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IM > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are the most common cause of thyroid nodules?

A

colloid nodules

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2
Q

What is the role of FNAB in thyroid cancer?

A

can help see cytology in papillary cancer but cannot distinguish follicular adenoma from follicular cancer

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3
Q

What is the preferred therapy for graves disease? What are the other treatment options available?

A

radioactive iodine therapy is preferred

propylthiouracil and methimazole also used

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4
Q

What are the characteristics of malignant thyroid nodules?

A

fixed, cold, solitary, hx of radiation

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5
Q

What is the difference between papillary vs. medullary vs. follicular carcinoma?

A

papillary - most common, least aggressive, positive iodine uptake
follicular - spreads early via hematogenous route, more malignant; variant = Hurtle cell
Medullary - produces calcitonin, associated with MEN II
Anaplsatic - highly malignant, can arise from previous cancer

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6
Q

What is the best way to diagnose nephrogenic vs. central DI?

A

water deprivation test (both central and nephrogenic will have decreased urine osmolarity); nephrogenic however will not respond to ADH

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7
Q

What are some of the signs of hypoparathyroidism?

A

rickets, osteomalacia, tetany, prolonged QT interval

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8
Q

What are the signs of hypercalcemia?

A

stones (nephrolithiasis), bones (bone aches, pathologic fractures), groans (muscle aches, gout, constipation, PUD), psych overtones (depression, anxiety, etc)

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9
Q

What are the signs/symptoms of Cushings?

A

central obesity, hirsuitism, moon face, HTN, diabetes, proximal muscle wasting, psych disturbances

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10
Q

What is the formula for corrected calcium?

A

measured Ca+ + 0.8(4-measured serum albumin)

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11
Q

What is the on the differential for hypertension + hypokalemia?

A

adrenal carcinoma, bilateral adrenal hyperplasia, adrenal adenoma

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12
Q

What is the best way to evaluate hypertension + hypokalemia?

A

plasma renin ratio

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13
Q

QUICK HIT - walk through the diagnostic algorithm for hypokalemia!

A

SEE LECTURE

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14
Q

What are the causes of thyrotoxicosis with reduced iodine uptake?

A

subacute thyroiditis, levothyroxine overdose,

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15
Q

Describe the treatment for diabetes neuropathic pain

A

tricyclics, gabapentin, NSAIDs

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16
Q

What are the causes of hypogonadotrophic hypogonadism in men?

A

gonadotroph damage, prolactinoma, Cushing’s, narcotic use, systemic illness, diabetes, hemachromatosis, anabolic steroid use, morbid obesity

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17
Q

What are some of the features of acromegaly?

A

course facial features, arthralgias, uncontrolled hypertension, increased ring size, skin tags, carpal tunnel syndrome

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18
Q

What is the best test available for diagnosing acromegaly?

A

IGF-1

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19
Q

What are the different forms of access in dialysis?

A

Fistula
Graft
Catheter (tunneled and no tunneled) - non tunneled is highest risk

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20
Q

What things do you look for on physical exam while looking a the fistula?

A

Trouble accesing?

Erythema, warmth, pus

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21
Q

What are some of the causes of DKA?

A 
Infection 
Noncompliance
Pregnancy
MI
Drugs (cocaine)
Pancreatitis
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22
Q

What labs should you draw for someone in DKA

A

BMP, CBC, blood ketones (beta hydroxy butyrate, acetoacetate) UA, CXR, LFT, Lipase, EKG

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23
Q

how do you prescribe synthroid? What if patient pregnant?

A

1.7 mg /kg in the young, 1 in the old, take without food or other meds. If patient pregnant, increase dose

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24
Q

How can you distinguish an insulin producing tumor from exogenous administration?

A

exogenous administration - lower C peptide levels

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25
Q

What are the risks of methimazole treatment for Grave’s? (and what should you do if a patient presents with a fever and sore throat on methimazole?)

A

agranulocytosis - if someone presents this way, stop therapy!

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26
Q

What are the clinical features of androgen use?

A

decreased sperm production, gynectomastia, LVH, mood disturbances, polycythemia

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27
Q

Explain the pathophysiology of carpal tunnel in hypothyroidism

A

deposition of protein complexes in perineurium and epineurium of median nerve

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28
Q

What test can be used to distinguish between cushings and ectopic ACTH?

A

high dose dexamethasone suppression test - failure to suppress suggests ectopic cause

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29
Q

What are the causes of ectopic ACTH?

A

small cell lung cancer, pancreatic cancer, neuroendocrine, bronchial carcinoids

30
Q

A patient presents with headaches, palpitations, abdominal pain, nausea. You give beta blockers - what are the potential complications?

A

no alpha blockade - can lead to a rapid rise in blood pressure. give alpha blockers before beta blockers!

31
Q

A patient presents with eye irritation, photophobia, decreased convergence, diplopia and pain in the setting of palpitations. What is the cause of the eye trouble?

A

anti- TSH autoantibodies causing increased volume of retro-orbital tissues

32
Q

What are the cancers associated with MEN2A? How does this differ from MEN2B?

A

MEN1 - pituitary, parathyroid, pancreas
MEN2A- medullary thyroid cancer, pheochromocytoma, primary parathyroidism
MEN2B - more aggresive, with marfanoid
—- mucosal neuromas

33
Q

A patient presents with difficulty raising her arms, a fine motor tremor and palpitations. This is likely due to …

A

hyperthyroidism

34
Q

What is one potentially life threatening complication of metformin?

