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2CK Smartbook > Endocrine/ Metabolism > Flashcards

Endocrine/ Metabolism Flashcards

1
Q

what are the symptoms of hypocalcemia

A

fatigue, anxiety, depression initially;
parasthesia, tetany (involuntary contractions) of the lips, face and extremities, seizures and QT prolongation in severe cases

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2
Q

in obese women what provides more continual estrogen despite loss of ovarian estrogen production

A

peripheral fat contains aromatase which converts endogenous androgens to estrogens so obese patients have increased aromatase activity leading to increased estrogen even despite menopause

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3
Q

a patient with hypogonadotropic hypogonadism as well as low TSH and mild hyperprolactinemia is likely suffering from what condition

A

nonfunctional pituitary adenoma (produces just the alpha subunit and suppresses other trophic hormones as well due to mass effect)

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4
Q

infants born to mothers with Grave’s disease are at increased risk for high circulating levels of what? what is the treatment for symptomatic patients?

A

anti-TSH receptor antibodies (activating)

Tx: methimazole and beta blockers for symptomatic patients until self-resolution

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5
Q

does thyroid hormone cross the placenta

A

not in significant amounts

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6
Q

algorithm for assessing precocious puberty (i.e. before age 8)

A

if bone growth is elevated check basal LH, if basal LH is elevated it is gonadotropin-dependent (most commonly idiopathic), if basal LH is low and does not respond to GnRH it is gonadotropin independent (likely CAH or a gonadal tumor), if LH is low but increases with GnRH stim then it is likely gonadotropin dependent

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7
Q

what should you be careful not to give when treating symptoms of pheochromocytoma

A

do not give beta blocker first; make sure to start antihypertensive therapy with alpha blocker before beta as unopposed alpha adrenergic activity can cause rapid increases in BP

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8
Q

what is the initial therapy for prolactinoma

A 
dopamine agonist (cabergoline); if sx do not improve then consider surgery
surgery is unlikely to be needed for microadenoma (tumor
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9
Q

what happens to the amount of albumin bound to calcium vs. ionized in acidosis vs. alkalosis

A

acidosis: more H+ bound to albumin leaving less space for calcium resulting in high ionized calcium concentration
alkalosis: fewer H+ bound to albumin resulting in increased binding of calcium to albumin and low ionized calcium concentration

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10
Q

A patient has surgery and develops tachycardia, hypertension, lid lag, tremor, agitation, delirium, warm moist skin, nausea, vomiting and diarrhea. What diagnosis do you suspect and what is the treatment?

A 
thyroid storm (occurs in predisposed patients with untreated hyperthyroidism after surgeries or iodine toxicity)
Tx:  TFT's, propranolol, PTU followed by iodine solution after an hour (decrease hormone synthesis then decrease release), glucocorticoids (decrease peripheral T4-->T3 conversion)
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11
Q

how do you differentiate between Cushing’s disease (ACTH-secreting pituitary adenoma) and ectopic ACTH secretion

A

dexamethasone suppression test: failure to suppress serum cortisol to

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12
Q

what should happen to a woman’s levothyroxine dose during pregnancy

A

it should increase: maternal hypothyroidism causes decreased IQ in infant

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13
Q

a diabetic patient has abdominal bloating, decreased appetite, early satiety and nausea; what is the problem and treatment?

A

diabetic gastroparesis

Tx=metoclopramide (has prokinetic and antiemetic properties) or erythromycin; optimize diabetes control; small, frequent meals (to decrease postprandial hypoglycemia due to malabsorption)

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14
Q

what plasma renin and aldosterone test values are suggestive of primary hyperaldosteronism

A

plasma aldosterone to renin activity ratio > 20

plasma aldosterone > 15ng/dL

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15
Q

in hyperaldosteronism, what prevents severe rapid hypernatremia and volume overload

A

aldosterone escape promotes spontaneous diuresis

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16
Q

what is the treatment for patients symptomatic with Paget’s disease (you don’t need to treat asymptomatic patients)

A

bisphosphanates (calcitonin is weaker, but used if pt cannot tolerate bisphosphanates)

