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Step 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Orphan annie, psammoma bodies

A

Papillary

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2
Q

Most common thyroid malignancy

A

Papillary

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3
Q

Ground glass, pale nuclei w/ inclusions and central grooving

A

Papillary

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4
Q

Ret gene

A

Papillary & Medullary

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5
Q

Amyloid stroma

A

Medullary

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6
Q

HypoCa, RET gene

A

Medullary

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7
Q

Calcitonin, C-cells

A

Medullary

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8
Q

Invasion of tumor capsule & blood vessels

A

Follicular carcinoma - adenoma does not invade capsule

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9
Q

Dense fibrous capsule

A

Follicular adenoma

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10
Q

RAS gene

A

Follicular

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11
Q

Hematogenous spread, no needle bx thyroid Ca type?

A

Follicular

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12
Q

NON-tender thyroiditis, very low RAIU

A

Subacute LYMPHOCYTIC

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13
Q

Tender thyroid, very low RAIU

A

Subacute/De Quervains Granulomatous

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14
Q

Firm thyroid

A

Riedel’s fibrosing

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15
Q

Chvostek & Trousseau sign

A

HypOCa d/t PT resection/hypothyroidism, CKD –> dec 1,25OH

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16
Q

Diffuse inc RAIU uptake –> most likely to develop hypOthyroidism

A

Grave’s (vs. subacute or exogenous=dec/low, tumor = patchy)

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17
Q

Scalloping of colloid

A

Grave’s - Ab to TSH-Receptor

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18
Q

SE of RAI tx for Graves’ (#1 choice)

A

Worse proptosis (10%) (pre-tx w/ steroids), perm hypOthyroidism (80%)

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19
Q

Use of anti-thyroid drugs for Grave’s

A

PTU in preg, PTU –> vaculitis, Both PTU & MMI –> agranulocytosis

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20
Q

Risks/SE of thyroid surgery

A

Laryngeal nerve damage, hypoCa

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21
Q

Low TSH, Inc T4, hot RAIU uptake

A

Functioning nodule –> I2 ablation or ?lobectomy

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22
Q

Low TSH, inc T4, cold RAIU next step?

A

U/S FNA –> usually tx w/ RAI?

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23
Q

Unsure US FNA, non-functioning RAIU scan

A

Cancer –> surgery

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24
Q

Low TSH, high T4,3, low RAIU, next step?

A

Measure Ig - low = exogenous, high = thyroiditis, extraglandular production

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25
Q

Chronic inflammation of germinal centers w/ Hurthule cells

A

Hashimoto’s (microsomal abs)

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26
Q

Lymphocytic infiltration of thyroid

A

Hashimoto’s (microsomal abs)

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27
Q

Hurthle cells

A

Hasimoto’s & Follicular thyroid CA

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28
Q

Anti-TPO Abs –> transient hyperthyroidism

A

Hashimoto’s

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29
Q

Hx of Hashimoto’s –> enlarging thyroid = ?

A

Marginal B-cell lymphoma/thyroid lymphoma —> core needle bx

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30
Q

Hypothyroidism, donut sign on CT, voice change, pseudocyst on US

A

Thyroid lymphoma

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31
Q

Pancreas (insulin or gastrinoma), Parathyroid, Pituitary

A

MEN I - Ca stones

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32
Q

Medullary, Parathyroid, Pheo

A

MEN IIA –> metanephrine measure + PCR DNA testing

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33
Q

Medullary, Marfan or mucosal/intestinal neuromas, Pheo

A

MEN IIB

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34
Q

Ret gene

A

MEN IIA/B

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35
Q

Thyroid nodule 1st step

A

PE + TSH +US

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36
Q

Thyroid nodule w/o hypoechoic, calcification or vascularity next step

A

High TSH = FNA ; Low TSH –> RAIU

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37
Q

Inc T4, Normal/High TSH, hyperthyroidism

A

Pituitary adenoma –> TSH

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38
Q

Very low TSH, tachy, weight loss - control Sx?

A

Propanolol for hyperthyroidism –> iodine tx/dx of Grave’s

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39
Q

Pregnancy THs

A

Inc total, bound T4,3, TBG, Dec TSH, Same free

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40
Q

Untx hyperthyroidism –> ?

