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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
Q

meds increase thyroid binding globulin

A

OCPs

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26
Q

adrenal infarct in complicated pregnancy

A

sheehan syndrome

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27
Q

indications to treat subclinical hypoT

A

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

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28
Q

big three for primary hyperaldo

A

HTN
metabolic alkalosis
hypokalemia

  • potassium - may be normal (hint is muscle cramps)
  • may then become hypoK with loops/thiazides
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29
Q

plasma:renin suggesting primary hyperaldo

A

greater than 20

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30
Q

confirm diagnosis primary hyperaldo

A

oral saline load for adrenal suppression

- also consider CT or adrenal venous sampling

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31
Q

management primary hyperaldo

A

unilateral - surgery

bilateral - aldosterone antagonist

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32
Q

initial test androgen deficiency

A 
AM testosterone level
if low - then REPEAT
then - LH and FSH
- elevated - primary hypogonad
- low or normal - secondary hypogonad
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33
Q

cutoff for adrenal incidentaloma CT findings high risk

A

greater 10 hounsfield units
greater 4cm
greater 50% contrast retention after 10 minutes

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34
Q

indications for statin

A

LDL greater 190
established ASCVD - MI, CVA, etc
40yo and DM
40yo and ASCVD 7.5% - mod-high intensity

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35
Q

high intensity statins

A

atorva 40-80

rosuva 20-40

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36
Q

dexamethasone and thyroid biochem?

A

decreases T4 to T3 peripheral conversion

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37
Q

tx thyroid storm

A

BB and thionamide

consider dexamethasone

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38
Q

risk with thionamide

A

agranulocytosis

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39
Q

euthyroid sick lab to check

A

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

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40
Q

hyperCa due to antacids - lab findings?

A

metabolic alkalosis
renal insufficiency
low-normal PTH

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41
Q

test to distinguish primary hyperPTH vs FHH

A

test urinary Ca

  • low in FHH
  • high in primary hyperPTH
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42
Q

parathyroidectomy indications in primary hyperPTH (6)

A 
age less 50yo
osteoporosis
serum Ca greater than 1 above ULN
renal insufficiency
stones
urine Ca greater 400mg/d
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43
Q

whipples triad

A

for hypoglycemia

- blood glucose less 55, symptoms, better with sugar

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44
Q

test to tell factitious insulin use

A

c peptide - low
- proinsulin is low as well

insulinoma - has high c peptide and high proinsulin

45
Q

indication for imaging in hypogonadism

A 
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
Q

central hypogonad

A

frequently seen in men with DMII

- low serum T and inappropriately low/normal FSH/LH

47
Q

when to start insulin?

A

A1c >10%, fasting glucose greater 300, symptoms of hyperglycemia

48
Q

etiology of acquired hypogonad

A

mumps, cirrhosis, chronic renal failure, HIV

49
Q

patient gets radioactive iodine ablation - how do you adjust levoT dose?

A

TSH - remains suppressed for months

- instead base tx on T3 and T4 levels and symptoms

50
Q

indications bariatric surgery

A

BIM greater 40

BMI greater 35 with at least 1 comorbid

51
Q

blood pressure and thyroid

A 
hyperT = increase SBP
hypoT = increased DBP
52
Q

initial eval for thyroid nodule

A

TSH and ultrasound

53
Q

labs monitor medullary thyroid cancer

A

calcitonin

54
Q

urine Cl in hypoK with met alkalosis?

A

low - vomiting/GI loss

high - renal handling issues, diuretics

55
Q

stridor after thyroidectomy

A

medical emergency

- DDX - hematoma, hypoCa, nerve injury

56
Q

DDx hypogonadism

A

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
Q

urine Ca in hyperPTH work up

A

helpful for prognosis as well as diagnosis

- more complications if greater 400 mg/d

58
Q

acute onset HA, bitemporal visual field deficits, paresis of CN III

A

pituitary apoplexy - most often hemorrhage

59
Q

red irritated eye

A

may represent grave ophthalmopathy

60
Q

thyrotoxicosis and Ca

A

increased osteoclast activity - lead to hyperCa

61
Q

vit D deficiency with primary hyperPTH

A

can mask hyperCa (increases once repleted)

62
Q

work up severe or early onset osteoporosis

A

hyperT, hyperPTH, vit D/Ca deficient, malabsorption, cushings, RA, meds (steroids), CKD, liver disease, alcohol

63
Q

PRL in CKD?

A

can see hypePRL - very common

- modest elevation and still less 100

64
Q

urine Ca in FHH

A

less than 100

65
Q

hyperCa and elevated 1,25 vit D

A

get a CXR - sarcoid/lymphoma?

