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- Med School Review 🔥 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Calcium levels during prolonged immobilization

A

Elevated

(due to increased osteoclastic bone resorption)

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2
Q

Immobilization can cause ____ due to increased osteoclastic bone resorption

A

Hypercalcemia

(Tx: Bisphosphonates)

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3
Q

Inhibit osteoclastic resorption, reducing bone loss

A

Bisphosphonates

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4
Q

Proximal myopathy in Cushing syndrome (hypercortisolism) is due to

A

Muscle atrophy

(from direct catabolic effects of cortisol on skeletal muscle)

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5
Q

___ in transfused blood binds ionized calcium

A

Citrate

(causes symptomatic hypocalcemia by affecting ionized calcium only)

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6
Q

Calcium after high-volume blood transfusion

A

Hypocalcemia

due to citrate-chelation of ionized calcium

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7
Q

Magnesium abnormality in hyperreflexia

A

Hypomagnesemia

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8
Q

Young woman with new-onset absence of menses, next step

A

Secondary amenorrhea w/u:

  • Pregnancy Test (beta-hCG)
  • Prolactin, TSH, FSH to test for most common causes of secondary amenorrhea
    • Hyperprolactinemia
    • Thyroid dysfunction
    • Premature ovarian failure (early menopause)
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9
Q

Hyperandrogenism presenting in non-obese adolescent

A

CAH: 21-hydroxylase deficiency

(elevated 17-hydroxyprogesterone)

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10
Q

Estrogen/Pregnancy & Thyroid Function

A

Estrogen increases TBG, necessitating increased endogenous thyroid production or increased levothyroxine dosing requirements in hypothyroid pts to achieve same level of free T4.

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11
Q

Prolonged glucocorticoid therapy can lead to

A

Central adrenal insufficiency (low [suppressed] ACTH secretion, low cortisol, normal aldosterone due to regulation by RAAS, not HPA axis)

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12
Q

Best markers to track resolution of DKA

A

Serum anion gap or beta-hydroxybutyrate levels

AG estimates unmeasured anion concentration in blood & returns to nml w/ disappearance of ketoacid anions

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13
Q

Enlarged hands and feet

A

Acromegaly

(excessive GH secretion from pituitary somatotroph adenoma)

  • +Coarsening facial features
  • +OSA
  • +Concentric LVH
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14
Q

Leading cause of death in acromegaly pts

A

Cardiovascular disease

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15
Q

Ease of bruising + hyperglycemia

A

Think Cushing syndrome

(hypercortisolism)

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16
Q

HTN + Hypokalemia vs. Hypotension + Hyperkalemia

A

Primary Hyperaldosteronism vs. Primary Adrenal Insufficiency (Addison Disease) respectively

  • Hyperaldo → HTN, Na+ reabsorption, K+ loss
  • PAI → Low aldosterone: Decreased Na+ reabsorption, increased K+
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17
Q

Hyperglycemia in Cushing is due to

A

Hypercortisolism-induced gluconeogenesis (physiological stress response)

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18
Q

Hypernatremia + increased serum Osm

A

Diabetes Insipidus

(central vs. nephrogenic): Too low ADH

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19
Q

Necrotic migratory erythema rash (w/ central clearing in thighs)

A

Glucagonoma

(+ hyperglycemia)

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20
Q

Predisposition in pts with Hashimoto

A

Thyroid lymphoma

(presents w/ rapidly progressive thyroid enlargement)

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21
Q

Wt gain, psychiatric sx, hirsutism, HTN, hyperglycemia

A

Hypercortisolism

(Cushing syndrome)

  • Dx: Low THen High
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22
Q

Most common cause of primary adrenal insufficiency in developed countries

A

Autoimmune adrenalitis

(Addison disease)

  • Associated w/ other autoimmune diseases, e.g. Hashimoto Thyroiditis
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23
Q

Plaques w/ central clearing & blistering; crusting & scaling at borders

A

Necrolytic migratory erythema

(Glucagonoma)

  • Usually in the thighs
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24
Q

Pancreatic tumor w/ elevated glucagon levels (>500)

A

Glucagonoma

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25
Q

5-HIAA

A

Carcinoid syndrome diagnosis

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26
Q

Anti-Glutamic Acid Decarboxylase Antibody

(Anti-GAD65)

A

Serum marker for T1DM predisposition

(pancreatic islet autoantibodies)