A

lactic acidosis

35
Q

How do thyroxine dosages change with the addition of oral estrogen?

A

prevent TBG clearence, so more levothyroxine required

36
Q

What occurs with K+ stores in DKA?

A

total body stores decreased by can get hyperkalemia due to acidosis and reduced insulin stores

37
Q

How is follicular thyroid cancer diagnosed and distinguished from follicular adenomas?

A

invasion of the tumor capsule and blood vessels

38
Q

What are classic pathological features of papillary thyroid cancer?

A

psmammoma bodies

39
Q

What are the X ray deformities seen in Charcot’s joint?

A

loss of cartilege, osteophyte development, loose bodies

40
Q

What are the causes of hypoparathyroidism?

A

post surgical, congenital (digeorge), autoimmune (APECED), resistance to PTH (pseudohypoparathyroidism)

41
Q

What is APECED?

A

autoimmune polyglandular endocrinopathy candidiasis and ectodermal dysplasia

42
Q

Does hypocalcemia resulting from hypoalbuminemia usually cause symptoms?

A

No - ionized Ca remains the same

43
Q

What drugs can trigger HHS?

A

thiazide diuretics

44
Q

Patients that present with abnormal thyroid levels during an MI likely have…

A

sick euthyroid syndrome

45
Q

A patient presents with a firm thyroid nodule. What is the next course of action?

A

TSH and thyroid ultrasound

46
Q

What if a patient with a firm thyroid nodule has a low TSH?

A

radionucleotide scan to see if nodule is hot or not

47
Q

A patient presents with headaches, visual disturbances and palpitations with a normal TSH and elevated T3. You should..

A

look for a pituitary adenoma

48
Q

A patient presents with hearing loss and headaches with high alk phosp as well as high urinary hydroxyproline. He has joint pains and CT shows a skull with thickened cortices and lytic lesions. What is the treatment?

A

bisphosphonates - this is Paget’s disease

49
Q

A patient presents with gynecomastia, testicular atrophy and low testosterone with normal FSH and LH. What should be done next?

A

serum prolactin levels - prolactinoma can cause hypogonadism

50
Q

What tests are used to diagnose addison’s disease?

A

ACTH, morning cortisol, cosyntropic (a synthetic analog of ACTH)

51
Q

What tests are used to diagnose Cushing’s syndrome?

A

low and high dose dexamethasone tests
low dose - suppression absent in Cushing syndrome
high dose - suppression absent in Cushings due to ectopic ACTH secretion/adrenal abnormalities

52
Q

What is the most common cause of death in patients with acromegaly?

A

Congestive heart failure

53
Q

A patient presents with cold intolerance, fatigue and a diffusely enlarged thyroid. Labs show positive TPO antibodies. What is the malignancy risk for this patient?

A

thyroid lymphoma

54
Q

A patient is discovered to have an active prolactinoma. What is the best course of treatment?

A

cabergoline (dopamine agonist)

55
Q

What test can be performed to determine if ED is psychogenic or organic?

A

noctural penile tumescence

56
Q

A patient presents with asymptomatic hypercalcemia. Urinary calcium/creatinine ration is low. This is..

A

familial hypocalciuric hypercalcemia

57
Q

What are the mechansims by which cancer can increase serium calcium?

A

PTHhP (lung cancer, head and neck, esophageal, renal and bladder)
Vit D production (lymphoma)
Bone metastasis (breast cancer, multiple myeloma) - release cytokines
Ectopic PTH

58
Q

Has tightening of glycemic control been shown to improve ED?

A

nope

59
Q

A diabetic patient has BPH and ED and wants to take sidenafil. What instructions to you give him?

A

give drugs with a 4 hour interval to prevent hypotension

60
Q

When is surgery recommended for patients with hyperparathyroidism?

A

serium Ca >1mg above upper limit of normal
young age
bone mineral density reduced
reduced renal function

61
Q

A patient presents with weight loss, fever, cough, nausea, abdominal pain. Cosyntropin test is performed and shows minimal response. CT shows calcification of the adrenal glands. this is..

A

TB in the adrenal glands causing adrenal insufficiency

62
Q

What are common infectious causes of adrenal insufficiency? What is the most common cause of adrenal insuffiency in developed countries?

A

HIV, TB, CMV, fungi; autoimmune

63
Q

A young anxious woman in the psych ward has been increasing her water intaake and has low urine osmolality in addition to low serium Na. Thsi is..

A

primary polydipsia

64
Q

A patient presents with polyuria, polydipsia and low urine osmolality. Suspect..

A

central DI

65
Q

What is the biggest side effect of radioactive iodine therapy?

A

hypothyroidism

66
Q

A patient presents with gynecomastia, elevated estrogen and testosterone, decreased FSH and LH and a 1cm nodule in the testis. This is..

A

leydig cell tumor

67
Q

A patient left untreated with a toxic adenoma is at increased risk for…

A

bone loss, cardiac arrhythmias

68
Q

A patient presents with increased free serium T3 and T4 as well as normal TSH and cold intolerance, fatigue, weight gain, constipation. This is..

A

generalized resistance to thyroid hormones

69
Q

What antibodies are present in Hashimoto’s thryoiditis?

A

anti - TPO

70
Q

A patient presents with AMS, rapid deep breathing, weight loss and excessive water intake. This is..

A

DKA with kussmaul’s expiration

71
Q

Hypothyroidism is associated with what other lab abnormalities?

A

hyperlipidema, hyponatriemia, elevated CK, elevated LFTs

IM (24 decks)

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