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Rizk Review > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Best test for excluding thyroid disease in asymptomatic patients?

A

TSH

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2
Q

Next best test for patient who presents with NML free T4, mildly elevated TSH?

A

Measure anti-TPO Ig

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3
Q

Patient presents with NML free T4, mildly elevated TSH – diagnosis?

A

Subclinical hypothyroidism

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4
Q

4 groups of patients with subclinical hypothyroidism who should be treated with low-dose levothyroxine?

A

Elderly, Pregnant, (+) anti-TPO Ig, Hypercholesterolemia

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5
Q

Change to levothyroxine dose during pregnancy?

A

Increase by 33%

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6
Q

Which other group of females require increase in levothyroxine dose?

A

Females on estrogen replacement therapy

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7
Q

Why do females on estrogen therapy require higher doses of levothyroxine?

A

Induction of liver enzymes

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8
Q

Change to thyroid hormones during pregnancy?

A

Increased thyroid binding globulin, Increased Total T4, NML free T4, NML TSH

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9
Q

4 medications that interact with levothyroxine … inhibiting absorption?

A

Ferrous sulfate, cholestyramine, calcium carbonate, sucralfate

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10
Q

Classic triad of symptoms seen in Graves Disease?

A

Goiter, Ophthalmopathy, Dermopathy

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11
Q

Which symptom in Graves Disease is irreversible?

A

Ophthalmopathy

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12
Q

Which test distinguishes Graves Disease from Thyroiditis?

A

Radioactive iodine uptake … early in its course, thyroiditis may mimic Graves Disease

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13
Q

Radioactive iodine uptake in thyroiditis?

A

NML

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14
Q

Radioactive iodine uptake in Graves Disease?

A

Increased

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15
Q

35 yo female who is 4 months pregnant presents with fatigue, weight loss, heat intolerance, palpitations; PE shows diffusely enlarged thyroid; Labs show low TSH, high free T4 – best treatment?

A

b blockers + PTU

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16
Q

Why should MMZ be avoided during pregnancy?

A

May cause aplasia cutis … (loss of fetal scalp)

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17
Q

2 indications for surgical resection in patient with Graves Disease?

A

Patients with cold nodules; Previous radioactive treatment

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18
Q

Alternate name for Hashimoto thyroiditis?

A

Chronic lymphocytic thyroiditis

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19
Q

Alternate name for Subacute granulomatous thyroiditis?

A

De Quervain thyroiditis

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20
Q

Distinguishing feature of De Quervain thyroiditis?

A

Tender thyroid

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21
Q

1st step of workup for thyroid nodule?

A

TSH levels

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22
Q

2nd step of workup for thyroid nodule?

A

Radioactive scan

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23
Q

Best treatment for hot thyroid nodule?

A

Radioactive iodine

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24
Q

Best treatment for cold thyroid nodule?

A

FNA … increased likelihood of CA

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25
Q

Next step in management of multiple nodular goiter?

A

Nuclear medicine thyroid scan

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26
Q

Alternate name for parafollicular thyroid CA?

A

Medullary thyroid CA

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27
Q

Best lab for monitoring thyroid carcinoma recurrence?

A

Thyroglobulin

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28
Q

First 2 steps of treatment for thyroid carcinoma?

A

Thyroidectomy; Total body thyroid scan

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29
Q

Example of Primary Hypogonadism in males?

A

Klinefelter Syndrome

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30
Q

Etiology of Primary Hypogonadism in males?

A

Problem with testes

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31
Q

Change to testosterone in Klinefelter Syndrome?

A

Decreased

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32
Q

Change to LH in Klinefelter Syndrome?

A

Increased

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33
Q

Change to FSH in Klinefelter Syndrome?

A

Increased

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34
Q

Change to GnRH in Klinefelter Syndrome?

A

Increased

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35
Q

Example of congenital Tertiary Hypogonadism in males?

A

Kallman Syndrome

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36
Q

Etiology of Tertiary Hypogonadism in males?

A

Problem with hypothalamus

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37
Q

What is the best value to monitor for assessment of patients who are recovering from DKA?

A

Anion Gap

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38
Q

MOA of Rosiglitazone?

A

Binds to PPARg to decrease insulin resistance

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39
Q

MOA of Glipizide?

A

Stimulates pancreatic b cells to increase insulin output

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40
Q

MOA of Metformin?