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27
Q

Palliation of anorexia to improve appetite & wt gain in cancer-related anorexia/cachexia syndrome

A

Progesterone analogs

(Megestrol acetate or​ Medroxyprogesterone acetate)

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28
Q

Diabetic w/ low blood sugars after meals

A

Diabetic Gastroparesis

(give metoclopramide)

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29
Q

Diabetic w/ early satiety

A

Gastroparesis

(2/2 diabetic autonomic neuropathy of the GI tract)

  • Tx: Metoclopramide
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30
Q

Severe hyperglycemia (>1000) without acidosis

A

HHS

(Hyperosmolar Hyperglycemic State)

  • Tx: IVF (Normal Saline) + slow IV Insulin
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31
Q

Hypercalcemia + Lymphoma

A

Due to increased 1,25-VitD from extrarenal production

(also seen in sarcoidosis)

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32
Q

Parathyroid Hormone-related Protein

A

Think Cancer-related hypercalcemia

(mimics PTH):

  • SCC of lung, renal/bladder, or breast/ovarian cancer
  • Released by SCC of lung, causing Humoral Hypercalcemia of Malignancy
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33
Q

Severe, rapid-onset hypercalcemia + hypophosphatemia + smoker

A

Humoral Hypercalcemia of Malignancy

(SCC of the lung) due to release of parathyroid hormone-related protein (PTHrP) by tumor cells

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34
Q

Low T3, Normal T4, Normal TSH

A

Euthyroid sick syndrome

(usually in setting of acute, severe illness)

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35
Q

Riedel’s Thyroiditis

A

Fibrous thyroiditis

(Fibrosclerosis of thyroid causing hard goiter + hypothyroidism)

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36
Q

Euthyroid sick syndrome

A

“Low T3 syndrome”:

Decreased peripheral 5’-deiodination of T4 due to caloric deprivation in setting of acute, severe illness

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37
Q

Pt w/ fever + sore throat within 90d of starting antithyroid drugs (propylthiouracil or methimazole)

A

DISCONTINUE PTU or MMI and check WBCs (agranulocytosis is a feared but uncommon side effect)

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38
Q

Does primary hyperaldosterone cause peripheral edema?

A

Not significantly, due to aldosterone escape

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39
Q

Tx for BL adrenal hyperplasia

A

MRAs

(aldosterone antagonists): Spironolactone, Eplerenone

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40
Q

Recurrent pregnancy loss + thyroid disease

A

Antithyroid peroxidase antibodies

(Hashimoto Thyroiditis; Anti-TPO Abs)

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41
Q

Hyperpigmentation

A

think high ACTH

(Cushing vs. ectopic ACTH-producing tumor)

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42
Q

Easy bruising, myopathy, virilization, lanugo hair

A

Cushing syndrome

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43
Q

Dx of Primary Adrenal Insufficiency

A

ACTH Stimulation Test

(then cortisol and aldosterone measured)

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44
Q

Tx of Primary Adrenal Insufficiency

(Addison’s disease)

A

Cortisol, Aldosterone, and Testosterone

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45
Q

Cravings for salty foods, N/V, fatigue, dizziness, syncopal episodes, hypovolemia

A

Primary adrenal insufficiency

  • Low aldosterone - hyponatremia, hypovolemia, hyperkalemia
  • Low cortisol - Elevated ACTH, hyperpigmentation
  • Low adrenal-produced testosterone - decreased sex drive in women
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46
Q

Hyperpigmentation + fatigue + dizziness

A

Primary adrenal insufficiency

(elevated ACTH due to low adrenal production of cortisol)

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47
Q

Addisonian Crisis

A

Acute primary adrenal insufficiency

(injury, surgery, infection)

  • Sudden pain in back, abd, or legs
  • Dehydration from Vomiting, Diarrhea
  • Syncope from Low BP
  • Can be fatal
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48
Q

Waterhouse-Friderichsen Syndrome

A

Acute adrenal insufficiency when sudden increase in BP causes blood vessels in adrenal cortex to rupture —> ischemia, adrenal gland failure

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49
Q

Multiple gastric ulcers + dyspepsia

A

Gastrinoma

(ZES)

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50
Q

VIPoma

(pancreatic tail tumor) Tx

A
  • IVF (volume repletion)
  • Octreotide (for diarrhea)
  • Surgical resection
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51
Q

Watery diarrhea, hypokalemia, achlorhydria, facial flushing & pancreatic tail tumor