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17
Q

what are the four symptoms of MEN2B

A
  1. medullary thyroid carcinoma
  2. pheochromocytoma
  3. mucosal neuromas
  4. marfanoid habitus
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18
Q

what are the three symptoms of MEN2A

A
  1. medullary thyroid carcinoma
  2. pheochromocytoma
  3. parathyroid hyperplasia
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19
Q

what are the symptoms of MEN1

A
  1. pituitary tumor
  2. primary hyperparathyroidism
  3. enteropancreatic tumors
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20
Q

what does hypomagnesemia do to calcium

A

hypomagnesemia causes hypocalcemia via PTH resistance

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21
Q

what is the difference between sick euthyroid and subclinical hypothyroidism

A

sick euthyroid: in acutely or severely ill patients total thyroid and free T3 are decreased (due to poor peripheral conversion to T3, then eventually T4 and TSH decrease)
subclinical hypothyroidism: TSH is elevated, but T3 and T4 are normal and patient is asymptomatic

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22
Q

Hurthle cells are seen in which cancers

A

follicular and papillary thyroid cancers

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23
Q

why must follicular thyroid neoplasm show invasion of capsule into bloodstream before diagnosis can be made of carcinoma vs. adenoma

A

follicular carcinoma is well-encapsulated and does not show much nuclear change so invasion is the only way to distinguish carcinoma from adenoma

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24
Q

what is the most common thyroid malignancy? describe its characteristics

A

papillary thyroid carcinoma: unencapsulated, slow growing, invasion of regional structures and lymph nodes, good prognosis, on histology ground glass cytoplasm and psamoma bodies, pale nuclei with central grooving and inclusion bodies

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25
Q

describe neuropathic pain in diabetes (distribution, characteristic pain of small vs. large fiber)

A

“stocking glove” distribution; small fiber involvement=pain, allodynia, parasthesias; large fiber involvement=loss of vibration, touch, pressure, and proprioceptive sensation

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26
Q

what are the treatments of diabetic neuropathic pain in order of preference

A
  1. TCA’s
  2. gabapentin
  3. NSAIDs
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27
Q

what happens to calcium and PTH in osteoporosis

A

calcium, PTH, phosphate and alkaline phosphatase are normal in osteoporosis despite lower bone density

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28
Q

what are carcinoid tumors and when does carcinoid syndrome develop

A

slow growing neuroendocrine tumors found in the small intestines, prox colon or lungs; carcinoid syndrome develops when mets to the liver prevent breakdown of secreted hormones (5HT, histamine, VIP)

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29
Q

how can you differentiate between primary polydipsia (DM and psychogenic), central DI and nephrogenic DI

A

primary polydipsia=low serum Na due to excessive water intake
central DI=high serum Na (>150) due to impaired thirst mechanism that is ADH-mediated
nephrogenic DI=normal to mildly elevated Na (142-150) due to intact thirst

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30
Q

what are the symptoms of a glucagonoma

A

necrolytic migratory erythema, hyperglycemia, GI distress, weight loss, ataxia, proximal muscle weakness, venous thrombosis

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31
Q

how do you interpret a water deprivation test

A

for polyuria and low urine Osm do a water deprivation test: if urine osm increases to >600 after 2-3 hours deprivation => primary polydipsia
if not do a desmopressin test: if urine osm increases by 50-100% it is central DI
if urine osm doesn’t increase after desmopressin it is likely nephrogenic DI

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32
Q

what is the medical therapy for Conn syndrome (used for pts who can’t undergo surgery or have bilateral adrenal hyperplasia)

A

spironolactone (also has antiandrogenic effects) or eplerenone (more selective aldosterone antagonist)

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33
Q

adrenal insufficiency and adrenal calcifications on CT suggest what etiology

A

adrenal tuberculosis (most common cause of adrenal insufficiency in developed world)

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34
Q

what are the best measures of response to treatment of DKA

A

serum anion gap and serum betahydroxybutyrate (more common ketone than acetoacetate)

35
Q

what is the risk of HPA axis suppression for patients taking low dose steroids (

A

no risk of HPA axis suppression

36
Q

at what gestational age should the 1 hour oral glucose tolerance test be given; and how is the decision made for following up with a 3 hour GTT

A

at 24-28 weeks the 1hr GTT is given

if glucose is >140 one hour after 50g load then follow up with 3hr GTT

37
Q

what is the classic triad of milk alkali syndrome

A

hypercalcemia, renal insufficiency, metabolic alkalosis

38
Q

what hormone allows you to distinguish an adrenal androgen-secreting tumor vs. a gonadal androgen-secreting tumor

A

DHEA-S (dihydroepiandrosterone-sulfate)

androstenedione, DHEA and testosterone are produced by both the ovaries and the ovaries and the adrenals, whereas DHEA-S is only produced by the adrenals

39
Q

what hormone is the key player in causing refeeding syndrome and what are the major lab abnormalities/ complications?

