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CB Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the most common cause of hypothyroidism?

A

Hashimoto thyroiditis

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2
Q

What are the lab findings in Hashimoto thyroiditis?

A

High TSH, low T4, antibodies to thyroid peroxidase (TPO)

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3
Q

Exophthalmos, pretibial myxoedema, and low TSH describes what disease?

A

Graves disease

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4
Q

What is the most common cause of Cushing syndrome?

A

Iatrogenic corticosteroid administration (Cushing Disease is the second most common)

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5
Q

A patient post-thyroidectomy presents with signs of hypocalcemia, increased phosphorus. Why?

A

Hypoparathyroidism (iatrogenic)

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6
Q

“Stones, bones, groans, psychiatric overtones” are signs and symptoms of what?

A

Hypercalcemia

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7
Q

Hypertension, hypokalemia, and metabolic alkalosis are signs of what?

A

Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)

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8
Q

A patient presents with: tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

A

Pheochromocytoma

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9
Q

What is first line for treating pheochromocytoma, alpha- or beta-antagonists?

A

ALPHA-antagonist (phenoxybenzamine)

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10
Q

A patient with a history of lithium use presents with copious amounts of dilute urine.

A

Nephrogenic diabetes insipidus (DI)

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11
Q

What is the treatment for central DI?

A

Administration of DDAVP and free-water restriction

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12
Q

A postop patient with significant pain presents with: hyponatremia and normal volume status.

A

SIADH due to stress

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13
Q

What anti diabetic agent is associated with lactic acidosis?

A

Metformin

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14
Q

A patient presents with: weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show: hyponatremia and hyperkalemia. What is the diagnosis, and what is the treatment?

A

Primary adrenal insufficiency (Addison Disease)

Treatment: glucocorticoids, mineralocorticoids, and IV fluids

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15
Q

What is the HBA1C goal for patients with DM?

A

<7.0 %

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16
Q

What is the treatment for DKA?

How do you monitor response to treatment?

A

Fluids, insulin, electrolyte replacement (potassium, phosphorus)
Bicarb rarely used unless pH < 6.9
Treat initiating event

Monitor response to treatment by closure of anion gap

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17
Q

What condition presents with: bone pain, hearing loss, and increased alkaline phosphatase?

A

Paget disease

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18
Q

Increased IGF-1

A

Acromegaly

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19
Q

What lesion creates: galactorrhea, amenorrhea, biltemporal hemianopsia?

A

Prolactinoma

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20
Q

What presents with: increased serum 17-hydroxyprogesterone?

A

Congenital adrenal hyperplasia (21-hydroxylase deficiency)

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21
Q

Triad of: pancreas, pituitary, parathyroid tumors

A

MEN1 syndrome

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22
Q

What are the typical lab findings in DKA?

A 
High serum glucose
Metabolic acidosis
Increased urine and serum ketones
High anion gap
Normal serum osmolality
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23
Q

What are the typical lab findings in HHS?

A 
Very high serum glucose 
No acidosis 
No ketons
Normal anion gap
High serum osmolality
24
Q

What is the treatment for HHS?

A

Aggressive fluids, electrolyte replacement, insulin

Treat initiating event

25
Q

What is the criteria for metabolic syndrome?

A 
"WEIGHHT" (3/5 = Dx)
Waist Expanded
Impaired Glucose
HTN 
HDL (low)
Triglycerides (high)
26
Q

What is the difference between hyperthyroidism and thyrotoxicosis?

A

Hyperthyroidism: a state of increased synthesis of T3/T4

Thyrotoxicosis: a site of increased levels of T3/4

Note: Graves Disease is the autoimmune form of hyperthyroidism, caused by thyroid stimulating antibodies increasing synthesis of T3/T4

27
Q

What is the acute, life-threatening form of thyrotoxicosis, that may present with: AFib, fever, delirium?

What is the treatment?

A

Thyroid Storm

Treatment: antithyroid drugs (methimazole, propylthiouracil), then iodine, IV esmolol, steroids, admit to ICU

28
Q

What condition causes: severe hypothyroidism, decreased mental status, hypothermia, hypotension, bradycardia, hypoventilation?

What is the treatment?

A

Myxoedema coma

Treatment: admit to ICU, treat urgently with IV levothyroxine, IV hydrocortisone (if adrenal insufficiency has not been excluded)

29
Q

Is sub-acute thyroiditis painful?

A

Yes!

Presents with a tender thyroid (all other forms associated with painless goiter)

30
Q

Are HYPERfunctioning (“hot”) thyroid nodules malignant?

A

No

31
Q

What is the most common form of thyroid carcinoma?

A

Papillary

75-80%

32
Q

What are the features of papillary thyroid carcinoma?

