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Clinical: General Surgery > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

what are examples of functional adrenal tumors

A

pheochromocytomas
aldosteronoma
cortisol-producing adenomas

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2
Q

what is Adrenal cortical cancer (ACC)

A

rare disease that can also be functional but should be considered on the differential of any adrenal mass, especially tumors larger than 4cm

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3
Q

what lab tests should be done with concerns for ACC

A

plasma fractionated metanephrines and 24hr urine metanephrines
serum potassium and aldeosterone and plasma renin activity
24hr urinary-free cortisol or dexmeth suppression test
DHEA-S
CT scan
MRI

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4
Q

what is the tx of adrenal tumors

A

if evidence of hormone production/suspicion for ACC - adrenalectomy

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5
Q

what is addisons disease

A

adrenocoritical insufficiency - adreanl gland destruction causing lack of cortisol and aldosterone secretion usually auto immune

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6
Q

what is the presentation of hypothyroidism

A

cold and heat intolerance
fatigue
constipation
depression, weight gain
bradycardia

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7
Q

what endocrine/metabolic causes can cause fatigue

A

Addisons
hypothyroid
DM
pituitary insufficiency
hypercalcemia
Chronic renal failure
hepatic failure

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8
Q

what labs are often completed for a pt presenting with fatigue

A

CBC - anemia
ESR - inflammatory
Chem panel - liver, renal and protein malnutrition
thyroid panel
HIV antibodies
pregnancy test (if indicated)

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9
Q

what is Hashimoto;s

A

hypothyroidism - can be from preivous thyroidecotmy/idione ablation, congenital

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10
Q

what are lab values for hypothyroidism

A

Elevated TSH, low T3 and T4

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11
Q

How does hypothyroidism present

A

cold/heat intolerance, fatigue, constipation, depression, weight gain, bradycardia

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12
Q

how does hyperthryoidism present

A

heat intolerance, palpitations, sweating, weight loss, tremor, anxiety, tachycardia

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13
Q

a female presents with heat intolerance, palpitations, weight loss, and sweating, what is her likely dx

A

hyperthryoidism

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14
Q

what is the presentation of thyroid storm

A

fever
tachycardia
delirium

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15
Q

what is the lab presetation of hyperthyroid

A

Low TSH, high T3 and T4

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16
Q

what is the most common cause of hyperthryoidism

A

Graves disease

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17
Q

what is graves disease

A

diffuse goiter with hyperthyroidism, exopthalmos, and pretibial myxedema

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18
Q

what specific physical finding is associated with graves disease

A

exopthalmous

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19
Q

what is a catecholamine secreting adreanl tumor

A

pheochromocytoma

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20
Q

what catecholamines do pheochromocytomas secrete

A

epinephrine and norepinephrine

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21
Q

how is a pheo diagnosed

A

24 hour catecholamines
MRI/CT of abdomen

22
Q

what is the treatment of a Pheo

A

resect tumor - complete adrenalectomy
medical tx preop - alpha blocker (phenoxybenzmine)

23
Q

what are common symptons of pheo

A

palpitations, headache, episodic diaphroesis

24
Q

what is the most common thyroid carcionma

A

papillary carcinoma (80%)

25
Q

what is the environmental risk for thyroid carcinoma

A

radiation exposure

26
Q

what is the diagnostic test of choice for thyroid mass

A

fine needle aspiration (FNA)

27
Q

what is a hot nodule

A

increased 123 I uptake = functioning/hyperfunctioning nodule (NON CANCEROUS)

28
Q

what is a cold nodule

A

decreased 123 I uptake = nonfuntioning nodule (CANCEROUS)

29
Q

what are symptoms of thyroid nodules

A

voice change
dysphagia
discomfort (in neck)
rapid enlargement

30
Q

what studies can be used to evaluate a thyroid nodule

A

US - solid of cystic
FNA- cytology 123 I scintiscan - hot or cold

31
Q

what is plummers disease

A

toxic multinodular goiter

32
Q

what are types of rest tremor conditions

A

parkinsons
wilsons
essential tremor

33
Q

45yo woman presetning to clinic complaining of episodes of rapid heartbeats that start and stop suddenly, lasting for a few minutes to several hours. she denies chest pain, SOB or dizziness. she has no hx of heart disease, DM or HTN. PE, including cardiaovascular is normal. ECG performed during an episode shows a narrow complex tachycardia with HR of 160bpm. which of the following is the most likely dx?
a. afib
b. vtach
c. PSVT
D.sinus tachycarida
e. aflutter

A

c. PSVT

34
Q

pt px with irritability, diaphroesis, weakness, tremulousness and palpitations

A

Insulinoma

35
Q

what is an insulinoma

A

insulin-producing tumor arising from pancreatic beta cells

36
Q

which of the following lab results is most indicative of hyperparathyroidism?
a. Elevated serum calcium and Low PTH
b. low serum calcium and elevated PTH
c. elevated serum calcium and elevated PTH
d. low serum calcium and low PTH
e. normal serum calcium and elevated PTH

A

c. elevated serum calcium and elevated PTH

37
Q

which of the following lab results is most consistent with the dx of secondary hyperparathyroidism?
a. elevated serum calcium and low PTH
b. low serum calcium and elevated PTH
c. elevated serum calcium and elevated PTH
d. low serum calcium and low PTH
e. normal serum calcium and elevated PTH

