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Step 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid nodules - work up?

A

GET and US, uptake. - Changes of benign are much higher than CA

But if irregular or cold nodule -> biopsy.

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2
Q

Thyroid

Follicular adenoma

v
Follicluar CA

A

Adenoma - capsule w/o invasioan. FNA CANT distinguish

AdenoCA - Invades capsule - hematogenous spread (RCC, HCC, ChorioCA, Follicular A)

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3
Q

Thyroid CA

Papillary
Medullary
Anaplastic

A

Papilalry - 80% of CA - Orphan annie , nuclear groove, Responds to radiation, excellent prognosis

Medullary - Parafollicular C cells - INC calcitonin (HypoCalcemia)-> amyloid stroma . MEN , ->

Anaplastic - highly malgiant - elderly

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4
Q

hyperparathyroism lab findings -

- - lab findings and urinary findings  
Primary HyperPara (aka?)

Familial hypoCalciuric, HypoCalcemia

A

HyperCa, INC urinary cAMP, INC ALK PHOSPH (from osteobalsts because they activate ostoeclasts)

Primary - Osteitis Fibrosa cystica - INC PTH, INC Ca, Ca/Cr >0.02 (hyperCa keeps spilling Calcemia in urine)

Familial - INC PTH, INC Ca, Ca/Cr

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5
Q

Pseduohypoparathyroidism

\

A

PTH resistance.

DINC PTH, but DEC Ca.

AD - short stature, 4/5 digiti problem.

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6
Q

Primary hyperparathyroidism - recommended tx? In whom?

A

Tx surgery if younger than 50. Even if asx.

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7
Q

Findings in malignancy related PTHrP release?

A

INC Ca,

Normal 25 oh

DEC 1,25OH!

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8
Q

Adrenal insufficiency causes?

dx?

A

TB (bilat calcifications), Autoimmune, Lung CA, fungal, CMV

Dx - Cosyntropin (ACTH analogue)

Fails to INC Ca

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9
Q

Addisons lab findings, acid base findings? Clinical findings

A

HypoNa, HyperK.

Non anion gap METABOLIC ACIDOSIS

Hyperpigmentation

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10
Q

Primary Aldo/Conns - what lab findings to check?

What can accentuate findings?

Tx

A

Aldo/renin > 20 . HTN, HypoK. (especially brought out with diuretic use !

Single adrenal - surgery
Double trouble - spirnololactone, eplerenone

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11
Q

DHEAS produced by?

A

Adrenals only

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12
Q

HyperNatremia tx (in dry pt)

A

Severe - NS

Once euvolemic - 1/2NS +D5

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13
Q

Presentation, lab findings

Central DI

Nephrogenic DI

A

Central - HyperNa, DIlute urine, impaired thirst.
water depreveation does NOT INC urine osm. Tx - DDAVP.

Nephrogenic- May be euNa due to intact thirst. May be HyperNa, No responset o DDAVP. Tx -NORMAL SALINE. Once euvolemic, can switch to D5 / (1/2 ns?)

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14
Q

SIADH

A

Free water restriction, Salt Tab, Hypertonic Saline.

Demeclocycline, vaptans.

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15
Q

Glycemic control in DM2 - waht does it do for the pt?

A

DEC microvascular complications - retinopathy, nephropathy

Does not change macro - MI, stroke, death

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16
Q

Ulcers tx algorithm

A

Offload, -> debride -> wound dressing - >abx -> revasc - > amputate

Dont need to use Abx until deep ulcer w/ cellulitis

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17
Q

Best way to test for DM neuropathy?

A

Monofilament test -

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18
Q

Retinopathy - findings - tx?

A

cotton wool, microaneurysm, ehmorrhage,s exudate, edema - tx argon laser

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19
Q

DKA tx -

A

Regular insulin + K + NS - Change to D5, 1/2NS when glucsse is 200-250.

20
Q

Insulinoma - clinical and lab findigns

Glucagonoma

A

Insulinoma - Hyperglycemia w/ AMS - resovles w/ glucose. INC insulin AND c peptide

Glucagonoma - DM in skinny - controleld w/ oral meds and diet. Necrolytic migrans erythem a

21
Q

Somatostatinoma presentation

A

Achlorhydria, Cholelithiasis, steatorrhea (block CCK)

22
Q

HyperT causes - x4

Graves
Multinodular Goiter
factitious

(DeQuervains Granulomatous Thyroiditis)

A

Graves - IgG to TSH. RadioI tx is preferred, but can worsen opthalmopathy. Highest risk of hypoT due to global shut down. Afib -> propanlol

Multinodular goiter - Can be from Iodine deficient. Euthyroid. If it becomes TSH independent -> toxic goiter.

Factitious - INC T3,4 w/ DEC TSH. Also LOW THYROGLOBULIN

Granulomatous Dequervains - hypo and hyper. After viral. Tender. SELF LIMITED.