A

insulin (feeding after starvation causes increased insulin that calls for nutrients that aren’t there to anabolize)

  • hypophosphatemia, hypomagnesemia, hypokalemia, low thiamine
  • complications: cardiac arrythmias, heart failure, Wernicke’s
40
Q

what is the preferred treatment for Grave’s disease

A

radioactive iodine ablative therapy

41
Q

tight glycemic control (Hgb A1c

A

microvascular diseases (retinopathy, nephropathy)

no data to support overall mortality benefit or benefit for macrovascular (stroke, MI)

42
Q

what are the indications for starting a statin

A

significant atherosclerotic disease, LDL >190, age 40-75 with diabetes, 10 year ASCVD risk > 7.5%

43
Q

what is the order of diagnostic tests for workup of acromegaly

A

IGF-1 –> oral glucose suppression test –> brain MRI

44
Q

once azotemia develops in the progression of diabetic nephropathy intensive control of what parameter is most important for slowing the decline in renal function

A

intensive control of blood pressure

45
Q

what three initial diagnostic blood tests should you order for a patient in whom you suspect adrenal insufficiency

A

morning serum cortisol, ACTH and cosyntropin stimulation test

46
Q

which therapy for Grave’s disease causes an initial worsening of opthalmopathy

A

radioactive iodine ablative therapy

47
Q

what should you suspect in a patient with cold intolerance, hypoglycemia, decreased libido and hypopigmentation?

A

panhypopituitarism (note aldosterone is not affected since the RAS axis is not mediated by the pituitary)

48
Q

what does a prussian blue stain of the urine tell you

A

detects the presence of hemosiderin which indicates hemolysis

49
Q

ectopic ACTH is mainly associated with what conditions

A

small cell lung cancer and bronchial carcinoid

50
Q

how can hypokalemia be seen in Cushing’s

A

cortisol has mineralocorticoid activity when it is not in its inactive state of cortisone

51
Q

what is the difference between steroid acne and adolescent acne

A

adolescent acne has comedones (blackheads and whiteheads), steroid acne does not

52
Q

in the workup for primary hyperthyroidism if you see low radioactive iodine uptake what subsequent study should you do and how do you interpret it

A

check thyroglobulin level; if it is low this indicates exogenous thyroid hormone, if it is high this indicates glandular source (thyroiditis, iodide exposure, extraglandular production)

53
Q

proximal muscle weakness can be seen in Cushing’s as well as what other endocrine disorder

A

hyperthyroidism

54
Q

what can hypothyroidism do to cholesterol

A

hypothyroidism can cause hyperlipidemia (increased LDL) and hypertriglyceridemia

55
Q

isolated premature adrenarche in a young (

A

the adrenal gland (androgens are mainly produced there and an ovarian tumor would likely cause thelarche as well)

56
Q

what are the levels of calcium, phosphorus, PTH and alkaline phosphatase in Paget’s

A

normal Ca, phosphorus and PTH

increased alkaline phosphatase

57
Q

what test is done to predict risk of diabetic foot ulcers

A

monofilament testing

58
Q

a patient on propylthiouracil develops a sore throat and fever; what is the next best step in management

A

discontinue propylthiouracil before doing anything else (WBC count, cultures, abx)

59
Q

a toddler who has hypotension, abdominal pain, hematemesis, metabolic acidosis and radiopaque tablets on x-ray should receive what treatment

A

deferoxamine for iron poisoning

60
Q

if you suspect lead poisoning what is the first diagnostic test you should do

A

fingerstick lead level followed by venous lead level if abnormal

61
Q

what are the steps for managing a caustic ingestion (e.g. sodium hydroxide aka lye)