A

Osteoporosis

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41
Q

Myalgias, proximal weakness, slow reflexes

A

Hypothyroidism - TSH, free T4 –> EMG –> Bx

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42
Q

Growth /yr, goiter, myxedema, amenorrhea, umbilical hernia, hypothermia

A

Hypothyroidism

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43
Q

Poor feeding, lethargy, constipation, large ant. Fontanelle, protruding tongue

A

Hypothyroidism

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44
Q

Apathy, weakness, hypotonia, large tongue, slow movements, constipation

A

Hypothyroidism

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45
Q

Low T3,4 Low TSH, hypothyroidism

A

Secondary (pituitary) or tertiary hypothyroidism

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46
Q

Inc T3,4 Normal TSH, hypothyroidism

A

Resistance to thyroid hormones

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47
Q

1 cause of congenital hypothyroidism

A

Thyroid dysgenesis (90%)

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48
Q

Sensorineural hearing loss, hypothyroidism

A

Penred syndrome

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49
Q

Other cause of congenital hypothyroidism

A

PTU in pregnancy, Maternal auto-immune

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50
Q

Tachy, warm, vitiligo, alopecia, can’t concentrate, gyecomastia in boys

A

Hyperthyroidism

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51
Q

1 congenital hypothyroidism in US

A

Thyroid dysgenesis; Iodine deficiency worldwide

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52
Q

Reduce decline in GFR/macroproteinuria in DM

A

Tight BP control - ACE

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53
Q

DKA acute tx

A

Normal saline + regular insulin –> D5 +K when BG 200-250

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54
Q

DM BP goal

A

<130/80

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55
Q

DM goals

A

A1c <7, LDL 70-100, low carbs, low sat fat,

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56
Q

Gestational DM screening

A

50g 1hr GCT @24-28wks

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57
Q

GCT >130 next step

A

100g 3hrs GCT >95, 180, 155, 140 = abnormal

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58
Q

Dx criteria for DM

A

Random >200, fasting >126, A1c >6.5

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59
Q

DM maintenance tests

A

Lipids, Cr, Microalbumin, eye exam, foot exam, EKG, TSH in type 1

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60
Q

Metformin CI

A

Renal insufficiency Cr >1.5men, 1.4 women –> lactic acidosis

61
Q

TZDs MOA

A

Inc insulin sensitivity in muscle, fat, dec gluconeogenesis

62
Q

TZDs SE

A

water retention –> renal compromise, CHF, slow onset

63
Q

Drug best for erratic eating habits, dec post-prandial glucose

A

alpha-glucosidase inhibitors

64
Q

Pramlintide MOA

A

amylin –> inhibits glucagon after meal

65
Q

GLP-1 agonists (exaenatide, glitazone) MOA

A

Stim insulin release –> hypog w/ sulfonylurea, acute pancreatitis

66
Q

DPP-4 inhibitor (-gliptin) MOA

A

Stim insulin synthesis in glucose dep manner, dec glucagon

67
Q

Hypoglycemia Tx

A

IM glucagon or D50

68
Q

7 y/o weight loss, polydipsia, polyphagia, glucose 500 work-up

A

DM-1 diabetic ketoacidosis –> Hospital, IVF, Insulin

69
Q

Gesational DM fetal risks

A

Macrosomia, polyhydramios, shoulder dystocia (also pre-gestational)

70
Q

Pain, tingling in feet, falls, hyperreflexia, + babinski next step?

A

Spine MRI - upper motor neuron/?compression - DM prone to epidural abscess

71
Q

Osteomyelitis adjacent to foot ulcer mech?

