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ABIM UWorld > Endocrine, Diabetes, and Metabolism > Flashcards

Endocrine, Diabetes, and Metabolism Flashcards

1
Q

labs/raiu exogenous thyroid

A

high T3 (dietary supps higher amounts), low thyroglobulin, suppressed TSH, <1% uptake

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2
Q

use of thyroglobulin

A

helpful differentiate exogenous vs other for thyrotoxicosis (low in exogenous)

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3
Q

increase risk of ? with acromegaly

A

cancer - esophageal, gastric, colon, melanoma

also - elevated CV risk

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4
Q

best lag dx acromegaly

A

IGF-1

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5
Q

phos in acromegaly

A

70% are hyperP (IGF-1 increases tubular P reabsorption)

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6
Q

monitoring and size for pituitary incidentaloma

A

greater 10mm - check hyper/hypofxn and visual field
5-9mm - follow up MRI 12 months
2-4mm - no further testing

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7
Q

T score cut offs

A

osteopenia -1.1 to -2.5

osteoporosis less than -2.5

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8
Q

tool to determine osteoporosis screening

A

FRAX

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9
Q

how to eval risk for adrenal incidentaloma

A

based on morphologic characteristics
- irregular, contrast enhancing, high attenuation
if B/L or larger 4cm - suggests malignancy

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10
Q

screening labs for adrenal incidentaloma

A

dex supp test - cushings
plasma/urine metanephrines - pheo
plasma aldo:renin ratio - hyperaldo

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11
Q

meds to give prior to pheo resection

A

alpha-blockade

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12
Q

typical Ca for malignancy

A

Ca more than 13

- most often PTH-rp secreting tumor

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13
Q

typical Ca for primary hyperPTH

A

mild (less than 11)

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14
Q

produced by lymphoma, leads to hyperCa

A

a1-hydroxylase

- leads to 1,25 vit D formation and GI absorption

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15
Q

tx diabetic peripheral neuropathy

A

antidepressant - amitriptyline/duloxetine
anticonvulsant - pregabalin/valproic acid
topical capsaicin
alpha-lipoic acid
TENS
lido patch

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16
Q

abx makes sulfonylurea hypoglycemia worse

A

bactrim

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17
Q

tx of dequervain thyroiditis

A 
NSAIDs and supportive
severe pain - glucocorticoids
thyroid is ALWAYS tender
thyrotoxicosis = consider BB
monitor TSH every 2-8 weeks
95% recover
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18
Q

clinical course dequervain thyroiditis

A

hyperT - euthyroid - hypoT

each phase up to 8 weeks

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19
Q

rule out test for acromegaly

A

IGF-1

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20
Q

test if IGF-1 is positive

A

oral glucose suppression test

  • if suppressed - no acromegaly
  • if does NOT suppress - MRI brain
  • MRI brain normal - check ectopic source GH
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21
Q

oral glucose suppression test

A

75g oral glucose load

  • normal - GH decreases to less than 1ng/mL in 2hrs
  • acromegaly - will have GH >2 - get brain MRI
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22
Q

labs for central hypoT

A

low TSH and low T4

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23
Q

work up central hypoT

A

neuroimaging

and other pituitary hormone testing

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24
Q

before start central hypoT on treatment

A

check for adrenal insufficiency

- can precipitate crisis!

