Endocrine

Question 1

Parathyroid regulates which mineral?

Answer 1

Calcium

Question 2

Pt who is on metformin but struggling decreasing FBS, what is a good second choice drug?

Answer 2

Sulfonylurea (Glipizide/Glucotrol, Glyburide/Diabets) decreased FBS as well as postprandial.

Question 3

For a pt on metformin but struggling with postprandial spikes but maintaining fbs, what second line therapy would be beneficial?

Answer 3

DPP4 (sitagliptin/Januvia), SGLT2 (Canagliflozin/Invokana or Empagliflozin/Jardiance) are both oral agents that exert action mostly on postprandial/

Question 4

Patient with hypotension, hypoglycemia n/v, loss of appettie, pale in appearance with muscle fatigue and slow/sluggish movements should be screened for what condition?

Answer 4

Addisons (adrenal isufficiency) would have low am cortisol levels

Question 5

How is addisons disease treated?

Answer 5

Corticosteroid replacent & ample sodium after potential insensible fluid loss.

Question 6

How would a patient with Cushings disorder present?

Answer 6

Progressive weight gain increased abd obesity, fatty deposits upper back (buffalo hump), striae on abd, moon facies, thin and fragle skin (easily bruises), fatigue/muscle weakness, and hirsutism.

Question 7

What tests would be done to confirm cushings disorder?

Answer 7

AM cortisol level (high)

Question 8

What drug is used to reduce symptoms in hyperthyroid crisis?

Answer 8

Beta blockers (propranolol)

Question 9

A non-tender and fixed thyroid nodule >4cm with dysphonia is likely to be?

Answer 9

Malignancy

Question 10

In >4cm thyroid nodule with elevated TSH, what is the most common next step?

Answer 10

FNA (nodule is not metabolically active)

Question 11

If TSH is low with a large thyroid nodule, what is the next step?

Answer 11

Nuclear med thryoid scan
Hot- metabolically active: radioactive ablation or surgery
Non hot- metabolically inactive: FNA

Question 12

What laboratory findings are suggestive of hyperparathyroidism?

Answer 12

elevated Ca+and PTH

With low K+/Pho_

Question 13

When TSH is low or normal BUT t4 is low, what is the likely condition?

Answer 13

Secondary hyperthyroidism (pituitary/hypothalmic disease)

Question 14

Loss of lateral third of eyebrows and thin/brittle nails is suggestive of?

Answer 14

Hypothyroidism

Question 15

Patient with hypothyroidism, what additional laboratory findings may be noted?

Answer 15

Hyperlipidemia, macrocytic anemia, and hyopnatremia

Question 16

What TSH levels generally indicate need for treatment with levothyroxine?

Answer 16

TSH >10, although 4.5-10 would consider based on clinical presentation

Question 17

What is the usual starting dose and treatment protocol for levothyroxine in hypothyroidism?

Answer 17

Levothyroxine starting 25-5mcg and increasing 12.5-60mcg q 2 mo until TSH normalizes. Usually dose is 1.6mcg/kg/d

Question 18

How should patients be instructed to take levothyroxine?

Answer 18

In am (same time) on empty stomach without any other medications

Question 19

When should branded version of levothyroxine (synthroid) be considered?

Answer 19

When unable to regulate with generic, some pts cannot metabolize generic.

Question 20

Armour thyroid is ____?

Answer 20

Dessicated T3 and T4

It is not recommended for cardiac pts, older and pregnant women.

Question 21

Low TSH but normal FT4/T3- what condition is likely present and what test should be ordered?

Answer 21

Subclinical hyperthyroidism (order radioactive uptake and scan)

Question 22

What tests should be done w/ palpable nodules?

Answer 22

Thyroid scan

Question 23

How does Adrenal Insufficiency usually presents?

Answer 23

Shocky: hypotension, N/V anorexia, confusion, weakness, fever

Question 24

Common causes of acute adrenal insufficiency?

Answer 24

Sudden and abrupt cessation of steroids
Pituitary destruction, adrenalectomy/trauma
Stress,trauma, infection or prolonged fasting in someone with Addisions disease

Question 25

Chronic adrenal insufficiency is known as?

Answer 25

Addisons disease

Question 26

What are the hallmark laboratory signs suggestive of addison’s disease?

Answer 26

Hypotension and hyperkalemia

Question 27

What are common signs of addison’s disease

Answer 27

Excessive pigment, volume and sodium depletion, chronic maliase/weakness/fatigue, anorexia n/v, scant pubic and axillary hair. Can have mild to mod depression and psychosis.

Question 28

What is the treatment for addison’s disease

Answer 28

Lifelong replacement of gluticosteroids and mineralcorticoids

Question 29

Addisons disease is ______?

Answer 29

Autoimmune destruction of adrenal cortices which causes chronic cortisol, aldosterone and adrenal androgen deficiency.

Question 30

Common causes of cushing’s?

Answer 30

Syndrome: Adrenal hyperplasia or tumor, extra-adrenal tumors, Chronic glucocorticoid use

Disease: pituitary adenoma causing ACTH hypersecretion

Question 31

What are common findings in cushings?

Answer 31

Truncal obesity, moon facies, buffalo hump, purple striae abd, thin extremities, progressive weight gain, acne, UE/LE weakness

Question 32

Pts who have episodic HTN, HA, tachycardia and sweating should be evaluated for?

Answer 32

Pheochromocytoma- a tumor in the adrenal gland
Lab: 24hr urine (elevated catecholamines, metanephrines and Cr)
+UA: CT abd w & w/o oral/IV contrast