A

VIPoma

(Tx: Surgical)

*

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52
Q

HTN, hyperglycemia, weight gain, proximal muscle weakness

A

Cushing syndrome

(Hypercortisolism)

  • Exogenous glucocorticoid intake
  • SCLC (ectopic ACTH)
  • Pituitary adenoma (Cushing disease [ACTH-producing])
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53
Q

Galactorrhea + amenorrhea + vaginal dryness

A

Prolactinoma

(dryness due to prolactin inhibition of LH secretion)

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54
Q

Basal ganglia lesion

A

Parkinson disease

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55
Q

Difficulty combing hair

A

Proximal muscle weakness

  • Polymyositis/Dermatomyositis (normal DTRs)
  • Glucocorticoid use/Cushing disease
  • Hypothyroidism/Hyperthyroidism
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56
Q

MG/Lambert-Eaton syndrome Basal ganglia lesion

A

Parkinson disease

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57
Q

Effects of CKD on Ca, Phos, VitD

A

Inadequate phosphate excretion, decreased conversion to 1,25-hydroxyvitamin D

(Elevated Phos, Low Ca, Elevated PTH, Low active VitD)

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58
Q

Positive sx in diabetic neuropathy

(pain, paresthesias)

A

Small nerve fiber neuropathy

(early)

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59
Q

Negative sx in diabetic neuropathy

(sensory loss)

A

Large nerve fiber neuropathy

(late; leads to foot ulcers)

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60
Q

Anti-thyroid peroxidase antibodies

A

Hashimoto thyroiditis vs. Painless

(silent) thyroiditis

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61
Q

Tx for painless

(silent) thyroiditis

A

Self-limited

(BBs for symptoms)

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62
Q

RET proto-oncogene mutation

A

MEN2A or 2B

(MPP, MPM)

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63
Q

Neuroendocrine parafollicular C cell malignancy

A

Medullary thyroid cancer

(Calcitonin-producing tumor)

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64
Q

MEN1

A
  • Primary hyperParathyroidism
  • Pituitary tumors
  • Pancreatic tumors (or gastrinomas)
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65
Q

MEN2A

A
  • Medullary Thyroid Cancer (calcitonin)
  • Parathyroid hyperplasia
  • Pheochromocytoma
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66
Q

MEN2B

A
  • Medullary Thyroid Cancer (calcitonin)
  • Pheochromocytoma
  • Mucosal neuromas/Marfanoid habitus
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67
Q

Diuretics that increase calcium resorption

A

Thiazides

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68
Q

Polyuria, polydipsia, shortening of QT interval

A

Hypercalcemia

(symptomatic)

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69
Q

Symptomatic hypercalcemia and AKI from excessive calcium intake

A

Milk-Alkali Syndrome

(often seen in OTC-treated osteoporosis)

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70
Q

Thyroid storm is often triggered by

A
  • Surgery
  • Trauma
  • Infection
  • Iodine Contrast
  • Childbirth
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71
Q

Lid lag + normal reflexes

A

Hyperthyroidism

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72
Q

Lid lag + absent reflexes

A

Hypothyroidism

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73
Q

Malignant hyperthermia tx

A

Dantrolene

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74
Q

T cell activation and stimulation of orbital fibroblasts

A

Graves Ophthalmopathy

(TRAB-induced)

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75
Q

Autoantibodies against ACh receptors

A

Myasthenia Gravis

(on the motor endplate)

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76
Q

Increases sensitivity to catecholamines

A

Thyroid hormone

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77
Q

Acid/Base in hyperaldosteronism

A

Metabolic alkalosis

(due to aldosterone-induced H+ loss)

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78
Q

Increased aldosterone, decreased renin

A

Primary Hyperaldosteronism

(Presents w/ HTN + hypokalemia)

  • Aldosterone-producing tumor, or
  • BL adrenal hyperplasia
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79
Q

PCOS increases risk for

A

Metabolic syndrome

  • T2DM
  • HTN
  • Dyslipidemia
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80
Q

Dx of Carcinoid Syndrome

A

Elevated 24hr urinary 5-HIAA

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81
Q

Tx for Carcinoid Syndrome

A

Octreotide

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82
Q

Carcinoid cells cause increased production of serotonin from tryptophan, resulting in ____ deficiency

A

Niacin

(tryptophan is required for niacin synthesis) —> Pellagra (dermatitis, diarrhea, dementia)

