia?

A

Stress hyperglycemia

228
Q

Typical clinical presentation of Stress hyperglycemia?

A

Sepsis

229
Q

Etiology of Stress hyperglycemia?

A

Increased circulating levels of stress hormones (catecholamines, cortisol)

230
Q

20 yo female presents for follow-up of idiopathic hypoparathyroidism; Takes 50,000u Vitamin D, 1.5g calcium daily; Labs show Ca 7.8, Phos 5.2, urinary calcium 680 - best step in management?

A

Begin thiazide diuretic

231
Q

What is best treatment for patients with hypoparathyroidism?

A

Vitamin D

232
Q

Role of thiazide diuretic in treatment of hypoparathyroidism?

A

Increases serum Ca2+, decreases urinary Ca2+

233
Q

40 yo male presents for follow-up of T1DM; Current A1c 6.6; Labs shows TC 170, LDL and TG are WNL - what is best management?

A

Start statin

234
Q

3 indications for starting statin as primary prevention?

A

Age > 40 with DM, LDL > 190, ASCVD risk > 7.5%

235
Q

Best management of patients with hyperthyroidism and cardiovascular manifestations (SVT, A-Fib)?

A

B blocker to control symptoms and HR

236
Q

67 yo male presents with CAD, warranting drug-eluting stent placement; TSH noted to be low in hospital; Today TSH is even lower (0.08); RAI scan shows increased homogenous uptake of RAI; Vitals are stable; Free T3 and T4 are both WNL - diagnosis?

A

Subclinical hyperparathyroidism

237
Q

Clinical presentation of Subclinical hyperparathyroidism?

A

NML T3/T4, Low TSH

238
Q

Best management of Subclinical hyperparathyroidism for patients with TSH < 0.1?

A

Anti-thyroid medications, radioactive iodine

239
Q

Best management of Subclinical hyperparathyroidism for patients with TSH 0.1-0.5?

A

Will likely experience spontaneous remission, should be monitored with periodic thyroid function tests

240
Q

10 yo male presents after tonic-clonic seizure; Recent muscle cramping (exacerbated by exercise), declining school performance; PE shows BL cataracts, 3+ reflexes; Labs show Ca2+ 6, Phos 8.3 (high), PTH 150 (high); Non-contrast head CT shows calcification of basal ganglia - diagnosis?

A

Pseudohypoparathyroidism

241
Q

Clinical presentation of Pseudohypoparathyroidism?

A

Seizures, muscle cramping, hyperreflexia (hypoCa2+), basal ganaglia calcification, cataracts

242
Q

Etiology of Pseudohypoparathyroidism?

A

End-organ resistance to PTH

243
Q

Lab findings associated with Pseudohypoparathyroidism?

A

High Phos, High PTH, Low Ca2+

244
Q

36 yo female presents with lower back pain HX of Roux-en-Y GBP surgery 2 years ago; Labs show PTH 955 (high); DEXA shows osteopenia - diagnosis?

A

Osteomalacia

245
Q

36 yo female presents with lower back pain HX of Roux-en-Y GBP surgery 2 years ago; Labs show PTH 955 (high); DEXA shows osteopenia - what is next best step?

A

Vitamin D measurements

246
Q

Risk of lactic acidosis associated with metformin increases with … (4)

A

Hypovolemia, liver disease, renal dysfunction, CHF

247
Q

36 yo female presents after multiple episodes of hypoglycemia, none of which were associated with symptoms; Current A1c 7.8 - which intervention is most likely to restore hypoglycemic awareness?

A

Carefully avoiding low BG levels

248
Q

60 yo female presents for diffuse abdominal pain, NV; Symptoms began a few hours ago after routine colonoscopy; HX of T2DM, managed with sitagliptin, canagliflozin, detemir; Reports significant weight loss after discontinuing metformin; Other meds include HCTZ, statin, ARB; Labs show AGMA, Cr 1.2, Ca2+ 8.8, BG 160; UA shows glucose, ketones; ABG shows 7.28, O2 99, CO2 28 - diagnosis?