A

Contiguous spread

72
Q

DKA hyperK w/ delepted K stores pathogenesis

A

Infection –> cortisol –> hyperglycemia –> diuresis of K –> K out of cell

73
Q

Anti-glutamic acid decaroxylase Abs

A

Indolent late-onset DM-1

74
Q

Weight loss, deep rapid breathing (acidosis), Viral GE, excessive thirst

A

DKA –> check glucose –> CBC, ABG,

75
Q

Age to start screening w/ no DM risk factors

76
Q

Elevated insulin, c-peptide + hypoglycemia

A

Beta cell tumor

77
Q

Low insulin, c-peptide, high IGF-II + hypoglycemia

A

Non-beta cell/mesenchymal tumor

78
Q

High insulin, LOW c-peptide + hypoglycemia

A

Exogenous insulin

79
Q

1st line drug of obesity (not DM)

A

Orlistat - up to 4yrs

80
Q

Contributing factor in diabetic foot ulcers

A

Neuropathy

81
Q

Blurred vision in uncontrolled DM

A

Infection –> cortisol is anti-insulin –> dehydration & hyperosmolar state

82
Q

Erythematous papules, DM, diarrhea, weight loss, normocytic anemia

A

Glucagonoma (>500pg) –> CT

83
Q

Islet cell Abs, Insulin Ab, Glutamic acid decarboxylase Ab

84
Q

Evening insulin too high –> hypoglycemia –> EPI, glucagon –> high BG, ketones AM

A

Somogyi effect

85
Q

DKA + sudden AMS

A

Cerebral edema - >100mg/hr drop - addD5 <250

86
Q

Thin boy fever, vomiting –> sleep w/o food –> AM seizure

A

Ketotic hypoglycemia

87
Q

Poor weight gain, polydipsia, polyuria, enuresis, nocturia

88
Q

HyperNa, dilute urine + inc serum Na and osmolarity, morning urine <1.018

89
Q

Water deprivation test inc serum osmolarity + dilute urine

A

DI –> DDAVP for CDI

90
Q

No response to ADH

91
Q

Bone scan in presence of DI?

A

R/O Langerhans histiocytosis

92
Q

High IGF-1, fail to suppress oral glucose

A

Acromegaly

93
Q

*Signs of hyperprolactinoma 1st steps?

A

Check TSH —> CT (unless mass effect then CT 1st)

94
Q

Low LH, testosterone, TSH, thyroxine, elevated prolactin

A

Pituitary adenoma

95
Q

Prolactinoma Tx

A

DA agonists - Cabergoline or Bromocriptine

96
Q

Dec GnRH, Dec LH, FSH, Dec sperm, Normal T + gynecomastic, acne

A

Anabolic steroid use

97
Q

Hypoglycemia, microphallus, cleft palate

A

Congenital hypopituitarism*

98
Q

Inc ACTH, dec cortisol

A

Primary adrenal insufficiency

- #1 = auto-immune adrenalitis

99
Q

Anorexia, weakness, dec Na, inc K, hypotension, inc pigment, Eosinophilia

A

Primary adrenal insufficiency - cortisol

100
Q

FTT, salt craving, dec Na, inc K

A

Primary adrenal insufficiency - aldosterone

101
Q

Hx Hashimoto, hypotn, hyperpigmented, hypoNa, hyperK, high ACTH

A

Primary adrenal insufficiency (Addison) = Auto-immune (80% of all)

102
Q

Causes of primary adrenal insufficiency

A

CMV, TB, sepsis + Warfarin, malignancy

103
Q

Primary adrenal insufficiency causes

A

Addison, CAH, adrenoleukodystrophy

104
Q

ACTH stim –> cortisol <2x

A

Primary adrenal insufficiency

105
Q

Adrenal insufficiency Tx

A

D5 + NS, steroids

106
Q

Normal K, hx steroid use (#1)

A

Secondary adrenal insufficiency

107
Q

Secondary adrenal insufficiency causes

A

Langerhans, Pituitary tumor, craniopharyngioma

108
Q

Ambiguous genitalia, hypotension, Dec Na, Inc K, Inc T

A

CAH (21 B-OH) = 17-OH

109
Q

HTN, HyperNa, HypoK, virilization, Inc T

A

CAH (11 B-OH) = Compound S

110
Q

Salt-wasting crisis, ambiguous genitalia

A

CAH (3 B-OH) = DHEA & 17-OH

111
Q

7 y/o acne, facial hair w/o inc testicular volume

A

Non-classical CAH (21-OH)