A

Decreases hepatic production of glucose

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41
Q

MOA of Miglitol?

A

Inhibits intestinal enzymes that break down CHO

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42
Q

Etiology of hyperglycemia due to Somogyi effect?

A

Nocturnal hypoglycemia … Increased release of glucagon … Overcorrection causes hyperglycemia

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43
Q

Best treatment of Somogyi effect?

A

Decrease bedtime insulin dose

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44
Q

Etiology of hyperglycemia due to Dawn Phenomenon?

A

Early morning release of Growth Hormone

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45
Q

Best treatment of Dawn Phenomenon?

A

Increased bedtime basal dose

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46
Q

How can you differentiate Dawn Phenomenon from Somogyi effect?

A

Somogyi effect = hypoglycemia, then hyperglycemia; Dawn Phenomenon = only hyperglycemia

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47
Q

Etiology of DM gastroparesis?

A

Autonomic neuropathy

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48
Q

2 DOC for DM gastroparesis?

A

Metoclopramide, Erythromycin

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49
Q

Most common cause of outpatient hypercalcemia?

A

Primary hyperparathyroidism

50
Q

Most common cause of inpatient hypercalcemia?

51
Q

Why does secondary hyperparathyroidism not cause hypercalcemia?

A

Increased PTH secretion in response to hypocalcemia in patients with CKD

52
Q

Etiology of tertiary hyperparathyroidism?

A

Prolonged secondary hyperparathyroidism

53
Q

28 yo female presents with Ca2+ = 11, PTH = 40; FHX of hyperparathyroidism that does not improve after parathyroidectomy – diagnosis?

A

Benign familial hypercalcemia

54
Q

Best test for confirmation of Benign familial hypercalcemia?

A

Urine calcium

55
Q

Change to Urine calcium in setting of Benign familial hypercalcemia?

56
Q

Inheritance pattern of Benign familial hypercalcemia?

57
Q

Etiology of Benign familial hypercalcemia?

A

Altered setpoint of calcium-sending receptors in renal tubules + parathyroid glands

58
Q

Change to PTH in setting of hypercalcemia of malignancy?

59
Q

4 steps in treatment of hypercalcemia of malignancy?

A

IV fluids, Loop diuretics, zolendronate, calcitonin

60
Q

Condition associated with Albright Hereditary Osteodystrophy?

A

Pseudohypoparathyroidism

61
Q

Etiology of pseudohypoparathyroidism?

A

Resistance to effects of PTH

62
Q

DOC for Paget’s Disease?

A

Bisphosphonates

63
Q

2 social exposures that raise risk for osteoporosis?

A

ETOH, smoking

64
Q

1 event that raises risk for osteoporosis?

A

Previous fracture in elderly patients

65
Q

Which RF is more associated with osteoporosis then BM < -2.5?

A

Fragility fracture

66
Q

Which thyroid disorder is associated with bone disease?

A

Hyperthyroidism

67
Q

3 medications that represent risk for osteoporosis?

A

Corticosteroids, phenytoin, heparin

68
Q

DOC for patient with HTN and osteoporosis?

A

Thiazide diuretics

69
Q

Which type of cancer indicates bisphosphonates?

A

Multiple myeloma

70
Q

Effect of superior mass effect of pituitary tumor?

A

Bitemporal hemianopsia

71
Q

Effect of inferior mass effect of pituitary tumor?

72
Q

What accounts for diplopia in setting of pituitary tumor?

A

Compression of CN 3, CN 4, CN 5, CN 6

73
Q

Effect of lateral mass effect of pituitary tumor?

A

CSF rhinorrhea

74
Q

Most common cause of galactorrhea?

A

Prolactinoma

75
Q

What accounts for elevated prolactin levels during pregnancy?

A

Estrogen inhibits dopamine release … when dopamine is high, prolactin is low

76
Q

4 CNS medications that cause elevated prolactin levels?

A

Risperidone, Phenothiazine, Haloperidol, Metoclopramide

77
Q

3 HTN medications that cause elevated prolactin levels?

A

Methyldopa, Reserpine, Verapamil

78
Q

Pain medication that causes elevated prolactin levels?

79
Q

Effect of Opiates in males?

80
Q

2 DOC for treatment of prolactinoma?

A

Cabergoline, Bromocriptine

81
Q

Is medical treatment or surgical resection more successful in aiding conception in female with prolactinoma?