A

Euglycemic DKA

249
Q

Which medication is associated with Euglycemic DKA?

A

SGLT2 inhibtors (-flozins)

250
Q

Typical BG levels seen in Euglycemic DKA?

A

BG < 250

251
Q

10 yo female presents with declining school performance, irritable mood, distraction, weight loss; PE shows anxiety, 3+ DTRs - diagnosis?

A

Hyperthyroidism

252
Q

Complication of Hyperthyroidism?

A

Osteoporosis

253
Q

32 yo female presents 6 months after total thyroidectomy and central neck dissection for medullary thyroid CA; Serum calcitonin before surgery 250, now is 120; What is next best step of workup?

A

CT scan neck + chest

254
Q

32 yo female presents 6 months after total thyroidectomy and central neck dissection for medullary thyroid CA; Serum calcitonin before surgery 250, now is 120 - diagnosis?

A

Metastatic thyroid CA

255
Q

26 yo female with hypothyroidism is on a stable dose of levothyroxine; Recently started on combination OCP; Thryoid function tests today show worsening hypothyroidism - how do OCPs alter thyroid hormone function?

A

OCPs alter thyroid hormone transport and tissue delivery … Estrogen/OCPs stimulates synthesis of TBG, so less free thyroid hormone available

256
Q

Best insulin regimen for T1DM patients who cannot intake PO due to NV?

A

Decrease glargine, continue short-acting SSI based on BG levels

257
Q

Patients with thyroid nodules should be evaluated with …

A

TSH, thyroid US

258
Q

Patients with thyroid nodules + suspicious findings on US should undergo …

A

Fine-needle aspiration, cytology

259
Q

Patients with thyroid nodules + low TSH …

A

Radionuclide scan

260
Q

What is the primary means of staging thyroid cancer?

A

US of neck + cervical LNs

261
Q

Best management for papillary thyroid cancer <1 cm?

A

Lobectomy

262
Q

Best management for papillary thyroid cancer <1 cm?

A

Thyroidectomy

263
Q

68 yo male presents with confusion, fatigue; BP 99/59, HR 132, RR 22; PE shows disorientation; Labs show Na 151, K 6.1, HCO3 18, Cr 1.6, BG 810; EKG shows A-Fib with RVR, non-specific T wave changes - diagnosis?

A

HHS (hyperosmolar hyperglycemic state)

264
Q

First step in management of HHS (hyperosmolar hyperglycemic state)?

A

Aggressive fluid resuscitation

265
Q

Typical K supply in patients with HHS (hyperosmolar hyperglycemic state)?

A

Total body deficit of K

266
Q

23 yo male presents with blurry vision in both eyes; Reports increased urination, polydypsia, weight loss; States that he has not been compliant with insulin regimen - what is best step in management?

A

Improve glycemic control

267
Q

54 yo female presents after recently-diagnosed DM; Reports new skin rash; PE shows 4x5cm lesion with central clearing; Patient also reports fatigue, weight loss, diarrhea, abdominal pain, facial flushing - diagnosis?

A

Glucagonoma

268
Q

Classic rash seen in cases of Glucagonoma?

A

Necrolytic Migratory Erythema

269
Q

Description of Necrolytic Migratory Erythema?

A

Erythematous scaly rash with central clearing and elevated border with crusting

270
Q

Description of rash seen in pellagra?

A

Symmetric, distributed in sun-exposed areas, forms vesicles and blisters

271
Q

34 yo female with Addison’s Disease was discharged from recent hospitalization with hydrocortisone; Reports episodes of LH, salt-craving; Labs show Na 130, K 5.5 - which medications should be added to her regimen?

A

Fludrocortisone

272
Q

Alternate name for Addison’s Disease?

