Endocrine

Question 1

PDT for primary hyperaldosteronism

Answer 1

Etiology: Bilateral Adrenal Hyperplasia or unilateral adrenal adenoma
P:hypertension (tx resistant), hypokalemic alkalosis (reslting in muscle weakness + parasthesias)
Dx: Elevated plasma aldosterone, low plasma renin, aldosterone remains elevated following oral salinel load

Work up: CT to ID b/l adrenal hyperpalasia vs. adrenal adenoma.

Tx: For pts w b/l adrenal hyperplasia: aldosterone antagonists such as sipronolacone, eplerenone)

Question 2

Diabetic foot ulcer caused by?

Answer 2

peripheral sensory neuropathy (microvascular damage is secondary)

Question 3

Most common cause of hypothyroidism and lab findings?

Answer 3

hashimoto thyroditis. High TSH, low T4, anti-TPO

Question 4

Most common cause of Cushing syndrome

Answer 4

Corticosteroids. Second most common is Cushing dz

Question 5

HTN, hypoK, and metabolic alkalosis

Answer 5

Primary hyperaldosteronism (due to Conn syndrome or b/l adrenal hyperplasi)

Question 6

Which anti-adrenergic (alpha or beta) drugs come first in treating pheochromocytoma?

Answer 6

alpha-antagonists first (phenoxybenzamine)

Question 7

Treatment for central DI

Answer 7

DDAVP and free-water restriction

Question 8

Postop patient with significant pain p/w hyponatremia and normal volume status

Answer 8

SIADH 2/2 stress of surgery

Question 9

DM II w Lactic acidosis. what drug?

Answer 9

metformn

Question 10

Pt with weakness, nausea, vomiting, weight loss, and skin hyperpigmentation. Lab results show HypoNa and HyperK, Tx?

Answer 10

Primary adrenal insufficiency (Addison disease). Tx w glucocorticoids, mineralocorticoids, and IV fluids.

Question 11

Goal HbA1c in Type II DM?

Answer 11

Less than 7%

Question 12

Bone pain, hearing loss, and increased AlkPhos. Dx?

Answer 12

Paget disease

Question 13

Increased insulin-like growth factor-1. Dx?

Answer 13

Acromegaly

Question 14

Classic CAH. What enzyme is deficient?

Answer 14

21-OH deficiency. 17-hydroxyprogesterone is elevated. 46, XX baby will show ambiguous genitalia and have hypotension
46, XY may have normal genitalia at birth or enlarged phallus

Question 15

MEN 1 syndrome

Answer 15

3 Ps: pancreas, pituitary, and parathyroid tumors

Question 16

Men 2A

Answer 16

2 Ps: Medullary thyroid cancer, parathyroid tumors, pheochromocytoma,

Question 17

MEN 2B

Answer 17

1P: MNoP: Medullary thyroid cancer, Neuromas, Pheochromcyomas

Question 18

4 types of thyroid cancer

Answer 18

Papillary (most Popular, Psammoma bodies, Orphan Annie Nuclei, lymphatic spread)
Follicular (hematologic spread)
Medullary (associated with MEN2A/B)
Anaplastic

Question 19

Hypercalcemia causes: CHIMPANZEES

Answer 19

Calcium supplementation, Hyperparathyroidism/hyperthyroidism
Iatrogenic - thiazides, parenteral nutrition OR Immobility
Milk-Alkali
Paget Dz of Bone
Adrenal Insufficiency  OR Acromegaly
Neoplasia
Zollinger Ellison Syndrome (MEN1)
Excess Vitamin D
Excess Vitmain A
Sarcoidosis (and TB)

Question 20

SIADH PDT+ Path

Answer 20

Too much ADH (can come from posterior pituitary lesion or brain injury) = too much water = hypotonic serum
D: Euvolemic Hyponatremia
Decreased serum Osms
Increased Urine Na and Urine Osms
Tx: H2O restriction, demclocycline or Vaptan

Question 21

Central DI PDT+ Path

Answer 21

No ADH production
P: polyuria, polydipsia, NL Blood glucose
D: H2O restrict, then if corrects with desmopressin (DDAVP), then it’s central
T:DDAVP

Question 22

Nephrogenic DI PDT+ Path

Answer 22

Kidney resistant to ADH
P: polyuria, polydipsia, NL Blood glucose
D: H2O restrict,
if doesn’t correct with desmopressin (DDAVP), then it’s nephrogenic
T: Gentle diuresis w loop diuretic

Question 23

PDT for Secondary hyperaldosteronism

Answer 23

Path: young woman, fibromuscular dysplasia OR old man w renal artery stenosis
P: HTn + hypoK
D: Aldo/Renin<10
Angiogram
Tx: RAS=medical management
Fibromuscular dysplasia=stent

Question 24

Multinodular goiter scan will show?

Answer 24

The thyroid scan is now demonstrating an enlarged gland with multiple nodules (“areas”), some avid/hyperfunctioning and other relatively depressed (either not “hyper”-functioning and thus relatively cold or actually cold, most commonly filled with colloid).

Question 25

ca and vit. D levels in sarcoidosis

Answer 25

Chronic sarcoidosis
↑ Calcium due to elevated levels of 1,25-(OH)2-vitamin D3
↓ CD4+ T cells: T helper cells are consumed during granuloma formation → CD4+ levels are low in serum and high in bronchoalveolar lavage.