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ABR > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Next step in management for pituitary mass/incidentolomas

A 
Check functionality
(Prolactin, TSH/T4, IGF1, 1mg DMS test)
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2
Q

Clinical features of prolactinoma/hyperprolactinemia

Management

A

F: galactorrhea, amenorrhea
M: impotence, decreased libido

Dopamine agonist
(Bromocriptine, carbegoline)

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3
Q

Surveillance for prolactinoma

A

> 1cm: MRI q6mo + visual field testing

< 1cm: MRI q1year

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4
Q

DM drug of choice in kidney disease

A

Meglitinides

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5
Q

DM Med to avoid in obese

A

Sulfonylureas (ie glyburide)

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6
Q

DM drug of choice in obese

A

Metformin

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7
Q

DM Med to avoid in kidney disease

A

Metformin

Acarbose

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8
Q

DM Med to avoid in CHF

A

Thiazolidinediones (ie pialitazone)

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9
Q

Side effects of GLP-1 agonist (ie liraglutide) and DPP-4 inhibitors (ie sitagliptin)

A

Pancreatitis

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10
Q

Side effect if SGLT2 inhibitors (ie empagliflozin)

A

UTI
Euglycemic Ketoacidosis
Fourniers gangrene

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11
Q

False elevation of HbA1c

A 
Decreased RBC turnover
Anemia (iron, B12, folate def)
ESRD
Asplenia
Hemiglobinopathies
Sickle cell trait
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12
Q

Falsely lower HbA1c

A 
Increased RBC turnover
Hemolytic anemia
HIV
Blood transfusions
Iron, B12, folate def treatment
EPO
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13
Q

Most common bacteria in diabetic foot ulcer

A

Staph aureus

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14
Q

Elevated proinsulin
Elevated c-peptide
Elevated insulin

A

Sulfonylurea use

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15
Q

No proinsulin
No c-peptide
Elevated insulin

A

Insulin use

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16
Q

Very Elevated proinsulin
Elevated c-peptide
Elevated insulin

A

Insulinoma

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17
Q

RAIU with diffuse uptake

A

Grave’s disease

TSH adenoma

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18
Q

RAIU with areas of increased uptake surrounding by areas of decreased uptake

A

Multinodular goiter

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19
Q

RAIU with areas of increased focal uptake surrounded by area of decreased uptake

A

Toxic nodule

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20
Q

RAIU with < 5% uptake

A

Thyroiditis

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21
Q

Next step in management for hypopituitary hypothyoidism

A

ACTH stim test

r/o adrenal insufficiency

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22
Q

Treatment for thyroid stone

A

Beta blockers

Then steroids

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23
Q

TrAb (thyroid receptor Ab)