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25
meds increase thyroid binding globulin
OCPs
26
adrenal infarct in complicated pregnancy
sheehan syndrome
27
indications to treat subclinical hypoT
TSH over 10 TSH 7 - 9.9 - if less than 70yo TSH ULN - 6.9 - convincing symptoms and less 70yo if age over 70yo - do NOT treat (more harm than good) anti-TPO Abs
28
big three for primary hyperaldo
HTN metabolic alkalosis hypokalemia - potassium - may be normal (hint is muscle cramps) - may then become hypoK with loops/thiazides
29
plasma:renin suggesting primary hyperaldo
greater than 20
30
confirm diagnosis primary hyperaldo
oral saline load for adrenal suppression | - also consider CT or adrenal venous sampling
31
management primary hyperaldo
unilateral - surgery | bilateral - aldosterone antagonist
32
initial test androgen deficiency
``` AM testosterone level if low - then REPEAT then - LH and FSH - elevated - primary hypogonad - low or normal - secondary hypogonad ```
33
cutoff for adrenal incidentaloma CT findings high risk
greater 10 hounsfield units greater 4cm greater 50% contrast retention after 10 minutes
34
indications for statin
LDL greater 190 established ASCVD - MI, CVA, etc 40yo and DM 40yo and ASCVD 7.5% - mod-high intensity
35
high intensity statins
atorva 40-80 | rosuva 20-40
36
dexamethasone and thyroid biochem?
decreases T4 to T3 peripheral conversion
37
tx thyroid storm
BB and thionamide | consider dexamethasone
38
risk with thionamide
agranulocytosis
39
euthyroid sick lab to check
low T3 can differentiate from hyperT (has high T3) there is decreased T4 to T3 conversion enzyme = 5 monodeiodinase also - decreased T4 production / clearance TSH is suppressed due to illness labs = low T3, low TSH, low T4
40
hyperCa due to antacids - lab findings?
metabolic alkalosis renal insufficiency low-normal PTH
41
test to distinguish primary hyperPTH vs FHH
test urinary Ca - low in FHH - high in primary hyperPTH
42
parathyroidectomy indications in primary hyperPTH (6)
``` age less 50yo osteoporosis serum Ca greater than 1 above ULN renal insufficiency stones urine Ca greater 400mg/d ```
43
whipples triad
for hypoglycemia | - blood glucose less 55, symptoms, better with sugar
44
test to tell factitious insulin use
c peptide - low - proinsulin is low as well insulinoma - has high c peptide and high proinsulin
45
indication for imaging in hypogonadism
``` serum T less 200 if age less 65 serum T less 150 if age greater 65 mass effect sx multiple pituitary hormone deficiencies hyperPRL ```
46
central hypogonad
frequently seen in men with DMII | - low serum T and inappropriately low/normal FSH/LH
47
when to start insulin?
A1c >10%, fasting glucose greater 300, symptoms of hyperglycemia
48
etiology of acquired hypogonad
mumps, cirrhosis, chronic renal failure, HIV
49
patient gets radioactive iodine ablation - how do you adjust levoT dose?
TSH - remains suppressed for months | - instead base tx on T3 and T4 levels and symptoms
50
indications bariatric surgery
BIM greater 40 | BMI greater 35 with at least 1 comorbid
51
blood pressure and thyroid
``` hyperT = increase SBP hypoT = increased DBP ```
52
initial eval for thyroid nodule
TSH and ultrasound
53
labs monitor medullary thyroid cancer
calcitonin
54
urine Cl in hypoK with met alkalosis?
low - vomiting/GI loss | high - renal handling issues, diuretics
55
stridor after thyroidectomy
medical emergency | - DDX - hematoma, hypoCa, nerve injury
56
DDx hypogonadism
primary - testicular - klinefelter, drugs, orchitis, trauma, CKD secondary - pituitary and hypothalamic - tumor, cranial trauma, hemochroma, apoplexy combined - hypercortisol and cirrhosis HA and visual loss - check a PRL
57
urine Ca in hyperPTH work up
helpful for prognosis as well as diagnosis | - more complications if greater 400 mg/d
58
acute onset HA, bitemporal visual field deficits, paresis of CN III
pituitary apoplexy - most often hemorrhage
59
red irritated eye
may represent grave ophthalmopathy
60
thyrotoxicosis and Ca
increased osteoclast activity - lead to hyperCa
61
vit D deficiency with primary hyperPTH
can mask hyperCa (increases once repleted)
62
work up severe or early onset osteoporosis
hyperT, hyperPTH, vit D/Ca deficient, malabsorption, cushings, RA, meds (steroids), CKD, liver disease, alcohol
63
PRL in CKD?
can see hypePRL - very common | - modest elevation and still less 100
64
urine Ca in FHH
less than 100
65
hyperCa and elevated 1,25 vit D
get a CXR - sarcoid/lymphoma?
