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Step 3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Hyperthyroid symptoms
High TSH, T3, T4
Dx?

A

Pituitary adenoma

Secretes alpha subunit which acts like TSH

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2
Q

Palpitations, hypercalcemia, goiter, lid lag

Tx?

A

Palpitations d/t hyperthyroid are d/t excessive sympathetic tone
Goal is to decrease sympathetic tone
Tx with Beta blocker

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3
Q

High TSH
NL T4
Asymptomatic
What other test would be useful in helping to guide therapy?

A 
Anti-TPO
Subclinical hypthyroid doesn't always need to be treated
Treat when 
1. Antithyroid AB detected
2. ABN lipid profile
3. Symptomatic
4. Ovulatory or menstrual dysfunction
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4
Q

Risks of untreated hyperthyroidism?

A

Cardiac arrhythmia
Cardiomyopathy
osteoperosis

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5
Q

Kiddo presents with acute illness + tachycardia, tachypnea, hyponatremia, UA with SG of 1.004 but yet, his A1C is 5.2%. Why?

A

Stress hyperglycemia

not true DM, but his response to stress hormones in the setting of acute illness

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6
Q

female infant
ambiguous genitalia
hypoNA, hypoglycemia
hypotensive

A

21-hydroxylase deficiency

17 hydroxyprogesterone will be elevated

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7
Q

female infant with ambiguous genitalia

Fluid, salt retention

A

11Beta-hydroxylase deficiency

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8
Q

infant with NL female genitalia

Fluid, salt retention

A

17alpha-hydroxylase deficiency

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9
Q

Tx for congenital adrenal hyperplasia?

A

Chronic glucocorticoid and mineralocorticoid replacement

Will need vaginoplasty/clitiroplasty later in life

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10
Q

What is refeeding syndrome?

A

People with poor po intake have low intracellelar phosphate, but Sr phosphate is normal
When the patient gets dextrose with refeeding, insulin drives phos into the cell to make ATP
Causes sr phosphate to crash –> cardiac arrhythmia, seizure, rhabdo –> death

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11
Q

SIADH is associated with which cancer?

A

Small Cell Carcinoma

Typically seen as a perihilar mass on CXR

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12
Q

Large peripheral mass on CXR concerning for which cancer?

A

Large cell carcinoma

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13
Q

CXR with cavitary lesion in bronchus is concerning for which cancer?

A

Squamous cell carcinoma

Associated with hypercalcemia d/t PTHlP

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14
Q

Tx of SIADH

A

Water restriction

Hypervolemic hyponatremia

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15
Q

Ribflavin/bit B2 deficiency causes

A

Angular cheilosis, stomatitis

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16
Q

Thiamine/ Vit B1 deficiency causes?

A 
Wet Beriberi (dilated cardiomyopathy, polyneuropathy)
Wernicke-Korsakoff (neuroloog impairment, oculomotor dysfunction, ataxia, encephalopathy, amnesia)
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17
Q

Niacin/Vit B3 deficiency

A

Pellagra (photosensitive dermatitis, diarrhea, dementia)

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18
Q

Two most common supplements that affect absorption of levothyroxine?

A

Calcium and Iron

Take 3-4 hours after levothyroxine

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19
Q 
Fatigue
Weight loss
myalgias
hyper pigmented patches
Decreased axillary and pubic hair
Hyponatremia
HyperK+
hyperchloremic metallic acidosis
Dx?
A 
Adrenal insufficiency (Addison's dz)
Confirm dx with low am cholesterol and high ACTH
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20
Q

How do you define delayed puberty in males?

A

small testicles by age 14 (<4mL)
Get a bone age, FSH, LH, and testosterone
Also consider getting a Prolacting and TSH as high levels of these interfere with GnRH

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21
Q

Delayed male puberty with elevated FSH/HL

A

Primary delayed puberty

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22
Q

ICU patient with normal TSH/T4 but low T3

A

Euthyroid sick syndrome
d/t low peripheral conversion of T4 to T3
Nothing to do, repeat labs in a couple of months

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23
Q 
Anemia
loss of proprioception
Brisk reflex
loss of ankle jerk
bald tongue
A 
Vit b12 deficiency
Often d/t low intrinsic factor in gastric mucosa
Pernicious anemia (autoimmune)
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24
Q

In severe B12 deficiency, what should be monitored in the first few days of treatment?

A

BMP
@ risk of hypokalemia
d/t reuptake of K+ in RBC formation

25
Q

Thyroid nodule
Low TSH
What next?

A

Iodine scintigraphy
If hot - treat hyperthyroidism
If cold - FNA

26
Q

Tyroid nodule
NL or Elevated TSH
Next step?

A

FNA

27
Q

Pt is dx’d with papillary thyroid cancer. What do you do next?

A

U/s of neck and lymph nodes to stage the cancer
If <1cm –> lobectomy
If >1cm –> excise thyroid

28
Q

High parathyroid hormone
Hyper calcemia
Osteroperosis
What next?

A

Parathyroidectomy

29
Q 
Young patient
Diabetes
osteoperosis
HTN
Hypokalemia
Dx?
A

Cushings syndrome

Dx - Overnight dexamethasone suppression test OR 24 hour urinary cortisol level

30
Q

borderline low calcium
High urinary calcium
Tx?