112
Q

Tx CAH

A

Cortisone , fluorocortisol (if low), follow growth

113
Q

Lymphocytic infiltrate into adrenal cortex

114
Q

Type 1 polyglandular syndrome

A

Addison, Hashimoto’s, DM-I

115
Q

Type 2 polyglandular syndrome

A

Addison, Hypoparathyroid, candidiasis

116
Q

Delayed bone age, moon facies, bruising, HTN

A

Cushing (cortisol excess)

117
Q

Obesity, easy bruising, high 24hr cortisol, ACTH, high dexa –> dec cortisol

A

Cushing disease

118
Q

Weakness, weight gain, hyperglycemia, easy bruising electrolyte abnormalities

A

Cushing disease –> aldosterone –> hypoK, hyperNa

119
Q

ACTH low

A

Exogenous cortisol or Primary adrenal tumor

120
Q

ACTH high

A

Pituitary or ectopic tumor –> high dose dexa

121
Q

Low dose dexa –> suppression

A

Fat person

122
Q

Low dose dex –> NO suppression + high 24 urine cortisol next step?

A

Proceed to high dose dexa

123
Q

High dose dexa –> suppression

A

Pituitary = Cushing Disease/adrenal adenoma

124
Q

High dose dexa –> NO suppression

A

Ectopic ACTH production - pituitary, small cell, pancreatic, carcinoid CA

125
Q

Obese, striae, easy bruising, 24hr cortisol 1000, ACTH high, high dexa no chg

A

Ectopic ACTH production - pituitary, small cell, pancreatic, carcinoid CA

126
Q

Obesity, striae, hypotension, low ACTH

A

Exogenous steroids, B/L AH, adrenal adenoma

127
Q

HTN, hypoK, Low renin: high Aldo >20, cramps, polyuria, inc aldo standing

A

Primary hyperaldosteronism (Conn) —> Oral saline load –> epelerone

128
Q

Inc aldo standing vs. lack of response in Conn syndrome

A

Hyperplasia vs. adenoma of adrenal gland

129
Q

Paroxysms, Pressure, Pain, Palpitations, Perspiration

A

Pheochromocytoma –> 24 urine VMA, metaneprine

130
Q

Pheo Tx

A

alpha blocker phenoxybenzamine, BBs inc BP

131
Q

Aldo:renin <10, HTN, hypoK

A

US + doppler –> Renal artery stenosis

132
Q

Young woman w/ fibromuscular dysplasia intervention

A

Arteriogram + stent OR ACE + aldo blockers if old man

133
Q

B/L Adrenal calcification

134
Q

Accumulation of long chain FA in young male, adrenal insufficiency

A

Adrenoleukodystrophy

135
Q

High DHEA-S, normal T

A

Androgen producing adrenal tumors

136
Q

Normal DHEAS, high T

A

Ovarian tumor

137
Q

Moon facies, steroid use, hypoNa, weakness, fatigue, orthostasis

A

3 adrenal insufficiency –> suppresses CRH, ACTH, cortisol, inc ADH

138
Q

Tx NDI

139
Q

Tx SIADH

A

Demeclocycline

140
Q

Short stature

A

2SD or evaulate RATE

141
Q

Normal growth rate

A

2”/yr 3 y/o –> puberty

142
Q

Delayed bone age, late puberty, 2”/yr

A

Constitutional short stature

143
Q

Normal U/L ratio, /yr, abn velocity

A

Pathologic short stature - proportionate

144
Q

Causes of proportionate short stature

A

Chr, genetic, viral, malnutrition, abuse, organ dz

145
Q

Bone age = real age disproportionate SS causes

A

familial, IUGR, Turner, skeletal dysplasia

146
Q

Bone age < real age disproportionate SS causes

A

Constitutional, dec thyroid, inc cortisol, dec GH

147
Q

Dec GH, 1 central maxillary incisor, cleft palate 1st step

A

MRI (craniopharyngioma), IGF-1 –> GH injections

148
Q

Visceromegaly, umbilical hernia, ear crease, inc insulin + hypoglycemia

A

Beckwith-Wiedmann syndrome

149
Q

Abdominal mass NOT cross midline, hematuria

A

Wilms tumor –> CT + contrast –> lung mets?

Step 2 (20 decks)

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