Endocrine

Question 1

Glucocorticoid deficiency, hypogonadism, and hypothyroidism

Answer 1

Hypopituitarism

• can have mass-effect sx like HA and vision change
• Aldosterone is mainly controlled by RAAS so level will be normal

Question 2

severe hyperglycemia and hyperosmolarity without significant ketosis.
altered sensorium
often precipitated by infection, meds (steroids), interruption of insulin therapy and injury or acute illness

Answer 2

Hyperosmolar hyperglycemic state

Question 3

MEN disorders

Answer 3

MEN1: primary hyperparathyroidism, pituitary tumors, pancreatic tumors (gastrinomas)
MEN2A: medullary thyroid cancer (calcitonin), pheochromocytoma, primary hyperparathyroidism
MEN2B: medullary thyroid cancer (calcitonin), pheochromocytoma, mucosal neuromas/marfinoid habitus

Question 4

Euthyroid sick syndrome

Answer 4

low T3 with normal TSH and T4 in patients with acute illness. Due to decreased peripheral conversion of T4 to T3

Question 5

Patient with dry eyes, dysphagia with sold foods, dental caries, oral thrush, bilateral, firm submandibular nodes

Answer 5

Sjogren syndrome - autoimmune disorder, inflammation of exocrine glands
-anti-Ro (SSA) and/or anti-La (SSB) antibodies

Question 6

diabetic patient with sudden loss of vision in the right eye, onset of floaters

Answer 6

vitreous hemorrhage due to diabetic retinopathy

Question 7

Patient with hypothyroidism presents with hoarsness, difficulty swallowing, fever, night sweats. Develops facial congestion, cyanosis, and inspiratory stridor on elevation of arms.

Answer 7

Thyroid lymphoma

• rapidly enlarging goiter with compressive sx and B sx
• retrosternal extension of tumor can result in venous compression

Question 8

Side effects of radioactive iodine therapy

Answer 8

• permanent hypothyroidism
• worsening opthalmopathy
• radiation side effects

Question 9

Side effects of antithyroid drugs

Answer 9

• agranulocytosis
• Methimazole: 1st timester teratogen
• PTU: hepatic failure, ANCA-assoc vasculitis

Question 10

Presentation and cause of exopthalmos in Graves disease

Answer 10

Caused by orbital tissue expansion and lymphocytic infiltration.
Presents with impaired ocular motion with sx of weight loss, htn, increased heart rate

Question 11

Primary tx for hyperosmolar hyperglycemic state

Answer 11

`normal saline

Question 12

Common cause of hypocalcemia in alcoholics

Answer 12

hypomagnesemia

- causes decreased PTH release and PTH resistance

Question 13

characteristic finding of papillary thyroid cancer

Answer 13

Invasion of the tumor capsule and blood vessels

Question 14

Patient with increased weight, proximal muscle weakness, hypertension, glucose intolerance

Answer 14

Cushings

-dx with: 24-hour urinary cortisol. late night salivary cortisol, low dose dexametasone suppression

Question 15

Labs in Conn syndrome

Answer 15

high aldosterone, low renin, low K+, mild hypernatremia, metabolic alkalosis (high bicarb)

Question 16

Woman with recently diagnosed diabetes presents with weight loss, loose stool and a rash that’s perioral and on her right thigh. The rash is described as erythematous plaques with central clearing and eroded borders.

Answer 16

Glucagonoma - necrolytic migratory erythema

Question 17

Patients taking exogenous thyroid hormone with have ___ thyroglobulin level

Answer 17

low with decreased RAIU

Question 18

Initial tx of subacute thyroiditis

Answer 18

NSAIDs

Question 19

myopathy in cushings is caused by

Answer 19

catabolic effects of cortisol on muscle - atrophy

Question 20

Fever and sore throat in a patient taking PTU

Answer 20

agranulocytosis - stop medication immediately and check WBC counts