A

Primary adrenal insufficiency

273
Q

Best management of Addison’s Disease?

A

Glucocorticoid (hydrocortisol) + Mineralocorticoid (fludrocortisone)

274
Q

31 yo female presents 5 weeks after vaginal delivery; Reports significant weight loss, fatigue, sweating, heat intolerance; States that her breast milk “dried up quickly”; TSH < 0.01, T4 18, (+) anti-TPO; Radioactive uptake in thyroid is 1.5% - diagnosis?

A

Post-partum thyroiditis

275
Q

Appearance of Post-partum thyroiditis on thyroid uptake scan?

A

Decreased

276
Q

Lab finding associated with Post-partum thyroiditis?

A

(+) TPO Ig

277
Q

Pattern of thyroid disease seen in Post-partum thyroiditis?

A

Hyper, then hypo

278
Q

Etiology of Sheehan Syndrome?

A

Obstetric hemorrhage

279
Q

Post-partum thyroiditis is a variant of …

A

Chronic lymphocytic thyroiditis

280
Q

17 yo male presents for breast mass; PE shows palpable, tender, well-circumscribed 5cm mass deep to the R nipple; Labs shows elevated b-HCG, elevated estrogen – diagnosis?

A

b-HCG secreting testicular tumor

281
Q

17 yo male presents for breast mass; PE shows palpable, tender, well-circumscribed 5cm mass deep to the R nipple; Labs shows elevated b-HCG, elevated estrogen – next step of workup?

A

Testicular US

282
Q

Physiologic cause of gynecomastia?

A

Imbalance between ratio of estrogens/androgens

283
Q

Gynecomastia with b-HCG elevation – diagnosis?

A

Testicular tumor

284
Q

Gynecomastia with decreased LH, decreased testosterone – diagnosis?

A

Central hypogonadism (pituitary tumor)

285
Q

Gynecomastia with increased LH, decreased testosterone – diagnosis?

A

Primary hypogonadism

286
Q

Gynecomastia with increased LH, increased testosterone – diagnosis?

A

Thyrotoxicosis

287
Q

Gynecomastia with estrogen elevation – diagnosis?

A

Testicular, adrenal tumor

288
Q

Change to serum thyroglobulin in the setting of exogenous thyroid hormone use?

A

Decreased … due to suppressed thyroid follicular activity

289
Q

Change to 24-hour radioiodine uptake in the setting of exogenous thyroid hormone use?

A

Decreased … suppression of thyroid follicular activity

290
Q

26 yo female presents 5 months after delivery for fatigue, weight gain, leg swelling; Labs show TSH 244, Na+ 128, low serum osmolarity – diagnosis?

A

Postpartum thyroiditis

291
Q

Postpartum thyroiditis is a variant of …

A

Lymphocytic (Hashimoto) thyroiditis

292
Q

What is the definitive management of hyponatremia in Postpartum thyroiditis?

A

Levothyroxine

293
Q

78 yo male presents with palpitations, dizziness, SOB; Thyroid exam and US reveals a 3cm nodule that should increase uptake of radioactive iodine; Labs show TSH < 0.01, T4 3.3; Patient started on metoprolol for palpitations; What is best next step for management?

A

MMZ

294
Q

What is the definitive therapy for toxic thyroid adenoma?

A

Radioactive iodine ablation … or … Thyroidectomy

295
Q

What must occur before radioactive iodine ablation or thyroidectomy for toxic thyroid adenoma?

A

Pretreatment with anti-thyroid drugs (MMZ)

296
Q

What are ideal instructions for patients with hypothyroidism taking levothyroxine?

A

On an empty stomach, with water 30-60 minutes before breakfast

297
Q

6 medications that decrease levothyroxine absorption?

A

Cholestyramine, iron, calcium, aluminum hydroxide, PPI, sulcrafate

298
Q

3 treatments that increase TBG concentration?

A

Estrogen replacement, OCP, tamoxifen

299
Q

3 treatments that decrease TBG concentration?

