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endocrine Flashcards

1
Q

Steatorrhea pts are at risk of which vit deficiency?

A

Vit D

Develop hypo calcemia and phosphatemia, high PTH (secondary hyperPTH)

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2
Q

hyper thyroid syx + radioactive iodine uptake study -> increased and homongenously distributed throughout the thyroid

A

Graves dz
Tx - antithyroid drugs (mild dz), radioactive I, or thyroidectomy
antithyroid drugs (ie propylthiouracil,methimazole) + Bblocker are used to prepare for radioactive iodine or thyroidectomy
if pregger - PTU

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3
Q

After induction of anesthesia, pt gets malignant HTN. Why?

A

Pheochromocytoma
Catecholamine producing tumor of the chromaffin cells in the adrenal medulla
Bblock -> unopposed alpha adrenergic vasoconstriction

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4
Q

Best marker for resolution of DKA?

A

Anion gap

Beta-hydroxygutyrate levels

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5
Q

Management of papillary thyroid cancer

A

Surgical resection
If pt at increased risk of recurrence - maintain post op on radioiodine ablation and suppressive doses of thyroid hormone

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6
Q

hyperthyroidism syx + proptosis, impaired EOM, eye pain

A

Graves dz
Thyrotropin (TSH) recepto autoAb (TRAB) stimulate thyroid hormone production -> hyperthyroid
exophthalmos, impaired EOM -> T cella ctivation and stimulation of orbital fibroblasts, adipocytes by TRAB -> orbital tissue expansion and lymphocyte infiltration

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7
Q

HTN + hypokalemia w/ low renin

A

Primary hyperaldosteronism

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8
Q

What is an important cause of hypocalcemia in alcoholics?

A

Hypomagnesmia

Hypo mag -> decreased PTH release

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9
Q

Two weeks after starting propylthiouracil, pt develops sore throat + fever

A

Stop propylthiouracil
Fever + sore throat on antithyroid drugs = agrnulocytosis
Stop med and check WBC

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10
Q

How does a PE affect calcium metabolism?

A

PE -> respiratory alkalosis
Increased pH -> H+ ions dissociate from albumin allowing increased binding of Ca2+ and drop in unbound (ionized) calcium.
Ionized is physiologically active so this can cause symptoms of hypocalcemia

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11
Q

How does pregabalin decrease neuropathic pain?

A

Inhibit release of excitatory NT’s

structural analog of GABA

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12
Q

Untreated hyperthyroidism puts the pt at risk of?

A

Bone loss d/t increased osteoclastic activity

Cardiac tachyarrhythmias

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13
Q

Pt has hypercalcemia after being hospitalized for a trauma. why?

A

Prolonged immobilizatoin
caused by increased osteoclastic activity
Bisphosphonates can help

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14
Q

Most serious side effect of anti thyroid durgs?

A

agranulocytosis

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15
Q

Hypogonadism + hypothyroid

elevated prolatin

A

Prolactin adenoma

Usually asyx until large enough to cause mass effect

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16
Q

proximal m. weakness in a pt w/ demineralization of vertebral bones, hirsutism

A

Cushing’s
Can have a myopathy characterized by progressive painless muscle weakness involving the proxima m. d/t catabolic effect of cortisol on the skeletal m.

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17
Q

Tx for hyperparathyroidism

A

Parathyroidectomy, even if asymptomatic

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18
Q

Tx for primary hyperaldosteronism

A

Unilateral - surgical adrenectomy

b/l - aldosterone antagonists (spironolactone, eplerenone)

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19
Q

Fever, neck pain, tender goiter after a URI

A

Subacute (de Quervain) thyroiditis
Self limited thyrotoxic phase followed by hypothyroidism and eventual return to normal thyroid function
tx - Bblock and NSAIDS

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20
Q

Which tx worsens Graves ophtalmopathy?

A

Radioactive iodine
eye dz is caused by effects of activated T cells and thyrotropin receptor Abs (TRAB) on TSH receptors in retro-orbital fibroblasts and adipocytes
Radioactive iodine tx can raise titers of TRAB and worsen the ophtalmopathy
glucoocorticoids and antithyroid drugs can minimize the effects of RAI

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21
Q

Healthy woman after surgery develops fever, tremor, lid lag

A

thyroid storm
Life-threatening thyrotoxicosis often triggered by thyroid or non thyroid surgery, trauma, infection, iodine contrast, childbirth
syx - tachy, HTN, cardiac arrhythmias, high fever, tremor, altered mentation lid lag
Get thyroid studies
Start propanolol

22
Q

Pt has hoarseness, dysphagia x weeks. What would be thyroid cause of this?