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83
Q

At risk for autoimmune thyroid disease

(e.g. Graves)

A

T1DM

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84
Q

Marfanoid habitus + thyroid cancer

A

MEN2B

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85
Q

Defective formation of type 1 collagen

A

Osteogenesis imperfecta

86
Q

Low bone mass w/ normal mineralization

A

Osteoporosis

87
Q

Marker of bone formation

A

Alkaline phosphatase

88
Q

Symmetric pseudofractures (looser zones) on x-ray

A

Osteomalacia

(VitD deficiency)

89
Q

Hypophosphatemia > Hypocalcemia; Elevated PTH & alk phos

A

Vitamin D Deficiency

(Osteomalacia / Rickets)

90
Q

Follicular thyroid carcinoma vs. benign follicular adenomas

A

Invasion of tumor capsule and/or blood vessels

91
Q

Thyroid carcinoma that metastasizes via hematogenous spread to distant tissues (e.g. bone, lung)

A

Follicular thyroid carcinoma

(FTC)

92
Q

Thyroid tumor + elevated calcitonin

A

Medullary thyroid carcinoma

(secreted by parafollicular cells)

93
Q

Slow spreading thyroid cells with large cells w/ ground glass cytoplasm, pale nuclei w/ inclusion bodies and central grooving, and lamellated calcifications

A

Papillary thyroid cancer

94
Q

Psammoma bodies

A

Papillary thyroid cancer vs. Papillary breast carcinoma

95
Q

HTN + hypokalemia

A

Think hyperaldosteronism

(check Plasma aldosterone/renin ratio to differentiate primary vs. secondary vs. non-aldosterone causes)

96
Q

Progressively worsening proximal muscle weakness, ptosis, dry mouth

A

Lambert-Eaton syndrome

97
Q

Proximal muscle wasting

A

Cushing syndrome

(Dexamethasone suppression test)

98
Q

Episodic HA, sweating, palpitations + tachycardia

A

Pheochromocytoma

99
Q

Elevated IGF-1, next step?

A

Oral Glucose Suppression Test

(glucose should suppress GH secretion)

100
Q

Coarse facial features, arthralgias, uncontrolled HTN, hyperhidrosis, digit enlargement, carpal tunnel syndrome

A

Acromegaly

(excessive GH secretion 2/2 pituitary somatotroph adenoma) —> Check IGF-1 levels

101
Q

Acromegaly Dx

A

Elevated IGF-1 levels

(GH-stimulated hepatic secretion)

  • GH varies widely throughout day and is not reliable
102
Q

Acute-onset hirsutism

A

Androgen-secreting neoplasm of ovary or adrenal glands:

  • Ovarian tumor (Elevated Testosterone, Normal DHEAS)
  • Adrenal tumor (Normal Testosterone, Elevated DHEAS)
103
Q

Prolactinoma therapy

A

Dopaminergic agonists

(cabergoline, bromocriptine)

104
Q

Radioactive iodine uptake in Graves disease

A

Increased

(hormone overproduction)

105
Q

Radioactive iodine uptake in painless thyroiditis

A

Decreased

(release of preformed hormone)

106
Q

Radioactive iodine uptake in subacute thyroiditis

A

Increased

(post-viral & painful; hormone overproduction)

107
Q

Decreased RAIU (radioactive iodine uptake)

A

Release of preformed hormone

  • Painless thyroiditis
  • Subacute thyroiditis (post-viral)
108
Q

Myalgias, proximal muscle weakness, elevated CK, delayed reflexes

A

Hypothyroid myopathy

(Polymyositis has nml DTRs)

109
Q

Chromaffin cells of the adrenal medulla

A

Pheochromocytoma

110
Q

Catecholamine surge due to anesthesia

A

Pheochromocytoma

111
Q

Despite normal to elevated serum potassium levels in DKA or HHS, pts have

A

total body potassium deficit due to excessive urinary loss caused by hyperglycemia-induced osmotic diuresis.

