Endocrine

Question 1

What disorder can be ruled out using the Cosyntropin stimulation test?

Answer 1

Adrenal insufficiency

Question 2

What side effect of levothyroxine is most likely to lead to non-compliance when first initiated?

Answer 2

Alopecia

Question 3

You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/synthroid effectiveness?

Answer 3

TSH

Question 4

What method should you use to treat hyponatremia related to SIADH?

Answer 4

3% hypertonic saline, calculated

Question 5

For the past few months, 29 year old Janine has been gaining weight while experiencing amenorrhea and increasingly severe acne. She has gained more than 20 pounds, and you note that she is carrying her weight around the midline, w/BL purplish striae across both flanks. You suspect Cushing’s syndrome. Which of the following findings would not contribute to a Dx?

Answer 5

After a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol (In Cushings, pituitary does not respond to dexamethasone)

Question 6

Which of the following is not a criteria of Metabolic Syndrome?

Answer 6

BP > 140/90 (it’s ≥130/85)

Question 7

Cushing labs, symptoms:

Answer 7

↑BG, ↑Na, ↓K. S/S: central obesity, moon face with buffalo hump.

Question 8

Addison’s disease labs & Tx: :

Answer 8

↓BG, ↓Na, ↑K. Tx: florinef, hydrocortisone, Steroid bolus. Test: Cosyntropin, + if serum cortisol < 18 mcg/dL in the morning.

Question 9

Pt is hypotensive + Addison’s. Tx?:

Answer 9

dopamine/pressors don’t work, so choose IVF (D5NS).

Question 10

SIADH

Answer 10

inappropriate water retention, CNS d/o, retain water, hypothermia, hyponatremia, ↓sOSm, ↑ urine osmolality (concentrated), urine sodium >20meq (kidneys trying to excrete water via salt), need 3% hypertonic fluids calculated

Question 11

Urine Na 28, serum osmo 250, urine osmo 115. What is the suspected cause?

Answer 11

SIADH

Question 12

23 yo F presents with DKA. ABD pH 7.3, glucose 520, BP 90/65, HR 120 and confused. Which of the following are not included in the initial management of DKA? Isotonic fluids, insulin infusion, sodium bicarb, or supportive care?

Answer 12

Sodium bicarb is only indicated for DKA if pH <7.1

Question 13

24 yo M presents with DKA. Now confused and irritable. ABG Ph 7.29/33/22. Received isotonic fulids x 1 hour, BP 110/70, HR 90. Blood glucose 550. What is the best IV fluid indicated

Answer 13

½ NS (d/t BG >500)

Question 14

HHNK: fluids to use:

Answer 14

NS for massive fluid volume deficit, then ½ NS to hydrate the cell, then D5 ½ NS if on insulin gtt

Question 15

Hyperthyroid labs

Answer 15

high T3, T4, resin uptake TSH >5;

Question 16

Hypothyroid labs

Answer 16

low T4, low resin uptake (T3 not reliable test)

Question 17

S/S of thyroid storm/crisis:

Answer 17

fever, goiter, tachycardia, low TSH

Question 18

Myxedema coma treatment:

Answer 18

loading synthroid followed by maintenance dose

Question 19

Pt w/BP 210/110 + HA, then BP ↓ 160’s, what is 1st Tx:

Answer 19

pheochromocytoma: alpha blockers preop Regitine/Phentolamine

Question 20

What is the first test you run when you see s/s of pheochromocytoma

Answer 20

TSH

Question 21

Diagnostic test confirmative for pheochromocytoma

Answer 21

CT

Question 22

DKA pt FIRST tx

Answer 22

IVF first (1L in 1st hr, then 500 ml/hr, use ½ NS if BG >500)

Question 23

Somogyi Effect

Answer 23

Low at 3am and rebounds to high at 7am

Question 24

15-year-old pt with DM1 reports ↑BG in am. The ACNP determines hyperglycemia is d/t dawn phenomenon

Answer 24

increases the insulin dosage at bedtime.