66
Q

vit D testing in PTH independent hyperCa?

A

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
Q

cushings diagnosis

A

abnormal results on TWO separate tests
- low dose dex supp, 24hr urine cortisol, late night salivary cortisol

then - check ACTH

68
Q

ACTH independent hypercortisolism

A

ACTH low

- adrenal mass or hyperplasia - get CT scan

69
Q

ACTH dependent hypercortisolism

A

ACTH high

  • pituitary adenoma
  • may need pituitary MRI or petrosal sampling
70
Q

use of high dose dex supp test

A

ectopic ACTH tumor - will have NO suppression

- they are resistant to feedback with high dose dex

71
Q

hyperTG cutoffs for tx

A

150-500 - lifestyle, statins if ASCVD risk
greater 1000 - fibrate, fish oil, NO alcohol
- this is to prevent pancreatitis

72
Q

risks with sulfonylureas

A

hypoglycemia and weight gain

73
Q

DPP-4 and weight?

A

neutral

74
Q

adrenal incidentaloma work up?

A

functional testing - urine metanephrines, aldosterone:renin, overnight dex suppression

if negative - FNA if cancer concern - greater 4cm or concerning imaging characteristics

75
Q

normocytic anemia, leukopenia, myeloneuropathy in gastric bypass patient

A

copper deficient

76
Q

ataxia, spasticity, weakness, positive romberg, dorsal column nutrient

A

B12

77
Q

metabolics with adrenal insuffiency

A

non-gap acidosis, hypoNa, hypoglycemia, hyperK

78
Q

can worsen copper deficient

A

zinc deficient

79
Q

low risk of per-op HPA suppression

A

daily morning prednisone less 5mg for less 3 weeks or 10mg QOD
- no need for per-op steroids

80
Q

intermediate risk peri-op HPA suppression

A

daily pred 5-20mg for greater 3 weeks

- pre-op- HPA axis testing recommended

81
Q

high risk peri-op HPA suppression

A

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
Q

testing to monitor central hypoT

A

T4 levels

83
Q

antidiabetic oral that is weight neutral and lower risk of hypoglycemia in CKD

A

DPP-IV

84
Q

tx of osteoporosis in CKD patients

A

denosumab

85
Q

FRAX score indicating treatment

A

10 year hip greater 3% risk

major osteoporotic fracture risk 20%

86
Q

ED in ESRD

A

most men will experience

- tx - sildenafil

87
Q

develop anti-androgen adverse effect on spironolactone - alternative option

A

eplerenone

88
Q

PTH with even mild elevation of Ca?

A

PTH should be less than 20

89
Q

hypoCa after parathyroidectomy

A

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
Q

pred mechanism in thyroid storm

A

inhibit T4 to T3 conversion

91
Q

central hypoT work up

A

DDx - mass lesion, radiation, infiltrative (hemochrom, sarcoid)

should get MRI - look for mass lesion
also - determine if AI present - cosyn stim test

92
Q

MEN 2A

A

parathyroid hyperplasia
medullary thyroid cancer
pheo

93
Q

MEN 2B

A

medullary thyroid cancer, pheo, marfan, mucosal neuroma

94
Q

diagnosis cushing syndrome

A

requires 2 different screening tests
1 - low dose overnight dex supp test
2 - late night salivary cortisol
3 - 24 hour urine free cortisol

95
Q

can lead to false positive dex supp test

A

estrogen - increases cortisol binding globulin

96
Q

can worsen statin myopathy

A

hypoT

97
Q

oral estrogen and thyroid binding globulin

A

increase it

98
Q

cancer risk in klinefelters

A

breast

99
Q

work up thyroid nodule

A

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
Q

concerning findings for thyroid nodule

A

larger, microCa, hypoechoic, indistinct margins

101
Q

contraindications for GLP-1

A

medullary thyroid cancer
MEN 2
pancreatitis history

102
Q

weight loss and low risk of hypoglycemia oral diabetic med

A

GLP-1

103
Q

size of micro vs macro prolactinoma

A

10mm

104
Q

work up if elevated aldosterone:renin

A

adrenal suppression test = salt load

- positive - image adrenals

105
Q

treatment for adrenal hyperplasia

A

unilateral - surgery

bilateral - medical

106
Q

MEN 1

A

primary hyperPTH, enteropancreatic tumor, pituitary

107
Q

what to do if diagnose medullary thyroid cancer? (3 things)

A

1 - eval for mets
2 - ID co-existing tumors
3 - identify possible germline RET mutations

108
Q

fibrate in hyperTG indication?

A

if greater 1000 TG level

109
Q

management TG pancreatitis

A

insulin gtt if glucose greater 500

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