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IM MedEd > Endocrine Shit > Flashcards

Endocrine Shit Flashcards

1
Q

Women with galactorrhea + amenorrhea….dx? poss other symptoms? tx?

A

prolactinoma, poss: bitemporal hemianopia

tx: cabergoline(Dag)

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2
Q

Men with decreased libido + bitemporal hemianopia. dx? tx?

A

Prolactinoma!

tx: cabergoline(Dag)

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3
Q

Causes of Prolactinemia…

A
  1. D antagonist(antipsychotics) - disinhibits prolactin

2. elevated TSH - stimulates prolactin production

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4
Q

you see a person who you think has excess prolactin. what tests do you need to run?

A
  1. prolactin levels
  2. TSH levels (hyperthy = trig prolac produc)
  3. look at meds list (antipsychotics)
  4. MRI
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5
Q

When do you do surgery for prolactinoma?

A

when Dag(cabergoline > bromocriptine) fails. usually responds well to Dag but if not then go to surgery.

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6
Q

Child who is very very tall for his age + super high blood glucose. dx? tx?

A

acromegaly/gigantism!

dx: w/ ILGF-1 levels(GH is pulsitile) & confirm w/MRI
tx: surgery + octreotide(stop existing GH)

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7
Q

adult who has enlarged hands, feet, face and visceral organs + diabetes. dx? tx?

A

Acromegly!

dx: ILGF-1 levels(GH is pulsitile) & confirm w/MRI +/- failure to supress GH w/glucose tolerance test
tx: Surgery + octreotide(stops existing GH)

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8
Q

How do you treat excess GH?

A

surgery + ocretotide

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9
Q

Why isnt a GH level helpfull when you suspect acromegly? what test do you look at instead?

A

bc GH is pulsitile and will almost always appear normal! must look at ILGF-1 instead

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10
Q

What would you see in a glucose suppression tests w/acromegly? whats norm?

A

NORMAL: give glucose and watch for decreased in GH

+ test: give glucose and no decrease in GH

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11
Q

Adult with acrogmegly will likely die from…

A

heart probs

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12
Q

Post-partum women who now presents wiht hypotension, lethargy, coma… dx? tx?

A

Seehan’s syndrome = hypopituitarism.

dx: cort + T4 levels
tx: replace!

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13
Q

pt w/bitemporal hemi hx that now presents w/hypotension, lethargy, coma, stupor, nuchal rigidity, HA, nausea, vomiting…dx?

A

Apoplexy = pit tumor outgrew blood supply or is bleeding.

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14
Q

Pt w/ libido probs, hypothyroid shit, and now presents w/hypotension. all occuring over a long period of time.. dx?

A

prob hypopituitarism due to tumor, infiltration or AI shit.

dx: insulin = no changes in GH or CORT

Normal: insulin = increase GH, Cort, Glucagon

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15
Q

Guy falls at work and gets an MRI, MRI is normal except the sella is empty. dx? tx?

A

Empty sella syndrome! = pit is there its just up in the brain!

DONT TREAT! they are fine =D

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16
Q

Normal healthy person comes in for regular check up and complains of polydipsis & polyuria. what test do you run first?

A

U/A! = check for glucose in urine

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17
Q

Normal person w/polyuria + polydip w/normal U/A. dx?

A

Diabetes Insipidus = central v nephrogenic v psycogenic

18
Q

psycogenic v nephrogenic v central DI dx? tx?

A

Water deprovation tests:

  1. Psycogenic = water depo shows rise in Uosm = stop drinking so much water
  2. Central = water depo + exogenous ADH = rise in Uosm = desmopressin
  3. Nephrogenic = water depo + exog ADH = no change in Uosm = diuretics
19
Q

Person w/NVH, confusion, decreased nrg, M weakness, spams, w/hyponatremia & hypotonic serum. dx? tx?