A

b. low serum calcium and elevated PTH

38
Q

60yo man with recurrent kidney stones undergoes eval for potential underlying cause. his serum calcium is elevated, and PTH is inappropriately normal. what is the most appropriate next step in eval of this pt?
a. 24hour urine calcium excretion test
b. Thyroid function test
c. sestambibi scan of parathyroid gland
d. bone density scan
e. serum phosphate level

A

c. sestamibi scan of parathyroid glands

39
Q

50yo woman is dx with primary hyperparathyroidism. she as osteoporosis and hx of nephrolithiasis. her serum calcium level is 11.2 mg/dL. what is the most apporopriate tx for this pt?
a. oral calcium supplementation
b. parathryoidectomy
c. thiazide diuretic
d. calcitonin injections
e. bisophosonates

A

b. parathyroidectomy

40
Q

how can you remember the symptoms of primary hyperparathryoidism?

A

Stones, thrones, bones, grones and psychiatric overtones

41
Q

what are methods of imaging the parathyroids

A

Surgical operation
US sestamibi scan
201TI scan

42
Q

38yo woman comes to the office with a 3month hx of sweating, palpitations, weight loss, nervousness, irritability, isnomnia, hand tremors and diarrhea. she has no significant past illness. one of her sisters has rhematoid arthritis. the pt, a stockbroker, is finding it increasinly difficult yoto perform her job because of profound fatigue and inability to concentrate. on exam, BP 140/70, HR 120bpm and regular. she demonstrates mild proptosis. you feel a smooth, diffusely enlarged and nontender thyroid gland. CV exam reveals a loud S1 and loud S2 with systolic enjection murmur heard loudest along LSB. Murmur does not radiate. no other abnormaliteis are noted. what is the most likely dx in this pt?
a. toxic multinodular goiter
b. graves disease
c. hashimoto thyroidiits
d. pheochromocytoma
e. panic disorder

A

b graves

43
Q

what is the best initial test to dx hyperthyroidism?
a. radioactive iodine uptake test
b thyroid US study
c. free serum Thyroxine (T4)
d. serum TSH
e. thyroid antibodies

A

d. serum TSH

44
Q

your diagnosis of hyperthyroidism is confirmed with appropriate test. which is the next most appropriate to determine underlying etiology?
a. radioactive iodine uptake
b. FNA
C. T4
D. US study
E. TSH receptor antibodies

A

a. radioactive iodine uptake

45
Q

what tx will be most effective to actually alleviate the pts symptoms of hyperthyroidism?
a. methimazole
b. radioactive iodine
c. PTU
d. atenolol

A

d. atenolol

46
Q

which of the following medication provides effective long-term control of the hyperthyroidism?
a. methimazole
b. propranolol
c. levothyroxine
d. prednisone

A

a. methimazole

47
Q

38yo woman is seen in your office for a complete baseline health assessment. you have never seen the pt before. she feels well and tells you she is “wonderfully healthy’. she has had no weight loss or gain; no sweasting, no tremors, no diarrhea, or constipation; no anxiety or depression; no irritability; and no other symtpoms. on exma, she is found to have a 2cm nodule on the left lobe of the thyroid gland. her BP is 120/70, HR 90bpm and regular. what is the first test that should be ordered to evaluate the pts physical exam abnormality?
a. MRI scan of thyroid
b. thyroid US study
c. radioactive iodine uptake scan
d. FNA of nodule
e. CT scan of thyroid

A

b. thyroid US study

48
Q

two suspicious thyroid nodules are identified after appropriate preliminary test is ordered. what is the next test in the evaluation of the pts thyroid nodules?
a. serum T4
b. radiactive idoine uptake thyroid scan
c. FNA of nodules
D. thyroid US study
E. Ct scan of thyroid

A

c. FNA of the nodules

49
Q

which of the following statements regarding “hot nodules” and “cold nodules”, found on radioactive iodine scan, is true?
a. cold nodules are more likely than hot nodules to be benign
b. cold nodules need not be investigated any further
c. cold nodules are more likely than hot nodules to be associated with signs and symptoms of hyperthyroidism
d. cold nodules always require further investigation to differentiate benign from malignant status
e. all nodules, whether cold or hot, require further investigation to differentiate benign from malignant status

A

d. cold nodules always require further investigation to differentiate benign from malignant status

50
Q

21yo female px to the clinic with complants of palpitations and HA. on PE, the pt is anxious and diaphoretic with BP of 175/105, HR 122bpm. ECG demonstrates sinus tachycardia. based on presentation, what is her likely dx?
a. SVT
b. ACS
c. Aortic dissection
d. pheochromocytoma

A

D. pheochromocytoma

51
Q

38yo man px to ED experienceing a severe HA and heart palpitations. he appears to be anxious and perspiring heavily. on exam he is found to be tachycardic and PB is 158/102. his urine catecholamines are increased. if imagin g were performed, what is the most likely location where a lesion would be found?
a. pituitary gland
b. liver
c. adrenal gland
d. testicle
e. kidney

A

c. adrenal gland

52
Q

which of the following CT scan characteristics is NOT considered concering for adrenal cortical cancer?
a. low attenuation
b. size > 4cm
c. calcification
d. irregular shape
e. central necorosis

A

a. low attenuation
(adenoma characteristics - low attenuation, rapid washout, smooth borders. ACC characteristics- size >4cm., high attenuation, enhancement on contrast, delayed contrast washout, calcifications, irregular shape, central necrosis)

Clinical: General Surgery (10 decks)

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