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Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Results of water deprivation test in Primary/Psychogenic polydipsia? DI?

A

Primary or psychogenic - negative water deprivation test (Concentrates Urine) DI - positive water deprivation test (Cant Concentrate urine)

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2
Q

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

A

Glaucognoma. Check gucagon levels > 500. Resect

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3
Q

Single most common cause of hypothyroidism? Test? Rx?

A

Hashimoto’s Thyroiditis. Measure TSH and FT4. Can to TPO antibodies if diagnosis unclear Rx: Thyroxine.

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4
Q

Pt presents with galactorrhea, amenorrhea and infertility. Men experience erectile dysfunction and decreased libido. Dx? Test? Rx?

A

Hyperprolactinemia. 1. Check levels > 200 means pituatiatry 2. Rule out other causes. Beta HCG, TRH, BUN/CR (Renal failure can lead to elevated prolactin levels) 3. Then MRI. Rx: 1. Dopamine agonist (Cabergoline/Bromocriptine) 2. Transphenoidal surgery (2nd line because most prolactinomas shrink with D2 agnosist)

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5
Q

Pt presents with Moon fascies and abdominal fat, skinny legs, osteoprosis, HTN, ammenorrhea, erectile dysfunction and polyuria. Dx? First step to diagnosis? Where to check for location? Rx?

A

Cushings Syndrome (hypercortisolism ATCH dependent- from pituitary or non-pituitary source ACTH secreting tumor or ACTH independent- due to adrenal source.) First step in diagnosis 24-hr urine cortisol or 1mg dexamethaseone supprssion test. Decreased ACTH means adrenal origin. If High and suppressed by Dexamethasone then pituitary. If high and not suppressed by dexamethasone then it could be Ectopic Carcinoid/Pituitary. Conduct MRI, if nothing seen on MRI, sample the inferior pertrosal sinus for ACTH after giving CRH. An elevated ACTH from the venous drainage will indicate a pituitary source. (Some are not seen on MRI) If this pertrossal sampling is normal then do CT chest to look for Ectopic carcinoid. Rx: Transphenoidal if brain, adrenalectomy if adrenal, minimize steroid if steroid induced.

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6
Q

Pt has thyroid surgery and now presents with Chovstek, Tetany, QT Prolongation, Hypotension, Circumoral tingling of the hands and feet. Dx? What are the other 3 common reasons? Tests (4)? Rx?

A

Hypocalcemia. Primary hypoparathyroidism from post neck surgery ie thyroidectomy. Hypomagnesemia (Mag stimulates PTH, low levels lead to Ca loss in urine) and Renal Failure (cant activate Vit D), Increased Albumin due to Respiratory Alkalotic State. 1. Check Ionized/Free and total Ca level and Albumin level (for every 1 pt decrease albumin the total Ca will decrease by .8 (Respiratory alkalaosis causes more binding of Ca to Albumin which would lower the ionized as well) 2. Check Vit D 3. PTH 4. Check Mag level Rx: Treat the underlying disorder. Replace mag. Give oral Calcium, Vitamin D.

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7
Q

Pt presents with EPISODIC/Paroxsymal Hypertension, HA, sweating, palpitations, tremors. Dx? First step in diagnosis? Next step after biochemical testing? When to do MIBG Rx? Common copmplication of rx?

A

Pheochromocytoma. 24 hr urinary fractionated metanephrines and catecholamines or plasma metanephrines. CT/MRI of abdomen. MIBG ( radioactive iosotope scan) if CT/MRI negative or if suspicion for malignancy or tumor >5cm. If positive then genetic testing (MEN 2A/2B.) Alpha blockers (Phenoxybenzamine.) for 2 weeks w/ IVF prior to surgery to prevent crisis then surgery for removal of adrenal. Can give BBB after alpha blockade. During surgery pts can become hypotensive due loss of catecholamines give NS bolus, pressors if needed.

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8
Q

Difference btw primary hypeparathyroidism and familial hypocalciuric hypercalcemia? Rx for FHH Rx for PPTH? Complication of PPTH?

A

both have elevated PTH, FHH has mildly elevate Ca with hardly no symptoms. Urine Ca <200, UCCR < 1.0 in FHH because mutation in calcium sensing receptor which causes in ability to excrete Ca. PPTH has urine Ca > 200 and UCCR >2.0 All the elevated CA is able to excrete. Rx for FHH is reassurance. PPTH is parathyroidectomy if symptomatic, kidney stones, CKD and < 50 to prevent osteoporosis.