A

Graves

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24
Q

Treatment for myxedema coma

A

Steroid + T4 + T3 + Abx

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25
Management of levothyroxine during pregnancy
Increase dose by 50%
26
Thyroid nodule | High TSH
Cold | FNA
27
Thyroid nodule | Low TSH
Hot | RAIU
28
Elevated Ca Elevated PTH UrCa > 200g/day
Primary hyperparathyroidism
29
Elevated Ca Normal PTH UrCa < 100mg/day
Familial hypocalciuric hypercalcemia
30
Elevated Ca | Low PTH
Malignancy Vit D toxicity Sarcoidosis
31
Indications for parathyroid surgery
``` Elevated PTH Age < 50 or elevated risk of complications OR sCa > 1mg above normal OR UrCa > 40mg/day OR CrCl < 60 OR symptomatic ```
32
Low PTH High Ca High Phos
Vit D toxicity (25 OH D3) Sarcoidosis (1, 25 OH2 D3)
33
Low PTH High Ca Low Phos
Malignancy | Milk alkali
34
Low PTH low Ca High Phos
Hypoparathyroidism
35
Low PTH low Ca High Phos Low K
HypoMg
36
High PTH Normal/low Ca Normal/low Phos High ALP
Vit D deficiency
37
High PTH low Ca High Phos Short 4th and 5th metacarpals
Pseudohypioarathyroidism
38
Normal PTH Normal Ca Normal Phos Short 4th and 5th metacarpals
Pseudopseudohypoparathyoridism
39
Drugs that cause osteoporosis
Steroids Aromatase inhibitor PPI
40
Biggest risk factor for osteoporosis
Sedentary lifestyle
41
Thickening and sclerosis of bone Increased ALP Normal Ca, Phos, PTH
Paget’s disease of bone
42
Normal BP 17(OH) progesterone elevated 21 B hydroxylase deficiency
Non-classical CAH
43
HTN Low L Elevated Aldosterone Low renin
Primary aldosteronism
44
Low BP High K Low Aldo low renin
Hyporeninemic hypoaldosteronism
45
Next step in management after aldo:renin > 20:1
Bilateral adrenal vein sampling
46
Best test to confirm hyporeninemic hypoaldosteronism
ACTH stim test
47
Cushing work up
24 hr free ruin cortisol (>100mcg/day confirms Cushing’s) Late night salivary cortisol 1mg DMS suppression test
48
Elevated cortisol Elevated DHEA Elevated ACTH
Cushing’s disease
49
Elevated cortisol Low DHEA Low ACTH
Adrenal adenoma (zona fasciculata)
50
Elevated cortisol Very Elevated DHEA Low ACTH
Adrenal cancer (zona reticularis)
51
Low cortisol Low DHEA Low ACTH
Exogenous steroids
52
Next steps in management If initial Cushing w/u positive
``` Serum ACTH level If + 8mg DMS test If ACTH suppressed, MRI brain If MRI neg, bilateral inferior petrosal sinus sampling If < 2-5x peripheral ACTH, CT chest ```
53
Confirmation of Addison’s disease
AM cortical < 3mg If AM cortisol 3-15mg, do ACTH stim If cortisol < 18mcg (primary) If cortisol > 18mcg (secondary)
54
Management for primary Addison’s Management for secondary Addison’s
Hydrocortisone + fludrocortison Hydrocortisone only
55
Screening for pheochromocytoma
24 hr Ur fractionated metanephrine and catecholamines
56
Initial management for adrenal incidentaloma
``` Check functionality 1mg DMS suppression test 24 hr Ur metaneph/catechol Aldo/renin. K 17(OH) ketosteroids ```
57
Surgical indication for adrenal incidentalomas
> 4cm regardless of function < 4cm + functioning Size increase by 1 cm per yesr
58
Adrenal incidentaloma < 10 HFU > 10 HFU
Fat Cancer or Pheo
59
Low BP Hemianopsia or nerve palsy Pituitary lesions or dense lesion in sella
Pituitary apoplexy
60
Dense suprasellar calcification
Craniopharyngioma
61
Small testes Gynecomastia High FSH and LH
Klinefelter (47 XXY) High risk for breast cancer
62
GnRH def. | Anosmia
Kallman
63
PSA > 2x
Prostate biopsy
64
Testosterone level low in obese or elderly
Check free testosterone
65
Primary amenorrhea Web neck Short statue
Turner syndrome (45XO)
66
Primary amenorrhea No vagina or uterus Ovaries and breast okay
Mullerian syndrome (46XY) Mayer Rokitansky Kuster Hauser Syndrome
67
``` Primary amenorrhea Acne Clitoromegaly Hirsutism No ovaries or breasts ```
46XY. Gonadal dysgensis
68
Primary amenorrhea Strophic vagina No cervix, Pubic or axillary hair Breasts
Androgen insensitivity syndrome (46XY)
69
Evaluation of secondary amenorrhea
1) pregnancy test 2) pituitary hormones 3) progesterone trials. If bleed, PCOS 4) estrogen/progesterone trial. If bleed, primary ovarian failure. If no bleed, primary uterine failure

ABR (12 decks)

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