Endocrine

Question 1

A 65 year old woman presents to the Emergency Room with a right hip fracture. She is scheduled for open reduction and internal fixation the following day. The orthopedic resident notices that the patient is tachycardic and hyper-reflexic. Blood tests confirm that the patient has hyperthyroidism. The appropriate peri-operative management of this condition is?
a) close observation in the ICU post-operatively

b) begin propylthiouracil and proceed with surgery

c) begin beta blockage with propranolol and proceed with surgery

d) arrange urgent radio-iodine ablation and proceed with surgery

Answer 1

C

Question 2

Pheochromocytoma triad

Answer 2

Palpitations
Headache
Episodic diaphoresis

Question 3

What are the 5 symptoms of DKA

Answer 3

Polyuria
Tachypnea
Dehydration
Confusion
Abdominal pain

Question 4

What electrolyte must be closely monitored in DKA?

Answer 4

Potassium and Hypokalemia (due to correction of acidosis requiring insulin, which drives K+ into the cells)

Question 5

What must you rule out in a diabetic with DKA?

Answer 5

Infection

Question 6

What is an addisonia crisis?

Answer 6

Acute adrenal insufficiency in the face of a stressor

Question 7

What are the signs and symptoms of addisonia crisis?

Answer 7

Abdominal pain
Hypotension
Eventual hypovolemic shock
Tachycardia
Nausea
Vomiting
Diarrhea
Fever
Progressive lethargy

Question 8

What are classic labs signs of addisonian crisis?

Answer 8

Decreased Na+
Increased K+

Question 9

What is the treatment of Addisonian Crisis?

Answer 9

IVFs (D5NS)
Hydrocortisone IV
Fludricortisone PO

Question 10

What are the two types of Diabetes Insipidus?

Answer 10

Central DI
Nephrogenic DI

Question 11

What are the 4 causes of central DI?

Answer 11

Brain injury
Tumour
Surgery
Infection

Question 12

What are the 3 classic causes of nephrogenic DI?

Answer 12

Amphotericin B
Hypercalcemia
Chronic Kidney INfection

Question 13

What are the lab values associated with DI? (4)

Answer 13

Hypernatremia
Decreased urine sodium
Decreased urine osmolality
Increased serum osmolality

Question 14

65-year-old smoker with severe COPD treated intermittently with
antibiotics, prednisone, and albuterol undergoes a colectomy.
Postoperatively the patient develops hypotension, dizziness, and
fever with normal hematocrit and abdominal exam

Answer 14

Adrenal crisis—adrenal insufficiency

Question 15

56-year-old alcoholic woman receives D5 1/2 NS IV bolus in the
ER; she develops confusion, ataxia, and inability of gaze laterally

Answer 15

Wernicke’s encephalopathy