  • Provide potassium after IV insulin/fluids administration
112
Q

Fetal hyperthyroidism

A

Graves disease

(TSHR antibodies cross placenta)

113
Q

Untreated hyperthyroid pts are at greatest risk for

A
  • Bone loss from chronically increased osteoclastic activity
  • AFib or other cardiac arrhythmias
114
Q

Stones, Bones, Abd Moans, Psychiatric Overtones

A

Primary Hyperparathyroidism

(elevated calcium & PTH)

115
Q

Tx of hypoparathyroidism

A
  • IV Calcium Gluconate (severe)
  • PO Calcium (mild-moderate)
116
Q

Tx of primary hyperparathyroidism

A
  • Surgery (parathyroidectomy) - first line
  • Diuretics (except thiazide!!)
117
Q

Tx of Toxic Adenoma or Toxic Multinodular Goiter (MNG)

A

BBs (symptomatic tx)

Thionamide (reduce thyroid hormone levels) - propylthiouracil, methimazole

Surgery vs. Radioiodine ablation (definitive tx)

118
Q

Hypocalcemia, High PTH, Hyperphosphatemia, low urinary cAMP

A

Pseudohypoparathyroidism

(end-organ resistance to PTH)

119
Q

Hypoparathyroidism is most commonly due to

A

Head & Neck surgery

120
Q

Elevated calcium & elevated PTH

A

Primary Hyperparathyroidism

121
Q

Low renin + elevated aldosterone

A

Primary Hyperaldosteronism

(Conn syndrome: excess aldosterone due to adrenal adenoma vs. BL adrenal hyperplasia)

122
Q

Na+, K+, & acid/base in hyperaldosteronism

A
  • Hypernatremia
  • Hypokalemia
  • Metabolic alkalosis (due to H+ secretion and hypokalemia-induced bicarbonate resorption)
123
Q

Conn syndrome leads to metabolic

124
Q

Elevated aldosterone + adrenal mass

A

Conn syndrome

(too much aldosterone 2/2 adrenal adenoma or BL adrenal hyperplasia)

125
Q

Muscle weakness and decreased exercise tolerance

A

hypokalemia

(severe)

126
Q

Cardiac effects of hyperthyroidism

A
  • Chronotropic (tachycardia)
  • Inotropic (Systolic HTN & widened PP) 2/2 increased contractility & cardiac output
127
Q

Prussian blue+ on urine

A

G6PD Deficiency

128
Q

Cause of refractory hypokalemia

A

hypomagnesemia

129
Q

Common cause of hypocalcemia in hospitalized alcoholics

A

hypomagnesemia

(decreases PTH and induces resistance to PTH)

130
Q

Slows progression of diabetic nephropathy

A
  • ACE-I (Tight BP control)
  • Tight glucose control
131
Q

Low thyroglobulin in hyperthyroid state

A

Exogenous or factitious thyrotoxicosis

132
Q

C-peptide is to insulin as ____ is to T3 & T4

A

Thyroglobulin

(elevation indicates endogenous release)

133
Q

Synthesized and formed in thyroid follicle cell with iodinated tyrosine (T3 and T4) before breaking down into T3, T4, and amino acids to diffuse out from follicular cells into circulation

A

Thyroglobulin

134
Q

Thyroid cancer order of prognosis

A

Papillary > Follicular > Medullary > Anaplastic

(often fatal)

135
Q

Thyroid suppression drugs

A

Thionamides

(Propylthiouracil or Methimazole)

136
Q

Post-radiation cancer of thyroid

A

Papillary carcinoma

137
Q

Hürthle Cell Tumor

A

A more aggressive variant of follicular thyroid carcinoma w/ lymphatic spread

138
Q

Elevated ratio of alpha-subunit to TSH

A

Pituitary adenoma

(Beta-subunit is thyroid-specific; alpha-subunit is pituitary specific)

139
Q

Malignancy that produces calcitonin

A

Medullary thyroid carcinoma

(Parafollicular cells [C cells] are the calcitonin-producing cells)

140
Q

If thyroid medullary carcinoma, screen for ___

A

Pheochromocytoma (MEN2)

141
Q

Most common thyroid cancer

A

Papillary carcinoma

(70-80%):

  • Least aggressive, excellent prognosis
  • Hx of radiation to head/neck
  • Positive iodine uptake
142
Q

Thyroid cystic masses are not malignant if

A

>4cm diameter

143
Q

FNA is reliable for all thyroid cancers except ___

A

follicular neoplasms —>

Thus surgery is always indicated in follicular FNA results

144
Q

___ nodules more likely to be malignant on thyroid scan

A

Cold nodules (20%) —> Surgery

145
Q

Fever, elevated ESR, painful tender thyroid gland

A

Subacute granulomatous thyroiditis

(“de Quervain’s thyroiditis”)