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9
Q

Severe Hypothyroidism, AMS, hypothermia. Dx? Rx?

A

Myxedema Coma. Admit to ICU, IV Levothyroxine + IV Hydrocortisone.

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10
Q

State if there is HTN and Virilization for each: 1. 21 alpha hydroxylase 2. 11-hydroxylase 3. 17- hydroxylase. Management?

A
  1. Hypotension, Virilization in Girls, Precocious Puberty in Boys 2. Hypertension, Virilization in Girls, Precocious puberty in boys 3. Hypertension and female like boys
    Rx: Fluids, Salt repletion and Cortisol to decrease ACTH. Can give fludrocortisone to severe 21 alpha-hydroxylase.
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11
Q

Common incidental finding on CT/MRI where no pituitary gland is present but pts have no functional endocrine deficiency. Dx?

A

Empty Sella Syndrome

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12
Q

Can be caused by Chronic Lung cancer, TB, Abcess, Sacroid, CNS stroke, Injury, Surgery or Trauma, SAH. SSRIS are ALSO a common cause. Pt presents with Euvolemic Hyponatremic State. Why? Test? Rx for Mild? Moderate? Severe? Chronic?

A

SIADH. Euvolemic because pts still have the ability to excrete free excess water. They retain free water and expel Na+. Test: Plasma Osmal 300 (In appropriately concentrated.) Plasma Na

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13
Q

Hyperthyroidism with proptosis and exopthalmus and myxedema. Dx? Best initial test? Most accurate test? Rx?

A

Graves Disease. Diangosed on Hx and physical exam. Lab studies confirm. TSH low and T4 High. RAUI shows Diffuse Increased uptake. (Only do if diagnosis is unclear.) Antimicrosomal and Antithyroglobulin abx are present as well. (Rarely checked). First give Propanolol and PTU or Methimazole before Ablation (Standard of Treatment) Will need Synthroid after this. Thyroidectomy during 2nd trimester if pt is pregnant give PTU during the first. Steroids for myxedema and exopthalamus.

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14
Q

Hyperthyroid with tender thyroid. Pt was sick previously with URI and fever. Compains of neck, jaw and ear pain. ESR > 90, Elevated AST/ALT. Dx? Best initial test? Most accurate test? Rx?

A

Subacute, Dequarveins Thyroiditis (occurs post viral infection.) Transient: Low TSH and High T4, Then High TSH and low T4 ( hyperthyroid to hypo) RAUI decreased uptake (due to destruction of gland no synthesis done). Seen in postpartum, silent, iodine induce thyroididitis. Give NSAID/ASA supportive.

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15
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, Cooling Blankets, IV PTU, IV Propanolol, Iodine (to inhibit hormone release) and IV Dexamethesone (prevents the conversion of T3 to T4 and gives adrenal support)

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16
Q

Pt presents with bilateraly carpal tunnel, facial puffiness, thin hair, dry skin, Constipation, DELAYED DEEP TENDON REFLEXES, Hypercholesterolemia, Fatigue, Cold intolerance. Dx? Best initial test? Most accurate test?

A

Hypothyroidism (Hashimoto’s, S/p ablation, S/p Surgery, Lithium and Amiodarone). Diagnosis based on history and physical exam. TSH High and T4 Low (Primary). Synthroid 150-200 mcg.

17
Q

Pt presents with delirium, been on ventilator, has had mutiple surgeries. Dx?

A

Sick Euthyroid State. Body preserves the ability to convert T3 to T4.

18
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?

A

Multinodular Toxic Goiter. (Patchy uptake on RAIU) as oppose to toxic adenoma which has a localized uptake on RAIU.

19
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 thyroid use. Check Thyroid Globulin levels because these are elevated in endogenous thyroid hormone production.

20
Q

Pt presents with Weakness, Hypotension, Weightloss, Hyperpigmentation, loss of pubic and axillary hair, Neutropenia, Dx? What are the metabolic derangement? Test? Rx? Management for Crisis?