66
vit D testing in PTH independent hyperCa?
elevated 1,25 - sarcoid/lymphoma elevated 25 - vit D toxicity normal vit D - hyperT, MM, adrenal tumor, acromegaly, vit A toxic, immobile, milk alkali
67
cushings diagnosis
abnormal results on TWO separate tests - low dose dex supp, 24hr urine cortisol, late night salivary cortisol then - check ACTH
68
ACTH independent hypercortisolism
ACTH low | - adrenal mass or hyperplasia - get CT scan
69
ACTH dependent hypercortisolism
ACTH high - pituitary adenoma - may need pituitary MRI or petrosal sampling
70
use of high dose dex supp test
ectopic ACTH tumor - will have NO suppression | - they are resistant to feedback with high dose dex
71
hyperTG cutoffs for tx
150-500 - lifestyle, statins if ASCVD risk greater 1000 - fibrate, fish oil, NO alcohol - this is to prevent pancreatitis
72
risks with sulfonylureas
hypoglycemia and weight gain
73
DPP-4 and weight?
neutral
74
adrenal incidentaloma work up?
functional testing - urine metanephrines, aldosterone:renin, overnight dex suppression if negative - FNA if cancer concern - greater 4cm or concerning imaging characteristics
75
normocytic anemia, leukopenia, myeloneuropathy in gastric bypass patient
copper deficient
76
ataxia, spasticity, weakness, positive romberg, dorsal column nutrient
B12
77
metabolics with adrenal insuffiency
non-gap acidosis, hypoNa, hypoglycemia, hyperK
78
can worsen copper deficient
zinc deficient
79
low risk of per-op HPA suppression
daily morning prednisone less 5mg for less 3 weeks or 10mg QOD - no need for per-op steroids
80
intermediate risk peri-op HPA suppression
daily pred 5-20mg for greater 3 weeks | - pre-op- HPA axis testing recommended
81
high risk peri-op HPA suppression
daily pred greater 20mg for greater 3 weeks or if cushingoid appearance present - need stress dose peri-op - 100mg IV hydrocort during surgery - then 50mg Q8h for 1-2 day with taper
82
testing to monitor central hypoT
T4 levels
83
antidiabetic oral that is weight neutral and lower risk of hypoglycemia in CKD
DPP-IV
84
tx of osteoporosis in CKD patients
denosumab
85
FRAX score indicating treatment
10 year hip greater 3% risk | major osteoporotic fracture risk 20%
86
ED in ESRD
most men will experience | - tx - sildenafil
87
develop anti-androgen adverse effect on spironolactone - alternative option
eplerenone
88
PTH with even mild elevation of Ca?
PTH should be less than 20
89
hypoCa after parathyroidectomy
hungry bone syndrome - monitor Ca 2-4 times per day - IV Ca if less 7.5 or severe symptoms - replete Mg, P replete only if severe (less than 1) - labs - hyperCa, hypoP, hypoMg
90
pred mechanism in thyroid storm
inhibit T4 to T3 conversion
91
central hypoT work up
DDx - mass lesion, radiation, infiltrative (hemochrom, sarcoid) should get MRI - look for mass lesion also - determine if AI present - cosyn stim test
92
MEN 2A
parathyroid hyperplasia medullary thyroid cancer pheo
93
MEN 2B
medullary thyroid cancer, pheo, marfan, mucosal neuroma
94
diagnosis cushing syndrome
requires 2 different screening tests 1 - low dose overnight dex supp test 2 - late night salivary cortisol 3 - 24 hour urine free cortisol
95
can lead to false positive dex supp test
estrogen - increases cortisol binding globulin
96
can worsen statin myopathy
hypoT
97
oral estrogen and thyroid binding globulin
increase it
98
cancer risk in klinefelters
breast
99
work up thyroid nodule
thyroid U/S and TSH - risk fx or concerning U/S finding = FNA - no risk fx but normal thyroid and normal/high TSH = FNA low TSH - iodine scintigraphy - hot nodule - treat hyperT - cold nodule - FNA
100
concerning findings for thyroid nodule
larger, microCa, hypoechoic, indistinct margins
101
contraindications for GLP-1
medullary thyroid cancer MEN 2 pancreatitis history
102
weight loss and low risk of hypoglycemia oral diabetic med
GLP-1
103
size of micro vs macro prolactinoma
10mm
104
work up if elevated aldosterone:renin
adrenal suppression test = salt load | - positive - image adrenals
105
treatment for adrenal hyperplasia
unilateral - surgery | bilateral - medical
106
MEN 1
primary hyperPTH, enteropancreatic tumor, pituitary
107
what to do if diagnose medullary thyroid cancer? (3 things)
1 - eval for mets 2 - ID co-existing tumors 3 - identify possible germline RET mutations
108
fibrate in hyperTG indication?
if greater 1000 TG level
109
management TG pancreatitis
insulin gtt if glucose greater 500

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