A

SIADH due to Brain, lung, hypothy shit. will have super concentrated urine.
tx: Demeclocycline

20
Q

Pt w/pretibial myxedema, opthalomopathy(proptosis, exophthalmos) dx? labs? tx?

A

Graves
Dx/Labs: dec TSH, elv T4 + diffuse RAIU
tx: sx! = propanolol, PTU or Methimazole

if not managed w/meds = Radio I ablation + surg.

21
Q

pt w/ transient hyperthyroidism but now cold thyroid on RAIU + fever dx?

A

Thyroiditis

22
Q

How to differentiate Factitious hyperthhyroidism vs Struma ovarii?

A

TBG = decreased with both! so do Sestamibi scan to look at ovaries.

23
Q

pt w/ hyperthyroidism, fever, delirium, hypotension dx? tx?

A

thyroid storm!

  • IVF, cooling blankets +
  • Steroids = decreases T4-T3 conv
  • Propanolol
  • PTU or Methimazole
24
Q

MCC of hypothyroidism? how do you treat all?

A

IATROGENIC! give T4!

25
Q

Pt w/bradycarida, dementia, decreased DTR, constipation + weight gain & lymphocytic infiltrate in thryoid biopsy…

A

Hashimotos

26
Q

Pt w/bradycarida, dementia, decreased DTR, constipation + weight gain history but now has HYPOTHEMIA, HYPOTENSION + COMA. dx? tx?

A

MYXEDEMA COMA

tx: IVF, Warming blankets, HD T4 and if really bad give T3.

27
Q

When do you start Hypothyroidism tx?

A

when symptoms start or when TSH > 10

28
Q

Orphan-annie nuclei, psammoma bodies, MC thyroid cancer. tx?

A

Papillary, resect

29
Q

thyroid cancer that looks normal & spreads hematogenously. tx?

A

resect + I2 ablation

30
Q

thyroid cancer + hypocalcemia. dx? association?

A

Medullary = tumor of c-cell making calcitonin. part of MEN2a&B

31
Q

MEN1

A

Pituitary, pancreas, parathyroid

32
Q

MEN2A

A

Pheo, parathyroid, medullary thyroid

33
Q

MEN2B

A

Pheo, medually thryoid, mucosal neuromas

34
Q

central obesity, extremity wasting, diabetes + hypertension. dx? other sx?

A

buffalo hump, moon faces. this is cushing syndrome!

+LD vs HD DST to differntiate from cushing dz

35
Q

Hypotension, NV, Fatigue, Hyperkalemia. dx? other sx? tx?

A

ADDISONS! = Primary Adrenal Insuff. decreased cortisol due to adrenal gland destruction = increase in ACTH will also give hyperpigmentation. Have Hyperkalemia due to loss of aldo. tx w/prednisone + fludrocortison

36
Q

Why do you have hyperkalmia w/addisons?

A

ADDISONS! = Primary Adrenal Insuff. decreased cortisol due to adrenal gland destruction = increase in ACTH will also give hyperpigmentation. Have Hyperkalemia due to loss of aldo.

37
Q

tx of addisons?

A

tx w/prednisone + fludrocortison

*adrenal destruction = must replace all that is loss

38
Q

Hypotension, NV, fatigue…dx?tx?

A

2nd adrenal insufficency. tx w/prednisone.

39
Q

how do you differentiate 1 vs 2 adrenal insuff?

A

Cosyntropin test. If no increase in Cort after 60 min = 2nd due to lack of ACTH. if no change in cort = 1(addisons) due to adrenal destruction

40
Q

pt w/HTN that is refractory to 3+ medications and now has hypokalemia. dx? ddx? how to tell them apart?

A

1(Conns=adrenal tumor) vs 2 hyperaldo(fibromusc dys)

1: increase aldo + decrease renin
2: increase aldo + increased renin

41
Q

When do you take out a incidental adrenal mass?

A

when its greater than 4cm or you have sx from it

IM MedEd (24 decks)

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