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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
Q

Management of levothyroxine during pregnancy

A

Increase dose by 50%

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26
Q

Thyroid nodule

High TSH

A

Cold

FNA

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27
Q

Thyroid nodule

Low TSH

A

Hot

RAIU

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28
Q

Elevated Ca
Elevated PTH
UrCa > 200g/day

A

Primary hyperparathyroidism

29
Q

Elevated Ca
Normal PTH
UrCa < 100mg/day

A

Familial hypocalciuric hypercalcemia

30
Q

Elevated Ca

Low PTH

A

Malignancy
Vit D toxicity
Sarcoidosis

31
Q

Indications for parathyroid surgery

A 
Elevated PTH
Age < 50 or elevated risk of complications
OR sCa > 1mg above normal 
OR UrCa > 40mg/day
OR CrCl < 60
OR symptomatic
32
Q

Low PTH
High Ca
High Phos

A

Vit D toxicity (25 OH D3)

Sarcoidosis (1, 25 OH2 D3)

33
Q

Low PTH
High Ca
Low Phos

A

Malignancy

Milk alkali

34
Q

Low PTH
low Ca
High Phos

A

Hypoparathyroidism

35
Q

Low PTH
low Ca
High Phos
Low K

36
Q

High PTH
Normal/low Ca
Normal/low Phos
High ALP

A

Vit D deficiency

37
Q

High PTH
low Ca
High Phos
Short 4th and 5th metacarpals

A

Pseudohypioarathyroidism

38
Q

Normal PTH
Normal Ca
Normal Phos
Short 4th and 5th metacarpals

A

Pseudopseudohypoparathyoridism

39
Q

Drugs that cause osteoporosis

A

Steroids
Aromatase inhibitor
PPI

40
Q

Biggest risk factor for osteoporosis

A

Sedentary lifestyle

41
Q

Thickening and sclerosis of bone
Increased ALP
Normal Ca, Phos, PTH

A

Paget’s disease of bone

42
Q

Normal BP
17(OH) progesterone elevated
21 B hydroxylase deficiency

A

Non-classical CAH

43
Q

HTN
Low L
Elevated Aldosterone
Low renin

A

Primary aldosteronism

44
Q

Low BP
High K
Low Aldo
low renin

A

Hyporeninemic hypoaldosteronism

45
Q

Next step in management after aldo:renin > 20:1

A

Bilateral adrenal vein sampling

46
Q

Best test to confirm hyporeninemic hypoaldosteronism

A

ACTH stim test

47
Q

Cushing work up

A

24 hr free ruin cortisol (>100mcg/day confirms Cushing’s)
Late night salivary cortisol
1mg DMS suppression test

48
Q

Elevated cortisol
Elevated DHEA
Elevated ACTH

A

Cushing’s disease

49
Q

Elevated cortisol
Low DHEA
Low ACTH

A

Adrenal adenoma (zona fasciculata)

50
Q

Elevated cortisol
Very Elevated DHEA
Low ACTH

A

Adrenal cancer (zona reticularis)

51
Q

Low cortisol
Low DHEA
Low ACTH

A

Exogenous steroids

52
Q

Next steps in management If initial Cushing w/u positive

A 
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
Q

Confirmation of Addison’s disease

A

AM cortical < 3mg

If AM cortisol 3-15mg, do ACTH stim
If cortisol < 18mcg (primary)
If cortisol > 18mcg (secondary)

54
Q

Management for primary Addison’s

Management for secondary Addison’s

A

Hydrocortisone + fludrocortison

Hydrocortisone only

55
Q

Screening for pheochromocytoma

A

24 hr Ur fractionated metanephrine and catecholamines

56
Q

Initial management for adrenal incidentaloma

A 
Check functionality 
1mg DMS suppression test
24 hr Ur metaneph/catechol
Aldo/renin. K
17(OH) ketosteroids
57
Q

Surgical indication for adrenal incidentalomas

A

> 4cm regardless of function
< 4cm + functioning
Size increase by 1 cm per yesr

58
Q

Adrenal incidentaloma
< 10 HFU
> 10 HFU

A

Fat

Cancer or Pheo

59
Q

Low BP
Hemianopsia or nerve palsy
Pituitary lesions or dense lesion in sella

A

Pituitary apoplexy

60
Q

Dense suprasellar calcification

A

Craniopharyngioma

61
Q

Small testes
Gynecomastia
High FSH and LH

A

Klinefelter (47 XXY)

High risk for breast cancer

62
Q

GnRH def.

Anosmia

63
Q

PSA > 2x

A

Prostate biopsy

64
Q

Testosterone level low in obese or elderly

A

Check free testosterone

65
Q

Primary amenorrhea
Web neck
Short statue

A

Turner syndrome (45XO)

66
Q

Primary amenorrhea
No vagina or uterus
Ovaries and breast okay

A

Mullerian syndrome (46XY)

Mayer Rokitansky Kuster Hauser Syndrome

67
Q 
Primary amenorrhea
Acne
Clitoromegaly
Hirsutism
No ovaries or breasts
A

46XY. Gonadal dysgensis

68
Q

Primary amenorrhea
Strophic vagina
No cervix, Pubic or axillary hair
Breasts

A

Androgen insensitivity syndrome (46XY)

69
Q

Evaluation of secondary amenorrhea

A

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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