A

Androgens, glucocorticoids, anabolic steroids

300
Q

3 medications that increase thyroid hormone metabolism?

A

Rifampin, phenytoin, carbamazepine

301
Q

4 aspects of hyperthyroidism in older adults?

A

Apathy, weight loss, decreased appetite, lethargy

302
Q

7 yo male presents with NV, abdominal pain, fatigue; HR 134; PE shows dry MM; Labs show K 5.8, BG 500; VBG shows pH 7, HCO3 4; US shows ketonuria, glucosuria; Patient treated with NS bolus, insulin drip – what is addition step of necessary management?

A

Admission to ICU

303
Q

5 lab findings associated with DKA?

A

BG > 200, HCO3 < 15, pH < 7.3, AG > 14, Serum/urine ketones

304
Q

Best management of DKA in children?

A

10 mL/kg isotonic fluids, Insulin insulin

305
Q

Complications of DKA in children?

A

Cerebral edema

306
Q

What should be added to fluids in patients with DKA?

A

K+ … but not HCO3-

307
Q

24 yo female presents for 2.1cm nodule in R thyroid lobe; Lab studies show NML T3, T4, TSH; Thyroid US shows 2.6x1.7x1.3cm solid nodule – what is next best step?

A

Perform fine-needle biopsy

308
Q

Best management of thyroid nodule >1cm with low TSH?

A

Radionucleotide thyroid scan

309
Q

Best management of thyroid nodule >1cm with normal TSH?

A

FNA with nodule cytology

310
Q

First step of management for patients with 1cm thyroid nodule?

A

Thyroid US, TSH levels

311
Q

24 yo female presents for 2.1cm nodule in R thyroid lobe; Lab studies show NML T3, T4, TSH; Thyroid US shows 2.6x1.7x1.3cm solid nodule; Further workup reveals diagnosis of medullary thyroid cancer; Serum calcitonin 300, genetic studies show mutation in RET – what is next best step?

A

Get plasma-free metanephrine levels

312
Q

Clinical presentation of MEN1 syndrome?

A

3 Ps – parathyroid, pituitary, pancreatic

313
Q

Clinical presentation of MEN2A syndrome?

A

Medullary thyroid cancer, pheochromocytoma, parathyroid hyperplasia

314
Q

Clinical presentation of MEN2B syndrome?

A

Medullary thyroid cancer, pheochromocytoma, marfanoid habitus, mucosal hamartomas

315
Q

All patients with new Medullary thyroid cancer should get …

A

Serum calcitonin, CEA, neck US (for regional metastasis), genetic studies for RET mutations

316
Q

56 yo female presents with lethargy, weight loss, NV, constipation; PE shows pallor, prolonged relaxation time of ankle reflexes; Labs show HGB 11.2, Na 129, BG 64, TSH 0.35, T4 0.5, cortisol 7 – diagnosis?

A

Central hypothyroidism, possible adrenal insufficiency

317
Q

Central hypothyroidism originates from …

A

Hypothalamus, pituitary

318
Q

2 lab values that suggest Central hypothyroidism?

A

Low T4, Low TSH

319
Q

Best test for patient with suspected adrenal insufficiency?

A

ACTH levels, ACTH stimulation test

320
Q

Response of adrenals to ACTH stimulation in patient with primary adrenal insufficiency?

A

Subnormal increase in cortisol to ACTH administration

321
Q

28 yo female with HX of T1DM presents to clinical for advice about insulin management; Reports that she takes 16u glargine at bedtime, and 4-6u lispro before meals; She plans to run a 5K this weekend – wondering how she should adjust her insulin regimen before the run?

A

Decrease breakfast dose of lispro

322
Q

What is best management for reducing risk of hypoglycemia during exercise in patients with T1DM?

A

Decrease dose of short-acting insulin within 1-3 hours prior to exercise

323
Q

Best management of familial hypocalciuric hypercalcemia?

