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DIT Step 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What causes increase of TBG? Decrease?

A

more with preggers and OCP. So more T4 is made to keep T4

Free T3/T4 are normal even in hepatic failure

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2
Q

Toxic adenoma or toxic multinodular goiter shows what on scan? Tx?

A

Increased thyroid uptake. Tx by thionamides again or radioactive iodine or resection

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3
Q

Tx of subacute thyroiditis?

A

Supportive. NSAIDs and bta blocker if needed for symptoms. IT IS TRANSIENT

Beta blockers can help with hyperthyroid symptoms

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4
Q

Amiodorone can do what to thyroid?

A

Hperthryroid. Check TFT, LFT and PFTs with it

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5
Q

Tx of thyroid storm?

A

Beta blockers
Thionamides
IV sodium iodid
Glucocorticoids reduce T4-T3 transition!!!

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6
Q

If you had to chose how to treat Graves, what would you do?

A

radioctive iodine

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7
Q

What is silent thyroiditis?

A

Temporary painless goiter with hyperthroiditis. IT IS SELF LIMITED

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8
Q

Most common cause of hypothyroid?

A

Hashimoto

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9
Q

What do you ee on biopsy of hashiomtos?

Tx of it

A

Lymphocytic infiltrates and fibrosis

Tx with levo forever

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10
Q

Cretinism scan?

A

Decreased uptake. IT is too late to save it, so Tx is TO THYROID REPLACEMENT

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11
Q

Subacute thyroiditis is what

A

De Quarvain from viral stuff

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12
Q

First step to palpable thyroid?

A

TSH, Free T4, US to look for others

If hyperthyroid, do radioactive scan. If hot, treat as hyperthyroid.

IF COLD or anything euthyroid or hyperthyroid, do FNA

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13
Q

Do thyroid cancers make excess thyroid?

A

NOOOOO SO IF SCAN IS HOT, it is not cancer!!

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14
Q

What is a toxic adenoma?

A

Noninvasive! not cancer. Hot ndule is seen

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15
Q

What if FNA is benign thyroid nodule?

A

Repeat workup in a year to make sure not growing, if it did, repeat FNA

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16
Q

Most common cancer?

A

Papillary. Follicular variant can be invasive, but rare

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17
Q

MEdullary thyroid carcinoma release what?

A

PArafolilcular cells. Associated with MEN

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18
Q

Malignant thyroid tx?

A

Surgical resection followed by radioidone ablation!

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19
Q

Hypothyroidism can lead to high ldl and total cholesterol!

A

OH OK Right Brain Bonus

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20
Q

what does PTH tell kidney to do?

A

More calcium reasorption, less phosphate reabsorption

More 25-OH to be made to 1,25 OH vit D

Vit D helps reabsorb phosphate

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21
Q

Rickets X ray shows what?

A

Bowing at the knees, legs bent out sideways

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22
Q

Symptoms with hypercalcemia:

A

Bones Stones Mones and Psych overtones

Groans is constipation, N/V, ulcers (gastrin b/c high calcium), PANCREATITIS

Psych is lethargy, depression psychosis….

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23
Q

Treatment of secondary hyperparathyroidism

A

Limit oral phosphate, Phosphate binders with meals: CaCO3, or calcium acetate

If you limit phosphatemia, then there is less bone resorption!

Calcitriol helps reduce PTH secretion

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24
Q

Tx of hypoparathyroidism? It makes sense dude

A

Calcitriol (1,25 D3) b/c kidney can’t make this!

Calcium

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25
Q

What is Albright’s hereditary osteodystrophy? What does it look like?

A

From pseudohypoparathyroidism

Autosomal dominant with maternal imprinting (if from mom, they will have it!!, if from dad only partial)

findings: short, short 4th metacarpal, developmental delay, OBESITY

Tx: Calcium, Vit D Calcitriol

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26
Q

What is cinacalcet?

A

Mimics calcium so PTH is lowered!

27
Q

Vit D deficiency does what to labs for Ca PTH and phosphate?

A

Low Ca, High PTH, low Phosphate

28
Q

Cabergoline?

A

DA agonist used for prolactinoma is the better one

29
Q

Tx of prolactinoma?

A

Cabergoline then promo, if those don’t work, then surgery

30
Q

Dx of acromegaly?

A

IGF1 is more consistent.

Do oral glucose suppression test, then measure GH at 1 and 2 horus, if stays high, it is ACROMEGALY

Do pituitary MRI after that!!

31
Q

Major complication of acromegaly?

A

HTN/DM can lead to cardiac failure. Also can have spinal cord compression

INSULIN RESISTANCE WITH IT!

32
Q

Tx for acromegaly?

A

Surgery, if not successful, use somatostatin analog

Octreotide or lanreotide (inhibits GH secretion)

Can follow ILGF to see if it works

if no working, try cabergoline

PEGVISOMANT is if all that fails which is GH antagonist

33
Q

Sheehan syndrome is what?

A

postpartum hemorhage with blood lose causing infarct of pituitary.

Lethargy, no lactation after delivery

No menses
May have fatigue, anorexia, weight loss

34
Q

Empty sella is what?