  • Usually post-viral (HLA-B35)
  • Hyperthyroid state —> Hypothyroid state
  • Low RAI uptake (damaged thyroid follicular cells)
  • Elevated T4 & T3 (at first), low TSH
146
Q

Antithyroid peroxidase antibodies

A

Hashimoto thyroiditis

autoimmune hypothyroidism w/ transient initial hyperthyroid phase)

147
Q

99% of circulating T4 is bound to:

A
  • TBG
  • Transthyretin
  • Albumin
148
Q

Increases T4-Binding Globulin levels (TBG) [w/ normal free T4, elevated total T4]

A
  • Estrogen
  • Hepatitis (acute)
  • Meds (Tamoxifen) ​
149
Q

Decreases T4-Binding Globulin levels (TBG) [w/ normal free T4]

A
  • Elevated cortisol or glucocorticoid use
  • Hypoproteinemia
  • Meds (Niacin, high-dose androgens)
150
Q

TSH, Free T4 in Graves

A

Elevated Free T4, Decreased TSH

151
Q

Calcium, phosphate, PTH in vitD deficiency

A
  • PTH elevated (secondary hyperparathyroidism)
  • Normal calcium
  • Normal to low phosphate
152
Q

Vitamin D deficiency is diagnosed by measuring:

A

25 hydroxyvitamin D

153
Q

Calcium & PTH in primary hyperparathyroidism

154
Q

Renal failure leads to phosphate

A

Retention

(hyperphosphatemia)

  • Decreases Ca2+
  • Increases PTH
155
Q

Renal failure leads to Phosphate Retention (hyperphosphatemia from decreased GFR, decreased renal phosphate excretion). Effects on calcium and PTH?

A

Hypocalcemia + Increased PTH

  • Increased phosphate/calcium binding —> Hypocalcemia —> Increased PTH
  • Directly stimulates increased PTH production
  • Decreases renal production of calcitriol (1,25-dihydroxyvitamin D) —> Decreased intestinal calcium absorption —> Hypocalcemia —> Increased PTH
156
Q

Hypocalcemia + hyperphosphatemia + Increased PTH

A

Secondary Hyperparathyroidism 2/2 Renal Failure

157
Q

Use ____ w/ Radioactive Iodine Ablation in Graves disease due to risk of ____

A
  • Use glucocorticoids w/ RAI due to risk of worsening of Graves ophthalmopathy 2/2 increased TRAB titers
  • Use Propylthiouracil or Methimazole w/ RAI due to risk of radiation-induced hyperthyroidism
158
Q

Thyrotropin Receptor Antibodies (TRAB)

A

Graves autoimmune disease

(TSH receptor antibodies)

159
Q

Graves ophthalmopathy MOA

A

Thyrotropin receptor antibody damage to TSH receptors on retro-orbital fibroblasts and adipocytes

160
Q

First line hyperthyroidism Tx (e.g. Graves)

A

Propylthiouracil or Methimazole

161
Q

Propylthiouracil

A

Antithyroid drug for Graves or hyperthyroidism

(along with methimazole)

162
Q

Lid lag

A

Hyperthyroidism

(e.g. Graves)

163
Q

Insulin effect on K+

A

Pushes K into cells

  • Can cause hypokalemia (C BIG K)
  • Via enhancing activity of Na/K ATPase in skeletal muscle
164
Q

Insulin effect on cells

A
  • Increases hepatic glycogen stores (increased glycogenesis, decreased glycogenolysis)
  • Increases glycogen storage in adipocytes and skeletal muscle
  • Increases protein synthesis in skeletal muscle
165
Q

Insulin inserts ___ into peripheral tissue membrane of adipose & muscle cells

A

GLUT4 transporter

166
Q

C-Peptide

A

Indicates endogenous insulin production

(pancreatic beta cells are producing their own insulin)

167
Q

A1C goal in pts w/ risk of hypoglycemia

168
Q

A1C goal in diabetics

169
Q

Benefit of intensive glycemic control in diabetes (A1C <6.5%)

A

Less microvascular complications

(retinopathy, nephropathy)

170
Q

Pretibial myxedema

A

Graves disease

(or can be Hashimoto)

171
Q

Nonpitting swelling of the skin and underlying tissues giving a waxy consistency

A

Myxedema

(severe hypothyroidism)

  • Due to deposition of mucopolysaccharides in dermis
  • Mucopolysaccharides include glycosaminoglycans, hyaluronic acid, chondroitin sulfate
172
Q