A

Adrenal Insufficiency (autoimmune, tumor, TB/sarcoid, infarction, surgery.) Hyponatermia, Hyperkalemia, metabolic acidosis, hypoglycemia. AM Serum Cortsiol and AM Serum ACTH levels (done w/ Cosynotropin Stimulation test (ACTH Stimulation test) - If cortisol levels rise in response to Cosynotropin then secondary insufficiency, if they dont then primary AI.) cortisol <5, If high suspcicion for central adrenal do metyarpone or insulin hypoglycemia test. Rx: IVF, HC. ADD FC for persistent hypotension, hyponatremia. Immediate FC + IVF if adrenal crisis.

21
Q

Male presents with Gynocomastia, lack of labido, Small Testes, sterility, Thin wrinkly skin and mental retardation. Dx? Test? Rx?

A

Kinefelter Syndrome (most common pimary developmental abnormality causing hypogonadism) 47, XXY (Barr Body never left.) Increase LH, FSH, estradiol levels with low urinary 12-ketosteroid and low testosterone levels. Testosterone replacement.

22
Q

HTN diagnosed under 30 or above 60, HTN not controlled on 2 medications, associated with polyuria, polydipsia, hypokalemia. Dx? Best initial test? Most accurate test? What test can be done if the first 2 test are equivocal? Rx for Adenoma? Rx for Hyperplasia?

A

Hyperaldosteronism (Conn Syndrome.) Labs show increased Na and deplete K. Best initial test is Aldosterone/Renin ratio > 30 (Tells the difference between Primary and Secondary). Most accurate is Aldosterone Suppresion Test (oral saline should suppress aldo). Can Check Venous Sampling if Aldosterone Suppression is Equivocal. CT scan can be done after biochemical testing. Adenoma - Rx with Laprotomy. Bilateral Hyperplasia Rx with - Eleprenone/ Sprinalactone

23
Q

Condition presents with increase ring, hat and shoe size in ADULTS. Carpal tunnel syndrome, Body odor (sweat gland hypertrophy) Coarsening facial features, Deep voice and macroglossia, Colonic polyps, Athralgias. Dx? What are they increased risk for? Test? Rx?

A

Best initial test : IGF-1 level Most accurate test: Oral glucose tolerance test 3. MRI of the brain after biochemical testing. Rx: 1. Transphenoidal surgery – First line (Hypopuititarism). 2. Octerotide (Cholestasis), Cabergoline/Bromocriptine (Hyperprolactinemia) , Pegvisomant. 3 Radiation if all else fails.

24
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 Elevated- Cold nodule, Family hx of thyroid cancer (MEN), or There were suspicious findings on US. 3. When the US is negative but the TSH is low (Equivocal Test.) (the Syntigraphy will tell if the nodule us hypo or hyper then you will do FNA.)
25
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, Renovascular Artery Stenosis (Increase Renin, Increase Aldosterone 3. Cushings, CAH, Exogenous mineralcorticoid use (Low Renin, Low Aldosterone)
26
Q

Hypercalcemia + Intractable Ulcers?

A

MEN 1 (Parathyroid, Pancreatic, Pituitary)

27
Q

Name the laboratory findings of Osteitis Deformans (Pagets Disease,)

A

Normal Ca and Phosphate, Elevated Alk Phos and Urinary Hydroxyproline, N- Telopeptide, C-Telopeptide.

28
Q

Low TSH and Noraml T3 and T4. Dx?

A

Subclinical Hypothyrodism.

29
Q
  1. Elevated RAIU + Elevated serum thyroglobulin? 2. Elevated RAIU + low thyroglobulin? 3. Low RAIU + low thyroglublin? 4. Low RAIU + elevated thyroiglobulin? 5. Normal RAIU + elevated thyroglobulin?
A
  1. Graves Disease 2. Toxic nodular goiter (nodules hyperfunctioning on own) 3. Exogenous 4. strum ovarii, thyroiditis 5. papillary, follicular thyroid Cancer
30
Q

Pt complains of amenorrhea and visual disturbances. LH and FSH low. All other hormone levels normal. Dx? Rx?

A

Non-functioning pituitary adenoma (arises from gonadotroph secreting cells. Transphenoidal surgery.

31
Q

Pt has hx of hashimotos with now rapidly growing thyroid gland causing obstructing symptoms. Dx?

A

Thyroid lymphoma

32
Q

Hyperthyroid with non-tender thyroid. Dx? Best initial Test? Most accurate test? Rx? Complication?

A

Lymphocytic Thyroiditis. Transient: Low TSH and High T4, then Low T4 and High TSH. RAUI decreased uptake. No therapy. Lymphoma is a complication.

Internal Medicine (13 decks)

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