A

It is empty on MRI, screen hormones. Often still functional hormones crunched up on there

35
Q

Tx of hypopituitarism?

A

Replace deficient hormones

GH in children
Hypogonadism give test or est maybe
Pulstaile GnRH can help for preggers
Hypothyrodism give Levo
ACTH give cortisol!!!
36
Q

Most common presentation in prolactinoma?

A

Hypogocnadism

37
Q

Cushing complications

A

CV, dm, HTN, thromboembolic, infection, osteoporosis, avascular necrosis of hip

38
Q

Dx of cushing

A

24 urinary cortisol. Late night salivary

Dex suppression test

39
Q

Dexamethasone suprresion test

A

1 mg at night, if it lowers cortisol next morning, then pituitary was lowered an not due to intrinsic cause

If still high, try high dose and see if that lowers it and if cortisol is suppressed, it is pituitary, if not check ACTH. If high, it is ACTH making tumor (like small cell), if not, it is a adrenal tumor

40
Q

Corticotrophin pituitary tumor tx?

A

Surgical removal and if not successful, do tradition

CONSIDER MIGHT NEED CORTISOL THEREPY LATER ON!

41
Q

Conn syndrome is what?

A

Hyperaldosteronism.

Primary is from adrenal tumor

42
Q

HTN, Hypokalemia and metabolic alkalosis?

A

Conn syndrome!

43
Q

Secondary hyperaldosteronism is from what?

A

Secondary from increased activity of RAAS (renin and ACE action making more ang II).

Kidneys think low blood pressure, so renal artery stenosis, Left sided CHF, Nephrotic syndrome, Cirrhosis (less intravascular volume in the latter 2)

44
Q

What does aldosterone to renin ratio tell you?

A

Conn syndrome (primary) is high aldosterone, low renin

Secondary is high aldosterone: high renin

45
Q

PAC: PRA high is what?

A

Primary hyperaldosteronism

Plasma aldosterone concentration: Plasma renin activity

46
Q

PAC low and PRA low?

A

Means stimulation of aldosterone receptor, consider cortisol or something like that!

Or lots of licorice (think people eating it from another country)

47
Q

Tx of hyperaldosteronism?

A

Treat underlying cause, or surgery or spironolactone until definitive tx is done

48
Q

Where is DHEAS made?

A

Only in adrenals

49
Q

Tertiary adrenal insufficiency is what? From what?

A

Hypothalumus not making CRH. From chronic corticosteroid use

50
Q

Increased skin pigmentation and hypotensive?

Easy to remember

A

Addisons.. primary. Autoimmune

EASY TO REMEMBER b/c POMC released and broken into ACTH and MSH (melanocyte stim hormone). So high ACTH and high MSH SO YHOU GET TAN

51
Q

Eosinophilia sometimes happens with what adrenal issue?

A

Hypoaldosteronism

52
Q

What is cosyntropin?

A

ACTH analog to stim aldosterone to determine if primary or not. WAS ON Q BANK

53
Q

Adrenal insufficiency treatment

A

Glucocorticoids, mineralocotricoids (fludrocortisone)

Extra cortisol during stress (illness or MI or surgery or whatever(

54
Q

Addisonian crisis is what?

A

history of adrenal insufficiency and SEVERE weakness fever, mental status change vascular collapse.

Get it b/c not met cortisol need during stress

Tx: glucose, hydrocortisone, can use vasopressors if in shock

55
Q

Mnemonic for CAH defficiencies?

A

If starts with a 1 it causes hypertension

If ends in a one, you have virilization

56
Q

17 alpha hydroxylase symptoms

Tx?

A

HTN, no sex hormones (does not end in a 1)

Ambiguous genitalia in boys

Amenorrhea in girls

Tx with cortisone to suppress ACTH

57
Q

21 alph hydroxylase deficiency

A

No htn (Actually you have hypotension). SALT WASTING

Women have virilization (ends in 1) and female infants ambiguous genitalia

Boys can have precocious puberty

Dehydration and HYPOTENSION possible

Low Na and increased K+ with increased androgen

58
Q

11 beta hydroxylase deficiency

A

Virilization, Hypertension

EXCESS deoxycorticosterone (has mineralocorticoid activity)

59
Q

Newborn ambiguous genitalia?

A

Check serum potassium to treat quickly.

Treat with cortisol replacement!!!

60
Q

Palpitations, chest pain, diaphoresis, headache?

A

PHEO

61
Q

Pheo dx?

A

24 hour urine catecholamines: metanephrine, normetanephrine, VMA

62
Q

Pheo tx?

A

Alpha blocker first, then beta blocker

PHENOXYBENZAMINE or PHENTOLAMINE first, then can give beta blockers

carvedilol or labetalol have weak alpha blocking affects

63
Q

MEN mnemonic. RET proto oncogene THINK MEN 2a and 2B

A

MEN 1 PPP (diamond)
Parathyroid
Pituitary
Pancreas

MEN 2A PPM (square)
Parathyroid
Pheo
Medullary

MEN 2B PMM (triangle)
Pheo
Medulary
Mucosal neuroma

64
Q

If you see ret, you think what?

A

MEN2a and MEN2b

DIT Step 2 (77 decks)

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