A

Add thiazide diuretic to promote calcium retention

31
Q

primary hyperparathyroidism
Gastric ulcer
pituitary dz

A

MEN neoplasia 1
parathyroid, pancreatic (gastronome), pituitary (prolactinoma)
Tx - parathyroidectomy

32
Q

What makes acromegaly dangerous?

A

Cardiovascular dz

also increased risk of colon cancer

33
Q

Hyponatremia
Low TSH
low T4

A

central hypothyroid

34
Q

if someone has a low am cortisol, what to do next?

A

ACTH stim test

workup for adrenal insufficiency

35
Q 
early puberty (girls<8, boys <9)
High LH/FSH
A

Central precocious puberty

36
Q

Hypertension
Hypokalemia
consider?

A

Hyperaldosteronism (conn’s)

measure plasma aldosterone to renin ratio

37
Q

what does amniodarone do to thyroid hormones?

A

decreases peripheral conversion of T4 to T3
So serum T4 can be high
normalizes over time

38
Q

episodic headaches, diaphoresis, tachycardia
nl thyroid
what next?

A

get plasma metanephrine and 24 hr urine catecholamine and metanephrine to r/o pheo

39
Q

s/p b/l adrenalectomy
Now with hemianopsia and hyperpigmentation
Dx?

A

Nelson’s syndrome
pituitary enlargement after a b/l adrenalectomy
happens because of loss of negative feedback from adrenal glucocorticoids

40
Q

Cushing syndrome that has cortisol levels that do not decrease with dexamethasone depression
low acth

A

adrenal cause of Cushing

get a ct

41
Q

how do OCPs interfere with thyroid hormone?

A

estrogen stimulates production of thyroid binding globulin (TBG)that soaks up peripheral thyroid hormone
usually need to increase levothyroxine dose with OCP use

42
Q

Teenager
Normal boob development
amenorrhea, no pubic hair
Dx?

A

Androgen insensitivity

check testosterone levels

43
Q

Young boy
acne
pubic hair
No testicular enlargement

A

Congential adrenal hyperplasia

44
Q 
Pt with seizures, muscle cramps, basal ganglia calcifications, cataracts
HypoCa
Hyper phos
elevated PTH
dx?
A

pseudohypoparathyroidism

45
Q

what diabetes med can cause pulmonary edema in heart failure its?

A

pioglitazone

acts on PPAR-gamma and can cause fluid retention

46
Q

Wha test can confirm diabetic neuropathy?

A

Tuning fork test

Loss of vibratory sense

47
Q

hypothyroid pt gets pregnant. any changes to tx?

A

Increase levothyroxine dose

Check TSH q 4wks

48
Q

when do you add d5 while a ska pt is on insulin gtt

A

<200

49
Q 
Hyperthyroidism
mass in neck
facial plethora and neck vein distension
dysphagia
dx?
A

Thyroid lymphoma

50
Q

indications for bisphosphonates

A

h/o fragility fx
T score <2.5 on DEXA (osteoporosis)
T score -1 to -2.5 and FRAX score >20% (osteopenia)

51
Q

erythematous scaly rasa with clearing in the center
Borders slightly elevated and crusty
angular cheilosis
Dx?

A

glucagonoma
pancreatic tumor with characteristic skin rash and mild diabetes
tend to met to the liver

52
Q 
Hypercalcemia
FHx of hypercalcemia
NL parathyroid
Low urinary excretion of Calcium
Dx?
A

Familial hypocalciuric hypercalcemia
Don’t need to do anything
hyperparathyroidism would have elevated urinary calcium

53
Q 
pt in cancer remission
hot flashes
osteoporosis
High LH/FSH
dx?
A

ovarian insufficiency
give estrogen patch
if they still have a uterus - need progestin as well

54
Q

People with subclinical hypothyroidism have an increased risk of?

A

pregnancy complications (SABs, pre-e, SGA, placental aburption)

55
Q

Hyperthyroid pt on methimazole gets preggo. Any changes?

A

Should change to propylthiouracil during the first trimester because methimazole has some teratogenic effects
Can then switch back to methimazoe for 2nd and 3rd trimesters

56
Q

Female is amenorrhea
Low LH/FSH, increased alpha subunit
dx?

A

Nonfunctioning pituitary adenoma
A functioning adenoma would have high LH/FSH
tx - trans-sphenoid resection

57
Q

What happens if a functioning prolactinoma goes untreated in a female?

A

At risk of osteoperosis 2/2 long term sex hormone exposure
Tx - Cabergoline (dopamine agonist)
Decreases prolactin levels and causes the tumor to shrink

58
Q

Newborn screening finds a low T4 and high TSH on a 1 week old. What do you do and why?

A

Congenital hypothyroidism
Start on levothyroxine
should be done asap to prevent permanent neurologic injuries

59
Q

A T1DM keeps having hypoglycemic episodes

Concerning for?

A

Adrenal insufficiency
Check cosyntropin stimulated cortisol levels
Also hx of weight loss, hyperkalemia, MAGA

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