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Internal Med EOR > Endocrine 3 > Flashcards

Endocrine 3 Flashcards

1
Q

Paget disease of the bone is also known as

A

osteitis deformans

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2
Q

what is Paget disease of the bone

A

abnormal bone remodeling in aging bones (increased osteoclast bone resorption and disordered osteoblastic bone formation) leading to focal areas of larger, weaker bone formation

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3
Q

sx Paget disease of the bone

A

most asx
incidentally high alkaline phosphatase

bone pain - MC
skull enlargement –> deafness (compression of CN 8), HA, osteosarcoma is rare

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4
Q

dx Paget disease of the bone

A

isolated markedly elevated alkaline phosphatase

increased urinary pyridinoline and N-telopeptide
increased serum C-telopeptide

plain radiograph

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5
Q

what will plain radiograph show for Paget disease of the bone

A

lytic phase - blade of grass or flame shaped lucency
sclerotic phase - increased trabecular markings
skull radiographs - cotton wool appearance - sclerotic patches that are poorly defined and fluffy as a result of thickened, disorganized trabecular, which leads to sclerosis in previously Lucent bone

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6
Q

tx Paget disease of the bone

A

asx - usually no tx
bisphosphanates first line
vit D and calcium supplemention during bisphosphonate tx

NSAIDs for pain

Calcitonin if unable to take bisphosphonates

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7
Q

what is pheochromocytoma

A

catecholamine-secreting tumor arising from the adrenal medulla

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8
Q

what percent of pheochromocytoma are benign

A

90%

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9
Q

what does pheochromocytoma secrete

A

norepinephrine
epinephrine
dopamine

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10
Q

sx pheochromocytoma

A

HTN MC
PHE - palpitations, HA, excessive sweating

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11
Q

dx pheochromocytoma

A

step 1 - biochemical testing
metanephrines - measurements for elevations in urinary and plasma fractionated metanephrines and catecholamines

step 2 - imaging
abdominal imaging - MRI or non contrast CT abdomen and pelvis to locate tumor after testing

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12
Q

tx pheochromocytoma

A

1 - nonselective alpha blockade (phenoxybenzamine or phentolamine followed by BB or CCB to control BP prior to surgery)
2 - BB
3 - surgery - definitive

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13
Q

what is the MC pituitary adenoma

A

prolactinoma

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14
Q

sx prolactinoma

A

women - oligomenorrhea, amenorrhea, infertility, decreased libido, galactorrhea

men - decreased libido, erectile dysfunction, infertility, oligozoospermia

HA
bitemporal hemianopsia

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15
Q

labs for prolactinoma

A

increased prolactin
decreased LH, FSH

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16
Q

tx prolactinoma

A

dopamine agonists - cabergoline or bromocriptine

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17
Q

somatotroph adenoma

A

growth hormone secreting pituitary adenoma that leads to acromegaly or gigantism

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18
Q

sx somatotroph adenoma

A

DM or glucose intolerance
enlargement of soft tissues, cartilage, bone –> increased ring size, shoe, hat size

HTN
HA
bitemporal hemianopsia
colonic polyps

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19
Q

dx somatotroph adenoma

A

insulins-like growth factor (IGF-1) initial test - increased

confirmatory - oral glucose suppression test - failure of GH suppression within 1-2 hours of an oral glucose load

MRI imaging of choice

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20
Q

tx somatotroph adenoma

A

transsphenoidal surgery

octretodie or lanreotide first line medical - somatostatins inhibit GH release

dopamine agonists - bromocriptine or cabergoline - dopamine inhibits GH

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21
Q

corticotroph adenoma is also called

A

Cushing’s disease

22
Q

what is corticotroph adenoma

A

ACTH secreting pituitary adenoma that leads to hypercortisolism

23
Q

sx corticotroph adenoma

A

proximal muscle weakness
weight gain
HA
oligomenorrhea
erectile dysfunction
polyuria
osteoporosis
mental disturbance

24
Q

what distinguishes Cushing’s disease from other causes of crushing’s syndrome

A

increased baseline ACTH + suppression of cortisol ion high-dose dexamethasone suppression test = Cushing’s disease

