Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

How should pheochromocytoma be treated prior to surgery?

A

Alpha-blocker (e.g. phenoxybenzamine, nonselective and irreversible) 7-14d before - beta-blocker alone could lead to hypertensive crisis due to unopposed alpha stimulation
Patient encouraged to increase sodium and water intake due to side effect of alpha blockade
Propranolol 2-3d before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Carcinoid syndrome - signs and treatment

A

Signs: flushing, diarrhea, elevated 5-hydroxyindoleacetic acid
Treatment: Somatostatin analog (e.g. octreotide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Papillary thyroid cancer - primary treatment

A

Surgical resection - smaller tumors may only require partial thyroidectomy/lobectomy

Adjuvant radioiodine ablation, thyroid hormone replacement - for those with increased risk of tumor recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Calcitonin is marker for which thyroid cancer?

A

Medullary - arises from parafollicular C cells

(Papillary and follicular arise from epithelial cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In absence of infection, what is likely causing persistent fever, tachycardia, and HTN in patient with severe burns?

A

Hypermetabolic response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypermetabolic response to burns - treatment

A
  1. Burn excision and grafting (to decrease inflammation)
  2. Beta blockers (to decrease catecholamine effects)
  3. Nutrition, anabolic steroids (to minimize lean muscle mass loss)
  4. Insulin (to control hyperglycemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which thyroid cancer has calcitonin?

A

Medullary - it is made by C cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What paraneoplastic syndrome is associated with thymoma?

A

Myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be done for patient in adrenal crisis?

A

IV dexamethasone or hydrocortisone + aggressive volume repletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the thyroid parafollicular cells?

A

These are the neuroendocrine C cells that secrete calcitonin
They are in medullary thyroid cancer
Surveil with calcitonin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of medullary thyroid cancer

A

Asymptomatic but may have some diarrhea and flushing
Calcium usually normal unless part of MEN2A hyperparathyroidism

Risk of metastasis and surveillance can both be assessed with calcitonin levels
Also measure carcinoembryonic antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What protooncogene is associated with MEN2?

A

RET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MEN1

A
  1. Parathyroid
  2. Pituitary
  3. Pancreas (enteropancreatic endocrine cell tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What cancers use thyroglobulin as a cancer marker?

A

Papillary and follicular differentiated thyroid cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MEN2

A
  1. Medullary thyroid cancer
  2. Pheochromocytoma
  3. A: Hyperparathyroidism; B: marfanoid habitus + mucosal neuromas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe testicular cancer appearance on scrotal ultrasound

A

Seminoma - solid, hypoechoic
Nonseminomatous germ cell tumor - cystic areas and calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does PTH do?

A

Increases calcium mobilization from bone
Decreases phosphate reabsorption at proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does CKD lead to hypocalcemia and hyperphosphatemia?

A

Decreased vitamin D conversion
Decreased filtration of phosphate

Secondary parathyroidism and chronic parathyroid stimulation can lead to parathyroid hyperplasia and tertiary parathyroidism due to autonomous PTH secretion, due to downregulation of calcium-sensing receptor and vitamin D receptor in parathyroid glands

At this point, you would see very high PTH, hypercalcemia, and hyperphosphatemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What bone observation on x-ray is highly specific for elevated PTH?

A

Subperiosteal resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to treat secondary hyperparathyroidism?

