Endocrine Hx and Exam

Question 1

T/F: the thyroid regulates body’s metabolism and has NO effect on calcium levels

Answer 1

True

[Parathyroid glands regulate calcium levels and have no effect on body’s metabolism]

Question 2

Viscerosomatic reflex for thyroid and parathyroid

Answer 2

T1-T4

Question 3

Where/what enzyme converts vit D to active form?

Answer 3

Kidney - 1 alpha hydroxylase

Question 4

What is the most common cause of hypocalcemia?

Answer 4

Hypoparathyroidism

Question 5

Cuases of hypoparathyroidism

Answer 5

Surgical removal of glands during thyroidectomy
DiGeorge syndrome
Hereditary autoimmunity syndrome

Question 6

Signs/symptoms of hypoparathyroidism: neuropsych

Answer 6

seizures, dementia, anxiety, depression, extrapyramidal symptoms like parkinsonism

Question 7

Signs/symptoms of hypoparathyroidism: neuromuscular

Answer 7

Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms

Question 8

Signs/symptoms of hypoparathyroidism: CV

Answer 8

CHF, hypotension, prolonged QT interval

Question 9

Signs/symptoms of hypoparathyroidism: autonomic

Answer 9

Biliary colic
Bronchospasm
Diaphoresis

Question 10

Signs/symptoms of hypoparathyroidism: other

Answer 10

Cataracts
Dry coarse skin
Hyperpigmentation
Eczema
Steatorrhea

Question 11

Test for hypoparathyroidism (hypocalcemia)

Answer 11

Chvostek sign

Trousseau’s sign

Question 12

Primary hyperparathyroidism most common cause

Answer 12

Adenomas (may be associated with MEN1)

[other causes are hyperplasia, carcinoma]

Question 13

Secondary hyperparathyroidism

Answer 13

Low calcium causes high PTH

Question 14

About 90% of hypercalcemia is caused by

Answer 14

Hyperparathyroidism or malignancy

Question 15

CNS, Renal, GI, and Cardiac symptoms of Hyperparathyroidism

Answer 15

Lethargy, weakness, confusion, coma

Polyuria, dehydration, nocturia, renal stones, renal failure

Constipation, nausea, anorexia, gastric ulcer, pancreatitis

Syncope from arrhythmias

Question 16

Stones
Bones
Groans
Thrones
Psychiatric overtones

Answer 16

Hyperparathyroidism

Question 17

Biologically active thyroid hormone

Answer 17

T3

Question 18

MCC of hypothyroidism

Answer 18

Hashimoto’s thyroiditis

[others include lithium medications, pregnancy, tx for hyperthyroidism, or thyroidectomy]

Question 19

Symptoms of hypothyroid

Answer 19

Constipation
Depression
Fatigue
Pale/dry skin
Sensitivity to cold
Elevated cholesterol
Dry brittle nails and hair
Weight gain

Question 20

MCC of hyperthyroidism

Answer 20

Grave’s disease

[others: toxic nodular goider, thyroiditis, excess consumption of iodine or amiodarone, pregnancy]

Question 21

Classic grave’s sign

Answer 21

Exophthalmos “proptosis”

Question 22

USPSTF recommendation for thyroid screen

Answer 22

Grade I = insufficient evidence; no recommendation

Question 23

Primary vs. secondary addisons disease (adrenal insufficiency)

Answer 23

Primary = adrenal problem

Secondary = due to lack of ACTH

Question 24

Symptoms of addison’s disease

Answer 24

N/V/D in about 50% of cases

Salty food craving

Hypotension

Skin and oral hyperpigmentation

Question 25

What causes addisonian crisis (acute adrenal insufficiency), what are symptoms

Answer 25

Times of stress (illness, surgery, etc) Sudden penetrating pain of back, extremities, vomiting, diarrhea

Question 26

Most common cause of endogenous form of cushing syndrome

Answer 26

Cushing’s disease

Question 27

Difference between addisons, cushing’s disease, and cushing’s syndrome

Answer 27

Addisons = adrenal insufficiency Cushing’s disease = adrenal overproduction of cortisol d/t tumor, MCC of cushing’s syndrome Cushing’s syndrome = adrenal overproduction d/t endogenous or exogenous cause

Question 28

When cushing’s syndrome is caused by a _______ tumor, it is called cushing’s disease

Answer 28

Pituitary tumor

Question 29

Symptoms of cushing syndrome

Answer 29

Fatigue and sleeping problems Headaches Backaches Swelling Irritability Repeated infections, poorly healing wounds Acne, hair loss

Question 30

Signs of cushings

Answer 30

Round face Abdominal striae Buffalo hump Easy bruising Excess facial hair

Question 31

Acanthosis nigracans may indicate what condition

Answer 31

Diabetes

Question 32

54 y/o female presents with tingling of toes and lips. She also notes muscle spasms. PMH includes hyperthyroidism with thryoidectomy 9 months ago. She is now on thyroid replacement meds. Current TSH is 4.9 (normal is 0.5-5) what is the cause of her sx? ``` A. Hypothyroidism B. Hyperthyroidism C. Hypoparathyroidism D. Hyperparathyroidism E. Cushing syndrome ```

Answer 32

C. Hypoparathryroidism