A

Thyroid lymphoma

Uncommon, but associated with Hashimoto thyroidits

23
Q

Woman is rapidly developing hirtuism, new amenorrhea. BMI 24

A

Hyperandrogenism, possible andrgen-secreting neoplasm of the ovary or adrenals
Get a Sr testosterone and DHEAS level

24
Q

Getting better glycemic control and A1C < 6.5% is most likely to reduce risk of?

A

Microvascular complications (retinopathy, nephropathy)

25
Q

What can a pt expect after having radioiodine therapy?

A

Development of hypothyroidism over months to years

26
Q

If you suspect Cushing’s you order a?

A

O/n low-dose dexamethasone suppression test

27
Q

At what point can you start tx for T2DM?

A

When fasting glucose and A1C both demonstrate DM

OR if these two numbers don’t agree (ie high A1C but low fasting glucose), repeat A1C

28
Q

Hyperparathyroidism
Pituitary tumor
Gastrinoma

A

MEN 1

29
Q

Crohn’s pt has diffuse bone pain. why?

A

Osteomalcia d/t vit D deficiency
Low Sr Calcium, phos
High PTH hormone
Elevated Alk Phos

30
Q

What changes are seen in the axonal nerves in T2DM?

A

Small fiber axonopathy - pain, parathesia

Large fiber axonopathy - loss of proprioception, numbness, bibration sense, diminished ankle reflex

31
Q

Tx for macro or symptomatic prolactinoma?

A

Dopaminergic agonists (cabergoline, bromocriptine)
Lowers prolactin levels and reduce tumor size
If >3cm they need referral tfor transspenoidal resection

32
Q

Hyperthyroid syx
low TSH
Radioactive iodine uptake in one nodule

A

Toxic adenoma

Overproduce thyroid hormone autonomously

33
Q

Most common cause of primary adrenal insufficiency in the first world

A

autoimmune adrenalitis

Has hyperpigmentation and hyperkalemia (vs central adrenal insufficiency which doesn’t have skin changes)

34
Q

Cardiac findings in acromegaly

A 
Concentric hypertrophy
diastolic dysfunction
left ventricular dilation
global hypokinesis
worsened by HTN, OSA, valvular heart dz
Heart failure, arrhythmias
35
Q

self limited hyperthyroid phase d/t release of preformed thyroid hormone -> hypothyroid phase -> eurthyroid

A

Painless thyroiditis

Beta blocker can control hyperthyroid syx

36
Q

Why does hyperthyroidism cause systolic HTN?

A

Increased myocardial contractility, increased hr

37
Q

A surgically excised follicular thyroid cancer nodule would reveal which unique pathology?

A

Invasion of the tumor capsule and/or blood vessels
Cold nodule on scintography
Can spread to ditant tissues via hematogenous speard
Follicular adenoma will not spread beyond the thyroid

38
Q

Long term smoker has hypercalcemia. NL PTH level Why?

A

Hypercalcemia of malignancy

Second most common cause of hypercalcemia after hyperPTH

39
Q

Insulinomas are from which cell type?

A

Beta cell tumors in the pancreas

40
Q

Why does a nephrotic pt have low calcium?

A

Low serum albumin level

41
Q

Why does a Hashimoto Thyroiditis pt have recurrent Spont abortions?

A

Antithyroid persocidase antibodies
Present in >90% of Hashimoto pts
high titers -> overt hypothyroidism, increased risk of miscarriage in euthyroid and hypothyroid women

42
Q

Why does a hyperPTH pt get diffuse bone pain?

A

Impaired osteoid matrix mineralizaiton (osteomalacia)

43
Q

Pt gets hyperthyroid syx after starting OCP’s why

A

Estrogen increases thyroid homone binding protein level
seen in pregnancy in OCP’s, HRT
TSH stays low-nl but T4 is high (thyroid binding globulin)

44
Q

Which T2DM drug can help in weight loss?

A

Glucagon like peptide 1 (GLP1 agonist)

risk for hypoglycemia

45
Q

Pt has DM but BMI is 18
Necrotic migratory erythema, diarrhea, anemia, weight loss
be suspicious for?

A

Glucagonoma

46
Q

Stage 3 CKD pt
hypocalcemia
hyperphos
high PTH

A

Secondary hyperparathyroidism d/t CRF

47
Q

hyponatremia
hyperkalemia
NL am cortisol

A

Get a ACTH stimulation test

dx - priamry or secondary adrenal insufficiency

48
Q

hypernatremia

hypokalemia

A

get a rening:aldosterone measurement

Initial screening for hyperaldosteronism

49
Q

hyperthyroid, cold thyroid on uptake study

A

exogenous hormone intake

Low serum thyroglobulin levels (T4)

50
Q

Best way to slow progression of diabetic nephropathy?

A

ACEI

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