A

“Most Popular is Papillary”

Papillae (branching)
Palpable lymph nodes 
"Pupil" nuclei (Orphan Annie nuclei)
Psammoma bodies within lesion 
Postive Prognosis
33
Q

What blood level should you check if you suspect Medullary thyroid carcinoma?

A

Calcitonin Levels

34
Q

What are the four main types of thyroid carcinoma?

A
  1. Papillary (lymphatic spread)
  2. Follicular (hematologic spread)
  3. Medullary (consider MEN2A, 2B)
  4. Anaplastic (BAD)
35
Q

What is the most common cause of fractures in thin, elderly women?

A

Osteoporosis

36
Q

What is caused by a mineralization defect often due to severe Vit D deficiency?
It presents with bone pain, decreased calcium/phosporus, and secondary hyperparathyroidism.

A

OsteoMALACIA (not osteoporosis)

Osteoporosis will have normal calcium, phosphate, parathyroid hormone levels

37
Q

What condition causes a “mosaic” lamellar bone pattern on x-ray?

A

Paget Disease

38
Q

What bone disease causes increased serum Alk Phos with normal calcium and phosphate levels?

A

Paget’s Disease

Note: if increased alk phase, but normal GGT, think BONE etiology, not liver etiology

39
Q

Hyperparathyroidism due to:

a single hyper functioning adenoma (80%), parathyroid hyperplasia (15%), parathyroid carcinoma (5%)

A

Primary hyperparathyroidism

high PTH, high calcium, low PO4

40
Q 
Hyperparathyroidism due to: 
renal insufficiency (due to decreased production of 1-25 dihydroxyvitamin D), calcium deficiency, or Vit D deficiency
A

Secondary hyperparathyroidism

high PTH, low calcium, high PO4 if renal failure

41
Q

Hyperparathyroidism due to:
dialysis (seen in patients with long-standing secondary hyperparathyroidism that leads to hyperplasia of parathyroid glands)

A

Tertiary hyperparathyroidism

high PTH, high calcium, high PO4

42
Q

What is the treatment for acute hypercalcemia?

A

IV fluids ++++
Loop diuretics (lasix)
IV Bisphosphonates

43
Q

How does cortisol secretion respond to the dexamethasone test in patients with Cushing Disease?

A

Cortisol section remains elected with the low-dose (1mg) dexamethasone test, but is suppressed with the high-dose (8 mg) dexamethasone test.

44
Q

What hormone disturbance causes the inability to concentrate urine in Diabetes Insipidus?

A

ADH

Central DI (ADH deficiency) 
Nephrogenic DI (ADH resistance)
45
Q

What causes euvolemic hyponatremia ia SIADH?

A

Persistent ADH release independent of serum osmolality

46
Q

What is the cornerstone of SIADH treatment?

A

Fluid restriction

47
Q

What is the difference between primary Adrenal Insufficiency and secondary/tertiary Adrenal Insufficiency?

A

Primary (Addison Disease)
Increased skin pigmentation (due to increased ACTH), decreased glucocorticoids, decreased mineralcoritocids
- Need both glucocorticoid and mineralocorticoid replacement

Secondary/Tertiary
Decreased glucocorticoids (low ACTH, no skin hyper pigmentation)
- Only need glucocorticoid replacement

48
Q

What is the Pheochromocytoma rule of 10s?

A 
10% extra-adrenal
10% bilateral
10% malignant
10% occur in kids
10% familial
49
Q

What are the 5 Ps of Pheochromocytoma?

A 
Pressure (BP)
Pain (headache)
Perspiration 
Palpitations
Pallor
50
Q

What is Conn Syndrome?

A

Hyperaldosteronism, excessive secretion of aldosterone from zona glomerulosa of adrenal cortex, due to unilateral adrenal adenoma

51
Q

What is the most common cause of congenital adrenal hyperplasia?

A

21-hydroxylase deficiency

inherited enzyme defect that impairs cortisol synthesis and results in accumulation of cortisol precursors

52
Q

What lab test is diagnostic of 21-hydrozylase deficiency causing congenital adrenal hyperplasia?

A

Elevated serum 17-hydroxyprogesterone level

53
Q

MEN 1 (3Ps)

MEN 2A (2Ps)

MEN 2B (1P)

A

MEN 1: Pituitary, parathyroid, pancreas

MEN2A: Parathyroids, pheochromocytoma

MEN2B: Pheochromocytoma

54
Q

What MEN syndromes are associated with medullary thyroid carcinoma?

A

MEN 2A, 2B

55
Q

What mutation causes MEN2A,B?

A

RET proto-oncogene

CB Internal Medicine (12 decks)

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