Hoarseness in hypothyroidism

A

Due to:

  • Vocal cord thickening from mucopolysaccharide build-up due to low T4 levels (same path as myxedema)
  • Thyroid cyst, nodule, or inflammation (Hashimoto)
  • Can present as “fullness in throat”
173
Q

Free T4, Serum cortisol, and Aldosterone in panhypopituitarism

A

Low, Low, Normal

174
Q

Hypercortisolism (Cushing) work-up

A

Low THen High

  • Low-dose dexamethasone suppression test
  • ACTH level
  • High-dose dexamethasone suppression test
175
Q

Distinguishes post-anesthesia pheochromocytoma vs. thyroid storm

A

Fever = Thyroid storm (pyrexia)

No fever = Pheo

176
Q

Dawn Phenomenon

A

Increased fasting hyperglycemia in early morning hours

(2/2 diurnal increase in counterregulatory hormones)

177
Q

Insulin preparations, fast to slow acting

(LAGIN DG)

A
  • Lispro (fast-acting; post-prandial)
  • Aspart (fast-acting; post-prandial)
  • Glulisine (fast-acting; post-prandial)
  • Regular Insulin
  • NPH
  • Detemir
  • Glargine (basal; peakless coverage; ~24 hrs)
178
Q

3 therapies for Graves disease (TRAb autoimmune disease) are:

  • Antithyroid Rx (MMI or PTU)
  • RAI
  • Thyroidectomy

When is Antithyroid Rx indicated?

A
  • Mild disease
  • Pregnant
  • Older w/ limited life expectancy
  • Otherwise, always treat w/ RAI or Thyroidectomy

  • Use w/ beta blocker for hyperthyroid sx*
  • beta blockers alone if only thyrotoxic phase of silent or painless thyroiditis (Hashimoto/anti-TPO)*
179
Q

Calcium levels in CKD

A

Decreased

(hypocalcemia)

  • due to decreased renal production of vitamin D
180
Q

Adrenal hemorrhage occurs in

A
  1. Warfarin user w/ acute stress (e.g. sepsis) even if within INR range
  2. Meningococcemia (children)
  3. Pseudomonas sepsis (children)
181
Q

Cosyntropin Test

A

ACTH Stimulation Test

(Cosyntropin = ACTH synthetic analog)

  • Used to identify pts w/ primary adrenal insufficiency (positive if minimal increase in cortisol)
  • If suspecting HYPERcortisolemia–use Low THen High diagnostic steps:
    • Low dex suppression test
    • ACTH level
    • High dex suppression test
182
Q

Treats infertility in PCOS

A

Clomiphene Citrate

(through ovulation induction)

183
Q

Stabilizes uterine lining

A

Estrogen

  • Progesterone stimulates endometrial differentiation
184
Q

Stimulates endometrial differentiation

A

Progesterone

  • Estrogen stabilizes uterine lining
185
Q

Pancreatic tail tumor

A

VIPoma

(VIPail-oma)

  • +watery diarrhea (secretory)
  • +hypokalemia
  • +episodic flushing in face
  • Age 30-50yo
  • Can have MEN1 (PPP: Pituitary, Parathyroid, Pancreatic/Gastric neuroendocrine tumors)
  • +Hypercalcemia (increased bone resorption)
  • +Achlorydia (or hypochlorydia–due to decreased gastric acid secretion)
  • Confirmation: VIP level >75 (vasoactive intestinal peptide)
186
Q

Elevated free T4 + low thyroglobulin

A

Exogenous hormone intake (or factitious)

187
Q

Autoimmune disorder of the exocrine glands

A

Sjögren Syndrome

  • p/w dry eyes, dry mouth, & dysphagia w/ solids
  • ANA+
  • Usually younger pts; if older pt, more likely age-related sicca syndrome (age-related exocrine gland atrophy of lacrimal & salivary glands, due partially to decreased blink rates, oxidative damage, & use of anticholinergic meds)
188
Q

Carpopedal spasm

A

Hypocalcemia

189
Q

Increased extracellular pH (e.g. respiratory alkalosis) effect on calcium?

A

Hypocalcemia

Increase in albumin-bound calcium due to alkalosis-induced H+ ion dissociation from albumin, decreasing ionized calcium and thus causing physiologic hypocalcemia

190
Q

Timing of:

  1. Maximal gout symptoms after onset of gout flare
  2. Lyme arthritis onset
A
  1. 12-24 hours
  2. Months after initial infection
191
Q

Effect of malabsorption on calcium and phosphate

A

Hypocalcemia & Hypophosphatemia

(+elevated PTH)

  • Malabsorption → Vitamin D deficiency
  • Vitamin D mediates intestinal calcium & phosphorus absorption
192
Q

Felty Syndrome

A

Advanced RA

193
Q

Purine antimetabolite that treats RA (1st line)

A

MTX

(folate antimetabolite; DMARD; nonbiologic)

  • Supplement long-term MTX therapy w/ folate
  • ADE:
    • Stomatitis (e.g. oral ulcers)
    • ILD
    • Hepatitis
    • Macrocytic anemia + other cytopenias (leukopenia, thrombocytopenia)
194
Q

____ is to low-dose methylpred as GCA is to high-dose methylpred

A

PMR (Polymyalgia Rheumatica)

195
Q

Hydroxychloroquine side-effect

A

Retinal toxicity

  • Treats SLE
  • Requires ophthalmologic eval & periodic assessment
196
Q

Lid retraction

A

Lid lag → Thyroid dysfunction

(sustained lid retraction w/ downward gaze)

197
Q

MOA of hyperthyroid HTN vs. hypothyroid HTN

A
  • Hyperthyroid HTN: Increased Contractility & CO
    • T3 acts directly on cardiomyocytes
    • Decreased SVR
    • Inotropic & chronotropic
  • Hypothyroid HTN: Increased SVR
198
Q

Rapidly progressive hyperandrogenic Sx in older woman

A

Ovarian or Adrenal tumor

(Testosterone-secreting)

  • Check T & DHEAS levels
    • High T + normal DHEAS = ovarian tumor
    • High T + high DHEAS = adrenal tumor
  • Note: PCOS is diagnosed younger
199
Q

Joint w/ punched-out erosions w/ a rim of cortical bone on XR

200
Q

Leading cause of death in acromegaly

201
Q

Cardiovascular effects of acromegaly

A

Concentric myocardial hypertrophy

(Cardiomyopathy)

  • +HTN
  • +HF
  • +Valvular disease (MR & AR)
202
Q

Rapidly enlarging, firm goiter w/ compressive sx in pt w/ Hashimoto thyroiditis

A

Thyroid lymphoma

  • Gland fixed to surrounding structures (does not move up when swallowing)
  • Facial plethora from retrosternal tumor extension causing venous compression
  • Pemberton sign: more prominent venous distension & facial redness w/ raising arms 2/2 compression of subclavian vein & R internal jugular vein
  • Doughnut sign on CT: diffuse enlargement of the thyroid around the trachea
  • Papillary thyroid cancer is SLOWLY enlarging & solitary, rather than rapid & diffuse
203
Q

Reidel thyroiditis

A

Fibrosis of thyroid gland

(chronic & slowly progressive)

204
Q

Proximal Muscle Weakness DDx

(Short List - covers most but not all)

A

M2S2T2N2

(“Ms. Tennessee” can’t reach the cookie jar = Ms. TN)

  • Myositis: Polymyositis/Dermatomyositis
  • Steroids: Glucocorticoids/Cushing
  • Thyroid: Hypo-/Hyperthyroidism
  • NMJ: MG/LEMS
205
Q

Effect of hypothyroidism on cholesterol levels

A

Hypothyroidism INCREASES cholesterol levels

(Increased Total cholesterol & LDL)

  • LDL is not broken down & removed as efficiently as usual
206
Q

Posterior Pituitary hormones

A
  • Oxytocin (released from paraventricular nucleus)
  • ADH (released from supraoptic nucleus)

Note: Posterior pituitary is neurally-mediated

207
Q

Anosmia + delayed puberty

A

Kallmann Syndrome

  • Tx: Pulsatile GnRH therapy
208
Q

Acanthosis nigricans occurs due to

A

Hyperinsulinemia

209
Q

Pituitary stalk compression 2/2 craniopharyngioma (benign, slow-growing, calcified suprasellar tumor) in 5-14yo

A

Panhypopituitarism

  • Growth failure in children (↓ TSH or GH)
  • Pubertal delay in children (↓LH & FSH)
  • Sexual dysfunction in adults (↓ ADH)
    *
210
Q

Give this with antibiotics to reduce the risk of sensorineural hearing loss in Haemophilus influenzae type b meningitis

A

Dexamethasone

- Med School Review 🔥 (23 decks)

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