A

Reducing serum phosphorus (e.g. dietary phosphate restriction, phosphate binders

Overtreatment –> adynamic bone disease, low bone turnover
Undertreatment –> osteitis fibrosa cystica, high bone turnover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Homocystinuria - common signs

A
  1. Lens dislocation
  2. Intellectual disability
  3. Marfanoid features
  4. Increased risk of arterial and venous thrombi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hypocalcemia symptoms

A
  1. Muscle spasms
  2. Hyperreflexia
  3. Paresthesias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Reversible causes of atrial fibrillation

A
  1. Hyperthyroidism
  2. Mitral valve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Primary adrenal insufficiency

A

Fatigue, malaise, weakness, weight loss
GI symptoms

Hypotension:
Aldosterone deficiency –> volume depletion, hyperkalemia, hyperchloremic metabolic acidosis
Cortisol deficiency –> loss of vascular tone

Increased secretion of ADH –> water retention, hyponatremia

Skin hyperpigmentation (cosecretion of melanocyte-stimulating hormone with ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Euthyroid sick syndrome - labs

A

Early: Low T3, normal T4 and TSH
Late: Low everything else

During recovery, patients may experience modest, transient increase in TSH that can be misinterpreted as subclinical hypothyroidism (elevated TSH, normal thyroxine levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Explain the hemodynamics of thyroid storm

A
  1. Decreased SVR (increased metabolism, direct endothelial vasodilation)
  2. Increased cardiac output (decreased SVR, direct effect on myocardium)
  3. High venous oxygen content (less time for tissues to extract oxygen –> low arterial-venous oxygen difference)
  4. Increased venous return –> increased pulmonary capillary wedge pressure + pulmonary edema
27
Q

Primary hyperparathyroidism vs familial hypocalciuric hypercalcemia - urinary calcium excretion

A

Both have hypercalcemia and high PTH

Primary hyperPTH: net urinary calcium excretion is increased due to resorption from bone > reabsorption from distal tubule

Familial: low urinary calcium excretion (<100 mg/24 hr)

28
Q

Primary adrenal insufficiency and adrenal crisis - treatment

A

Glucocorticoid (dex > hydro, does not interfere with cortisol measurement), followed by mineralicorticoid (fludrocortisone), which takes a few days to

29
Q

Somatostatin receptor scintigraphy

A

Used in evaluation of pancreatic or metastatic gastrin-producing tumor (Zollinger-Ellison syndrome)

30
Q

What causes hoarseness in hypothyroidism?

A

Deposition of matrix glycosaminoglycans in tissue interstitial space

31
Q

Alpha subunit is common to which pituitary hormones?

A

TSH, LH, FSH, bhCG

32
Q

Main sign of glucagonoma

A

Necrolytic migratory erythema - painful, pruritic papules that coalesce to large indurated plaques

Due to excess catabolism, aa deficiency

33
Q

Primary adrenal insufficiency - testing

A

Concurrently do these tests:
1. AM cortisol + ACTH level
2. ACTH stimulation test

34
Q

Cushing - testing

A

24-hr cortisol
Dexamethasone suppression test

35
Q

What does excess cortisol do to muscle?

A

Catabolic muscle atrophy due to breakdown and impaired regeneration -> proximal weakness

No pain because not direct injury to myocytes
CK is normal

36
Q

VIPoma symptoms

A

VIP increases fluid and electrolyte secretion in intestinal lumen:
1. Watery diarrhea (tea-colored, odorless)
2. Muscle weakness/cramps (hypokalemia)
3. Hypochlorhydria (decreases gastric acid secretion)

Hypercalcemia from bone turnover
Hyperglycemia from glycogenolysis

Stool sodium increased, osmolal gap <50

VIPoma commonly found in pancreatic tail
May have concurrent MEN and hyperthyroidism

37
Q

Systemic mastocytosis

A

Mast cell proliferation, causing pruritius, flushing, and dyspepsia from gastric hypersecretion

Diagnosis via skin or bone marrow biopsy

38
Q

What endocrine conditions can causd carpel tunnel?

A

Hypothyroidism, acromegaly - cause soft tissue swelling in tunnel

39
Q

When to do radioactive iodine uptake test?

A

Differentiating hyperthyroid (low TSH) or when low TSH in discovered nodule
Cold nodule workup then depends on ultrasound features - suspicious requires FNA or repeat US based on size, whereas nonsuspicious also may require FNA or repeat US based on size

40
Q

When should thyroid FNA be done?