25
Q

tx corticotroph adenoma

A

transsphenoidal resection of the pituitary tumor

26
Q

meds that cause iatrogenic hypothyrodism

A

amiodarone
interferon alfa
lithium
Propylthiouracil and methimazole

27
Q

what characterizes subclinical hypothyroidism

A

isolated increased TSH - give levo if TTSH 10 mIU/L or higher
normal free T4

28
Q

dx hypothyroidism

A

increased TSH + decreased free T4 or T3

positive antithyroid peroxidase and/or anti-thyroglobulin antibodies

bx - lymphocytic infiltration w germinal centers and hurthle cells (enlarged epithelial cells w abundant eosinophilic granular cytoplasm)

29
Q

how often should you monitor TSH after starting levo

A

every 6 weeks when initiating or changing dose

30
Q

ADE levo

A

cardiovascular effects w overshoot - A fib
osteoporosis

31
Q

what is euthyroid sick syndrome

A

abnormal thyroid function tests in patients w normal thyroid function

most commonly seen w severe non-thyroidal illness (sepsis, cardiac, malignancies)

low T3 syndrome - decreased free T3 and increased reverse T3 most common

tx and management of underlying dz

32
Q

what is subacute thyroiditis

A

inflammation of the thyroid gland characterized by neck pain, a tender diffuse goiter, and transient thyrotoxicosis often occurring after a viral infection

33
Q

sx subacute thyroiditis

A

hyperthyroidism is usually initial presentation followed by euthyroidism then hypothyroidism then restoration of normal thyroid function

neck pain or discomfort + sore throat

URI sx - low grade fever, myalgias, malaise, fatigue, anorexia

34
Q

PE subacute thyroiditis

A

diffusely tender goiter

35
Q

dx subacute thyroiditis

A

high ESR + negative antibodies

hyperthyroid profile early in disease

36
Q

tx subacute thyroiditis

A

supportive

NSAIDS or aspirin for pain and inflammation

37
Q

what is suppurative thyroiditis

A

bacterial infection of the thyroid gland by gram-positive bacteria (staph aureus MC) or gram-negative

38
Q

sx suppurative thyroiditis

A

thyroid pain and tenderness - sudden onset; may have overlying erythema

fever, chills, pharyngitis

39
Q

dx suppurative thyroiditis

A

leukocytosis and increased ESR

thyroid function tests usually normal

fine needle aspiration w gram stain and culture

thyroid US

40
Q

tx suppurative thyroiditis

A

abx
surgical drainage if fluctuant

41
Q

what is graves disease

A

autoimmune dz which primarily affects the thyroid gland, characterized by hyperthyroidism due to an increase in synthesis and release of thyroid hormones due to thyroid stimulating autoantibodies

42
Q

what is MC cause of hyperthyroidism in US

A

graves

43
Q

dx graves disease

A

decreased TSH + increased free T4 or T3

thyroid stimulating immunoglobulins (TSH receptor antibodies) hallmark

radioactive uptake scan - increased iodine uptake

44
Q

what is the MC type of thyroid CA

A

papillary thyroid carcinoma

45
Q

risk factors for papillary thyroid carcinoma

A

ionizing radiation exposure of head and neck - esp in childhood

increase age

46
Q

fine needle aspiration papillary thyroid carcinoma

A

the 2 hallmark morphological features of conventional PTC are the papillae and nuclear findings.

neoplastic epithelial lining and cells organized into papillary fingers. nuclear grooves, ground glass/empty nuclei (orphan Annie nuclei) and the presence of psammoma bodies (calcifications)

47
Q

tx papillary thyroid carcinoma

A

thyroidectomy usually followed by post levothyroxine

48
Q

what is the least aggressive type of thyroid CA

A

papillary thyroid carcinoma

49
Q

important things about follicular thyroid CA

A

generally more aggressive than papillary but also slow-growing

distant METS are more common than local METS - lung most common ; think follicular = FAR

50
Q

how does follicular thyroid carcinoma present

A

single asx painless thyroid nodule with or without thyroid gland enlargement

51
Q

tx follicular thyroid carcinoma

A

thyroidectomy followed by postop levo

52
Q
A

Internal Med EOR (17 decks)

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