A

remove clothing, IV hydration, chest and abdominal x-rays with water soluble contrast to r/o perforation, upper endoscopy to evaluate extent of caustic injury

62
Q

how can you differentiate between a beta cell tumor and non-beta cell tumor in a patient with episodes of hypoglycemia

A

IGF-II will be elevated in a non-beta cell tumor (mesenchymal tumor); C-peptide will be elevated in a beta cell tumor

63
Q

what is the antidote for TCA toxicity

A

sodium bicarbonate (prevents TCA-induced inhibition of sodium fast channels in myocardium to prevent/resolve QRS widening)

64
Q

sodium thiosulfate is the antidote for what poisoning

A

cyanide poisoning

65
Q

a patient ingests a toxin and develops calcium oxalate stones; what is the toxin and what is the treatment

A

ethylene glycol toxicity

treat with fomepizole to prevent conversion of ethylene glycol to oxalic acid and glycolic acid

66
Q

what is adrenoleukodystrophy

A

accumulation of long chain fatty acids in the adrenal glands leading to adrenal insufficiency

67
Q

how do you manage acetaminophen ingestion? (algorithm)

A

if single dose >7.5g or 150mg/kg in peds or chronic ingestion check timing; if

68
Q

what is the antidote for diphenhydramine overdose

A

physostigmine

69
Q

what are the two main toxins in the air of house fires

A

cyanide (HCN) and carbon monoxide

70
Q

what are the three ways you can treat cyanide poisoning

A
  1. hydroxocobalamin
  2. sodium thiosulfate
  3. nitrites (to induce methemoglobinema and have ferric iron in hemoglobin bind up the cyanide)
71
Q

what is the mechanism of action of cyanide toxicity

A

cyanide binds and inhibits cytochrome oxidase in the electron transport chain

72
Q

what distinguishes methanol poisoning from ethylene glycol poisoning (both cause anion gap met acidosis)

A

optic disc hyperemia (whereas ethylene glycol damages the kidneys with Ca oxalate stones, methanol damages the eyes leading to blindness)

73
Q

a patient was at an indoor barbecue and now has a pinkish hue to skin and tachycardia/tachypnea; what diagnostic test should you do

A

check carboxyhemoglobin levels for suspected CO poisoning

74
Q

a patient with carbon monoxide poisoning has normal pulse ox readings; how is this possible

A

don’t trust the pulse ox in CO poisoning; carboxyhemoglobin is tricky and gets read as oxygenated hemoglobin; GIVE 100% OXYGEN VIA NRB RIGHT AWAY REGARDLESS

75
Q

what are three key symptoms of VIPoma

A

watery diarrhea (secretory), hypokalemia, hypochlorhydria (due to decreased gastric acid secretion); note: tumor will likely be in pancreatic tail

76
Q

increased appetite, dry mouth and conjunctival injection are symptoms of what substance use

A

marijuana

77
Q

when a hypothyroid woman starts oral estrogen replacement what happens to her thyroid levels

A

oral estrogen increases TBG (note transdermal does not) therefore requiring more thyroid hormone to saturate the increased TBG and increasing the required levothyroxine dose for a woman on thyroid hormone (the body cannot naturally compensate)

78
Q

how does sodium bicarb treat QRS prolongation in TCA overdose (mechanism)

A

pH and extracellular sodium hinder ability of TCA’s to bind to fast sodium channels

79
Q

what is the antidote for beta-blocker intoxication

A

glucagon

80
Q

you should screen all patients for diabetes who _____

A

have BP > 135/80, are age 45 or older, or have risk factors for diabetes

81
Q

hashimoto’s has an increased risk of complication by what thyroid malignancy

A

lymphoma of the thyroid

82
Q

what does hyperthyroidism do to bones

A

increases osteoclastic bone resoprtion leading to decreased bone mass and hypercalcemia

83
Q

what are the predisposing factors for thyroid storm and how is it treated

A

predisposing factors: surgery, acute illness, childbirth, iodine load (contrast)

tx: propranolol and steroids, admit to ICU

84
Q

in a patient with familial medullary thyroid carcinoma what do you have to screen for before thyroidectomy?

A

pheo; check VMA

make sure they don’t have pheo so that there’s no risk of hypertensive crisis during surgery

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