A

Medical therapy

82
Q

What is screening test for suspected acromegaly?

A

IGF-1 level

83
Q

Diagnostic test for acromegaly?

A

Glucose load test

84
Q

Result of (+) glucose load test in acromegaly?

A

GH level is not suppressed

85
Q

Untreated acromegaly results in decreased life expectancy due to …

A

Colon CA … screen early with colonoscopy

86
Q

Initial therapy for acromegaly?

A

Trans-sphenoidal resection

87
Q

Indication for octreotide in acromegaly?

A

Post-operative residuals

88
Q

___ refers to hemorrhagic infarct of pituitary adenoma

A

Pituitary apoplexy

89
Q

RF for development of Pituitary apoplexy?

A

Warfarin use

90
Q

Treatment of Pituitary apoplexy?

A

Trans-sphenoidal decompression

91
Q

Epidemiology of lymphocytic hypophysitis?

A

Postpartum, Pregnancy

92
Q

Etiology of lymphocytic hypophysitis?

A

Autoimmune

93
Q

Clinical presentation of lymphocytic hypophysitis?

A

Refractory hypotension

94
Q

How can you differentiate between Sheehan Syndrome vs. lymphocytic hypophysitis?

A

Sheehan Syndrome precipitated by prolonged bleeding

95
Q

Treatment of central diabetes insipidus?

A

Desmopressin

96
Q

Alternate DOC for central diabetes insipidus?

A

Chlorpropamide

97
Q

MOA of Chlorpropamide in treatment of central diabetes insipidus?

A

Stimulates release of ADH

98
Q

DOC for nephrogenic diabetes insipidus?

99
Q

3 drugs responsible for nephrogenic diabetes insipidus?

A

Chlorpropamide, Carbamazepine, Clofibrate

100
Q

Best treatment for SAIDH?

A

Fluid restriction, Demeclocycline

101
Q

AE of Demeclocycline?

A

Nephrogenic DI, Photosensitivity

102
Q

DOC for refractory cases of SIADH?

A

Conivaptan

103
Q

MOA of Conivaptan in treatment of SIADH?

A

ADH receptor antagonist

104
Q

Optimal screening tool for diagnosing Cushing Syndrome?

A

24-hour urine for free cortisol level

105
Q

Etiology of ACTH-dependent Cushing Syndrome?

A

Pituitary excess; Ectopic ACTH production

106
Q

Etiology of ACTH-independent Cushing Syndrome?

A

Adrenal tumor; Exogenous steroid use

107
Q

DOC for ACTH-dependent Cushing Syndrome?

A

Ketoconazole

108
Q

Role of Ketoconazole in treatment of ACTH-dependent Cushing Syndrome?

A

Inhibits production of 11a hydroxylase … needed for production of cortisol in adrenal cortex

109
Q

Need to evaluate for ___ in patients with HTN + unexplained hypokalemia

A

Primary hyperaldosteronism

110
Q

Most common cause of Primary hyperaldosteronism?

A

Bilateral adrenal hyperplasia

111
Q

Best treatment for Primary hyperaldosteronism caused by adrenal hyperplasia?

A

Spironolactone

112
Q

Best treatment for Primary hyperaldosteronism caused by adrenal adenoma?

A

Adrenalectomy

113
Q

Which type of CA can cause primary adrenal insufficiency?

A

Lymphoma, leukemia

114
Q

Best treatment for primary adrenal insufficiency?

A

Glucocorticoids + mineralocorticoids

115
Q

Most common cause of secondary adrenal insufficiency?

A

Rapid cessation of glucocorticoids

116
Q

Best treatment for secondary adrenal insufficiency?

A

Glucocorticoids

117
Q

Conditions associated with pheochromocytoma?

A

MEN 2A/2B, Von Hippel Lindau, Neurofibromatosis

118
Q

DOC for pheochromocytoma prior to surgical excision?

A

Phenoxybenzamine

119
Q

3 clinical signs of MEN1?

A

Parathyroid hyperplasia, Pituitary tumor, Pancreatic tumor

120
Q

If both MEN2A and MEN2B have medullary thyroid CA + pheochromocytoma, what distinguishes the two?

A

MEN2A = Parathyroid hyperplasia, MEN2B = Marfanoid, Mucosal neuromas

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