Endocrinology Flashcards
what are examples of functional adrenal tumors
pheochromocytomas
aldosteronoma
cortisol-producing adenomas
what is Adrenal cortical cancer (ACC)
rare disease that can also be functional but should be considered on the differential of any adrenal mass, especially tumors larger than 4cm
what lab tests should be done with concerns for ACC
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
what is the tx of adrenal tumors
if evidence of hormone production/suspicion for ACC - adrenalectomy
what is addisons disease
adrenocoritical insufficiency - adreanl gland destruction causing lack of cortisol and aldosterone secretion usually auto immune
what is the presentation of hypothyroidism
cold and heat intolerance
fatigue
constipation
depression, weight gain
bradycardia
what endocrine/metabolic causes can cause fatigue
Addisons
hypothyroid
DM
pituitary insufficiency
hypercalcemia
Chronic renal failure
hepatic failure
what labs are often completed for a pt presenting with fatigue
CBC - anemia
ESR - inflammatory
Chem panel - liver, renal and protein malnutrition
thyroid panel
HIV antibodies
pregnancy test (if indicated)
what is Hashimoto;s
hypothyroidism - can be from preivous thyroidecotmy/idione ablation, congenital
what are lab values for hypothyroidism
Elevated TSH, low T3 and T4
How does hypothyroidism present
cold/heat intolerance, fatigue, constipation, depression, weight gain, bradycardia
how does hyperthryoidism present
heat intolerance, palpitations, sweating, weight loss, tremor, anxiety, tachycardia
a female presents with heat intolerance, palpitations, weight loss, and sweating, what is her likely dx
hyperthryoidism
what is the presentation of thyroid storm
fever
tachycardia
delirium
what is the lab presetation of hyperthyroid
Low TSH, high T3 and T4
what is the most common cause of hyperthryoidism
Graves disease
what is graves disease
diffuse goiter with hyperthyroidism, exopthalmos, and pretibial myxedema
what specific physical finding is associated with graves disease
exopthalmous
what is a catecholamine secreting adreanl tumor
pheochromocytoma
what catecholamines do pheochromocytomas secrete
epinephrine and norepinephrine
how is a pheo diagnosed
24 hour catecholamines
MRI/CT of abdomen
what is the treatment of a Pheo
resect tumor - complete adrenalectomy
medical tx preop - alpha blocker (phenoxybenzmine)
what are common symptons of pheo
palpitations, headache, episodic diaphroesis
what is the most common thyroid carcionma
papillary carcinoma (80%)
what is the environmental risk for thyroid carcinoma
radiation exposure
what is the diagnostic test of choice for thyroid mass
fine needle aspiration (FNA)
what is a hot nodule
increased 123 I uptake = functioning/hyperfunctioning nodule (NON CANCEROUS)
what is a cold nodule
decreased 123 I uptake = nonfuntioning nodule (CANCEROUS)
what are symptoms of thyroid nodules
voice change
dysphagia
discomfort (in neck)
rapid enlargement
what studies can be used to evaluate a thyroid nodule
US - solid of cystic
FNA- cytology 123 I scintiscan - hot or cold
what is plummers disease
toxic multinodular goiter
what are types of rest tremor conditions
parkinsons
wilsons
essential tremor
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
c. PSVT
pt px with irritability, diaphroesis, weakness, tremulousness and palpitations
Insulinoma
what is an insulinoma
insulin-producing tumor arising from pancreatic beta cells
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
c. elevated serum calcium and elevated PTH
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
b. low serum calcium and elevated PTH
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
c. sestamibi scan of parathyroid glands
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
b. parathyroidectomy
how can you remember the symptoms of primary hyperparathryoidism?
Stones, thrones, bones, grones and psychiatric overtones
what are methods of imaging the parathyroids
Surgical operation
US sestamibi scan
201TI scan
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
b graves
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
d. serum TSH
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. radioactive iodine uptake
what tx will be most effective to actually alleviate the pts symptoms of hyperthyroidism?
a. methimazole
b. radioactive iodine
c. PTU
d. atenolol
d. atenolol
which of the following medication provides effective long-term control of the hyperthyroidism?
a. methimazole
b. propranolol
c. levothyroxine
d. prednisone
a. methimazole
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
b. thyroid US study
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
c. FNA of the nodules
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
d. cold nodules always require further investigation to differentiate benign from malignant status
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
D. pheochromocytoma
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
c. adrenal gland
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. 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)