A

Reassurance

324
Q

Inheritance pattern of familial hypocalciuric hypercalcemia?

A

AD

325
Q

Etiology of familial hypocalciuric hypercalcemia?

A

Mutation in CaSR that leads to decreased calcium sensitivity

326
Q

Equation for calculation of calcium/creatinine clearance ratio (UCCR)?

A

UCCR = (Ca-urine/Ca-serum) / (Creat-urine/Creat-serum)

327
Q

UCCR for familial hypocalciuric hypercalcemia is …

A

<0.01

328
Q

UCCR for primary hyperparathyroidism is …

A

> 0.02

329
Q

Electrolyte abnormalities associated with primary adrenal insufficiency?

A

Hyponatremia, hyperkalemia, hyperchloremia, metabolic acidosis

330
Q

First step of workup for patients with suspected primary adrenal insufficiency?

A

AM cortisol, ACTH

331
Q

AM cortisol and ACTH that are diagnostic for primary adrenal insufficiency?

A

Low cortisol, High ACTH

332
Q

If Am cortisol and ACTH are non-diagnostic for primary adrenal insufficiency, what is the next appropriate step of workup?

A

ACTH stimulation test

333
Q

What accounts for loss of axillary and pubic hair in primary adrenal insufficiency?

A

Decreased androgen production

334
Q

What accounts for increased pigmentation in primary adrenal insufficiency?

A

Increased ACTH and MSH

335
Q

54 yo female presents after recently-diagnosed DM; Reports new skin rash; PE shows 4x5cm lesion with central clearing; Patient also reprots fatigue, weight loss, diarrhea, abdominal pain, facial flushing - diagnosis?

A

Glucogonoma

336
Q

Classic rash seen in cases of Glucogonoma?

A

Necrolytic Migratory Erythema

337
Q

Description of Necrolytic Migratory Erythema?

A

Erythematous scaly rash with central clearing and elevated border with crusting

338
Q

Description of rash seen in pellagra?

A

Symmetric, distributed in sun-exposed areas, forms vesicles and blisters

339
Q

32 yo female presents for follow-up visit after head CT showed abnormal sella; Patient reports normal menstrual cycles; Labs show no abnormalities in prolactin, IGF-1, LH, FSH, TSH, free T4; Plasma cortisol is normally suppressed after administration of dexamethasone; MRI shows a 5mm hypointense lesion in the pituitary space - next step of workup?

A

Repeat MRI of pituitary in 6-12 months

340
Q

Nerve damage associated with diabetes mellitus?

A

Distal symmetric polyneuropathy in “stocking glove pattern”, erectile dysfunction, loss of cremasteric reflex, diminshed testicular sensation, bladder dysfunction, inability to masturbate

341
Q

26 yo female with PMHX of papillary CA treated with thyroidectomy and radioactive ablation presents for checkup; Currently on levothyroxine 125 mcg; TSH 4.8, free T4 1.3 (NML 0.8-1.8); Recent US shows no recurrence of thyroid disease - what is best management of her levothyroxine?

A

Increase levothyroxine to bring TSH to low-NML range

342
Q

Goal TSH for patient with HX of thyroid CA with distant metastasis?

A

< 0.1

343
Q

63-year-old male presents for wellness visit; BG 255; reports frequent urination, polydipsia, 23 pound weight loss in past 6 months; history of obesity, hypertension, chronic pancreatitis, OSA, CKD, HF with EF 35%; which medication is most appropriate for treatment of DM in this patient?

A

Insulin

344
Q

63-year-old male presents for wellness visit; BG 255; reports frequent urination, polydipsia, 23 pound weight loss in past 6 months; history of obesity, hypertension, chronic pancreatitis, OSA, CKD, HF with EF 35%; diagnosis?

A

Pancreatogenic DM, in the setting of chronic pancreatitis

UWorld (21 decks)

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