A

Nodules >1 cm with high-risk features or any nodules >2 cm

41
Q

What is the most common cause of ACTH-secreting paraneoplastic Cushing?

A

SCLC

Other neuroendocrine tumors (e.g. bronchial carcinoid, medullary thyroid)

42
Q

What is the only cause of severely elevated hypercalcemia (>12)?

A

Malignancy - PTHrP
Expect to see significant lethargy, other neuro symptoms

Other causes would have modest hypercalcemia with milder, nonspecific symptoms (e.g. constipation)

43
Q

Hyperthyroidism vs pheochromocytoma

A

Hyperthyroidism has widened pulse pressure due to peripheral vasodilation (decreased diastolic) and increased stroke volume (PP)

Pheochromocytoma typically have episodic headaches and diaphoresis

44
Q

Glitazones

A

Thiazolidinediones - increase insulin sensitivity by binding PPAR-gamma and regulating transcription

Associated with weight gain and peripheral edema

45
Q

Methimazole - primary concern

A

Agranulocytosis

46
Q

Propylthiouracil - primary concerns

A

Fulminant hepatic necrosis
ANCA-positive vasculitis

47
Q

What is cosyntropin?

A

Synthetic ACTH

48
Q

Medullary thyroid cancer should be worked up for what else?

A

Pheochromocytoma (as part of MEN2 due to RET gene) - can be asymptomatic but manifest with hypertensive crisis during surgery

49
Q

Primary hyperparathyroidism has what CV effect?

A

Hypertension - variety of pathways

50
Q

Thiazolidinedione - adverse

A

Weight gain, edema (don’t use in HF), hepatotoxicity, bone loss

51
Q

What are the gliptins?

A

Dipeptidyl peptidase-4 inhibitors - inhibit degradation of GLP-1

52
Q

Alpha-glucosidasr inhibitors (acarbose, miglitol)

A

Decrease intestinal absorption of carbs

53
Q

How to differentiate thyroiditis/iodine exposure/extraglandular production vs exogenous hormone?

A

Exogenous hormone would have low thyroglobulin in blood

54
Q

Graves ophthalmopathy treatment

A

Remove surgically; if causing diplopia or threatening vision, give steroids

55
Q

Thyroid storm management

A
  1. Beta-blocker
  2. Antithyroid (PTU preferred)
  3. Potassium iodide
  4. Cholestyramine
56
Q

Thyroid cancer histology showing round microcalcifications and large, optically clear nuclei

A

Papillary thyroid cancer - Psammoma bodies and Orpahn Annie nuclei

57
Q

Papillary vs follicular thyroid cancer

A

Papillary has Psammoma bodies and Orphan Annie nuclei; lymphatic spread ( vs hematologic)

58
Q

Other osteoporosis treatments

A

Teriparatide (PTH analog)
Denosumab (anti-RANK-L)
Raloxifene (SERM)

59
Q

Shortened 4th and 5th metatarsal or metacarpal bones

A

Albright hereditary osteodystrophy - PTH resistance with low calcium, high phosphate despite high PTH

60
Q

How to prevent secondary hyperPTH in CKD?

A

Phosphate binders (Ca salts, sevelamer, lanthanum carbonate)
Restrict phosphate intake

Cinacalcet is calcimimetic that lowers serum PTH in hyperPTH caused by renal failure or those who cannot undergo surgery

61
Q

Hyperpigmentation seen in primary or secondary adrenal insufficiency?

A

Primary adrenal insufficiency

62
Q

Pegvisomant

A

Growth hormone receptor antagonist - blocks peripheral effects of GH in acromegaly

63
Q

Petrosal sinus sampling with CRH

A

When no pituitary adenoma detected, used to assess central-peripheral ACTH gradient; if positive, Cushing disease, otherwise it is ectopic ACTH-dependent Cushing syndrome

Internal Medicine (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions