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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
What can a pt expect after having radioiodine therapy?
Development of hypothyroidism over months to years
26
If you suspect Cushing's you order a?
O/n low-dose dexamethasone suppression test
27
At what point can you start tx for T2DM?
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
Hyperparathyroidism Pituitary tumor Gastrinoma
MEN 1
29
Crohn's pt has diffuse bone pain. why?
Osteomalcia d/t vit D deficiency Low Sr Calcium, phos High PTH hormone Elevated Alk Phos
30
What changes are seen in the axonal nerves in T2DM?
Small fiber axonopathy - pain, parathesia | Large fiber axonopathy - loss of proprioception, numbness, bibration sense, diminished ankle reflex
31
Tx for macro or symptomatic prolactinoma?
Dopaminergic agonists (cabergoline, bromocriptine) Lowers prolactin levels and reduce tumor size If >3cm they need referral tfor transspenoidal resection
32
Hyperthyroid syx low TSH Radioactive iodine uptake in one nodule
Toxic adenoma | Overproduce thyroid hormone autonomously
33
Most common cause of primary adrenal insufficiency in the first world
autoimmune adrenalitis | Has hyperpigmentation and hyperkalemia (vs central adrenal insufficiency which doesn't have skin changes)
34
Cardiac findings in acromegaly
``` Concentric hypertrophy diastolic dysfunction left ventricular dilation global hypokinesis worsened by HTN, OSA, valvular heart dz Heart failure, arrhythmias ```
35
self limited hyperthyroid phase d/t release of preformed thyroid hormone -> hypothyroid phase -> eurthyroid
Painless thyroiditis | Beta blocker can control hyperthyroid syx
36
Why does hyperthyroidism cause systolic HTN?
Increased myocardial contractility, increased hr
37
A surgically excised follicular thyroid cancer nodule would reveal which unique pathology?
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
Long term smoker has hypercalcemia. NL PTH level Why?
Hypercalcemia of malignancy | Second most common cause of hypercalcemia after hyperPTH
39
Insulinomas are from which cell type?
Beta cell tumors in the pancreas
40
Why does a nephrotic pt have low calcium?
Low serum albumin level
41
Why does a Hashimoto Thyroiditis pt have recurrent Spont abortions?
Antithyroid persocidase antibodies Present in >90% of Hashimoto pts high titers -> overt hypothyroidism, increased risk of miscarriage in euthyroid and hypothyroid women
42
Why does a hyperPTH pt get diffuse bone pain?
Impaired osteoid matrix mineralizaiton (osteomalacia)
43
Pt gets hyperthyroid syx after starting OCP's why
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
Which T2DM drug can help in weight loss?
Glucagon like peptide 1 (GLP1 agonist) | risk for hypoglycemia
45
Pt has DM but BMI is 18 Necrotic migratory erythema, diarrhea, anemia, weight loss be suspicious for?
Glucagonoma
46
Stage 3 CKD pt hypocalcemia hyperphos high PTH
Secondary hyperparathyroidism d/t CRF
47
hyponatremia hyperkalemia NL am cortisol
Get a ACTH stimulation test | dx - priamry or secondary adrenal insufficiency
48
hypernatremia | hypokalemia
get a rening:aldosterone measurement | Initial screening for hyperaldosteronism
49
hyperthyroid, cold thyroid on uptake study
exogenous hormone intake | Low serum thyroglobulin levels (T4)
50
Best way to slow progression of diabetic nephropathy?
ACEI

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