23
Q

Hypo T - histo? Concerns?

Hashi

Reidels Fibrosing

A

Hashin - Anti T peroidase, Tg, MICROSOMAL. - Germinal Center and Hurthle cells - INC risk of B cell lmyphma

Reidel - Young female, hard. Chronic Inflam. ? Anaplastic if older.

24
Q

Thyeroi myopathy - presentation and differnetiation from polymyositis and steroid induced

A

hypo and hyper , INC CK, slow or fast reflexes

This is how you can differentiate from steroidf and polym oysitis. REFLEXES

25
Q

Sick Euthyroid. Lab findings?

A

Normal function. But T3,4 is lower. Due to DEC peripheral conversion.

26
Q

Acromegaly - Dx? Concerns?

A

Dx - IGF1 test - If INC, then do a glucose tolerance test - > MRI

CV death

27
Q

Mech and tox

Sulfonylurea

Metformin

Glitazone/TZD

DPP4 (sitagliptain)

GLP-1 - exenatide

A

Sulfonyurea - INC endogenosu release - hypoG.
Tolbutamide and chlorpropamide and have disulfiram like reactio. Glyburidie, glipizide, glimepiride less os

Metformin - DEC gluconeogensis -> lactic acidosis. Dont give in Renal pt

Glitazone - INC insulin sensitivity - Hepatotox (LFT), may INC HF

Sitagliptain DDP4 - nothign

GLP1 - exenatide (weight loss, but PANCREATITIS
(gulp… weight loss but pancreatitis)(

28
Q

Thyroid strom - presentation? triggers?

A

Lid lag, HTN, arrhythmias, Febrile, AMS

Can be triggered by - Surgery, Trauma, Infection, Iodine, Child birth

DONT confuse w/ malig HTN

29
Q

SIADH - urine osm and urine Na?

A

has HIGH URINE SODIUM with High Urin osmolality!

30
Q

Thyroid affect on reflexes

A

Hypo – slow, HyperT – fast

31
Q

Initial gout attac – tx?

A

Lifestyle : Alcohol cessation + weight loss&raquo_space;> low protein/diet changes.

32
Q

In panhypopit - what to replace first?

A

Replace cortisone before thyroxine

33
Q

Tx of subacute thyroiditis?

A

Aspirin

34
Q

Pt w/ thyroid nodule

Workup algorithm?

A

TSH -> Free T4 –> Biopsy if >1cm`

35
Q

Acute tx of hyperCa?

A

Hydrate

Calcitonin! (FAST ACTION - inhibits osteoclasts - much faster than bisphosphnates, which take days to work)

36
Q

How does low albumin affect Ca?

A

Lowers total level of Calcium.

But the free level of calcium is normal, hence no symptoms.

37
Q

When do you see Chvostek sign?

A

Hypocalcemia - after accidnetly taking out all parathyroids, you get DEC Ca.

38
Q

EKG findings in

HypoCa

HyperCa

A

HypoCa - prolongs QTc, which si why you get torsades.

HyperCa - shortens QTc

39
Q

Best initial test for ohypercortisolism?

A

24 hr urine coritosl.

If not available, then 1mg overnight dexamethasone suppression test.

40
Q

Evaluating adrenal incidentaloma? alrogirth?

A

Metanephrines
Renin/aldo levels
1mg overnight dexamethasone suppression.

41
Q

Pheo- Best initial test, best confirmatory test?

If positive findings, what scans?

A

Initial - Free metanephrines in plsama

Confirmatory - 24 urine metanephrines

Imaging w/ Ct/MRI AFTER!!! BIOCHEM

Or MIBG scanning - if outside of adrenal gland

42
Q

All diabetics should receive which health implemetnations/drugs?

A 
Aspirin
ACEi/ARB (bp >140)
Statin until LDL 100 or less
Pneumococcal vaccine
Yearly eye exam, 
Yearly screen for MICROALBNINURIA (also reason to start ACEi/ARB regardless of BP) 
Foot exam for neuroapthy, ulcers
43
Q

Oral estrogens affect on levothyroxine –

A

Oral estrogens INC TBG, thus need to INC levo to saturate TBG sites.

44
Q

Test for Addisons vs Cushings?

A

Addisosn cosyntropin/basal early morning cortisol. Cushings – 24 hr free cortisol and low dose dex suppression test.

45
Q

HTN and hypoK what to do first?

A

Aldo/renin . It is the initial screen for primar yhyperaldo. Adrenal suppression confirms.

46
Q

Hyperthyroid with globally DEC radioiodine. Not taking exogenous. What is this?

A

THYROIDITIS.

Primary Hyperthyroid (INC T4, DEC TSH) with DEC radioactive iodine uptake – other causes subacute granulomatous thyroiditis, iodine induced thyrotoxicosis.

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