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USMLE Step 2 CK > Endocrinology > Flashcards

Endocrinology Flashcards

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USMLE® Step 1 flashcards
1
Q

DIAGNOSIS-MEN ASYMPTOMATIC, WOMEN: CANNOT LACTATE

A

PROLACTIN DEFICIENCY

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2
Q

DIAGNOSIS-WOMEN: NO OVULATION, AMENORHEIC MEN:NO SPERM,DECREASE HAIR&LABIDO

A

FHS AND LH DEFICIENCY

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3
Q

DIAGNOSIS-DECREASED FSH,LH FROM LOW GnRH ANOSMIA AND RENAL AGENESIS IN 50%

A

KALLMAN SYNDROME

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4
Q

DIAGNOSIS-SHORT STATURE, ADULTS FEW SYMPTOMS:CENTRAL OBESITY, INCREASED LDL AND CHOL. REDUCED LEAN MASS

A

GH DEFICIENCY

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5
Q

DIAGNOSIS- ALL ABOVE SX.

A

PANHYPOPITUITISM

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6
Q

INITIAL TEST- PANHYPOPITUITISM

A

HYPONATREMIA, MRI OF PITUITARY

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7
Q

INITIAL TEST- CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW TSH, T4 IN BLOOD

A

DECREASE IN TSH IN RESPONSE TO TRH

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8
Q

INITIAL TEST-CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW ACTH AND CORTISOL

A

COSYNOTROPIN(ACTH)=CORTISOL RISE (ACUTE), CORTICOTROPIN(CRH)=INC.ACTH BUT NO CORTISOL

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9
Q

INITIAL TEST- CONFIRM LOW HORMONE PANHYPOPITUITISM WITH LOW LH, FSH,TEST

A

NO CONFIRMATORY TEST

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10
Q

TIP- OLDER TESTS FOR PANHYPOPITUITISM

A

METYRAPONE(CAUSE ACTH LEVEL RISE), INSULIN STIMULATION(CAUSE GH TO RISE)= ABNORMAL SHOULD RESULT OPP.

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11
Q

INITIAL TREAT- PANHYPOPITUITISM

TIP- OXYTOCIN HAS NO DISEASE? TRUE OR FALSE

A

REPLACE HORMONES: CORTISONE, THYROXINE, TESTOSTERONE/ESTRO,GH

TRUE

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12
Q

P.ASS.-POST- STROKE,TUMOR, TRAUMA HYPOXIA OR INFITRATION OF THE PIT GLAND INFECTION/IFLAM.

P.ASS.-CHRONIC PYELONEPHRITIS, AMYLOIDOSIS, MYELOMA OR SICKLE CELL, HYPERCALCEMIA, HYPOKALEMIA, LI

DIAGNOSIS- POLYURIA AND HYPERNATREMIA (CONFUSION,LETHARGY, SEIZURES /COMA

INITIAL TEST-
INITIAL TREAT-
INITIAL TREAT-

A

DIABETES INSIPIDUS CENTRAL

DIABETES INSIPIDUS NEPHROGENIC

DIABETES INSIPIDUS

SERUM SODIUM THEN VASOPRESSIN TEST: BETTER IN CENTRAL AND NO CHANGE IN NEPHROGENIC

CENTRAL DI= LONG-TERM VASOPRESSIN (DESMOPRESSIN/ ADH)

NEPHROGENIC DI= TREAT CAUSE:(E.G.HYPOKALEMIA OR HYPERCALCEMIA), HYDROCHLOROTHIAZIDE, AMILORIDE, PROSTAGLANDIN INH (INDOMETHACIN)

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13
Q

P.ASS- PITUTARY ADENOMA, GASTRINOMA OR INSULINOMA OR ECTOPIC GH OR GHRH (LYMPHOMA OR BRONCHIAL CARCINOID)

DIAGNOSIS- INCREASED HAT,RING,SHOE SIZE, CARPAL TUNNEL, ODOR,DEEPVOICE,COLONIC POLYPS,ARTHRALGIAS,HYPERTENSION, CHF, ED

INITIAL TEST- ACROMEGALY
ACC. TEST- ACROMEGALY
INITIAL TREAT- ACROMEGALY

A

ACROMEGALY

ACROMEGALY

SERUM IGF-1, GLUCOSE (INTOLERANCE), HYPERLIPIDEMIA THEN MRI

GLUCOSE SUPPRESSION TEST

SURGERY (TRANSPHENOIDAL RESEC)OR RADIATION, PHARM:CABERGOLINE(DOPAMINE), OCTREOTIDE OR LANREOTIDE (SOMATOSTATIN), PEGVISOMANT

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14
Q

P.ASS.-INC.GH/TRH(HYPOTHYROIDISM), PIT ADENOMA, PREGNANCY,EXCERISE,RENAL INS.,CHEST STIMULATION, LOW DOPAMINE (DRUGS)

DIAGNOSIS- WOMEM: GALACTORRHEA, AMENORRHEA, INFERTILITY/MEN:ED GYNECOMASTIA

INITIAL TEST- HYPERPROLACINEMIA
INITIAL TREAT- HYPERPROLACTINEMIA

A

HYPERPROLACTINEMIA

ANTIPSYCHOTICS, METHYLDOPA, METOCLOPROMIDE, OPIOIDS, TRICYCLICS, VERAPAMIL

SERUM PROLACTIN, TFT, PREGNANCY TEST, BUN/CR, LFT THEN MRI(PROBABLE TUMOR)

DOPAMINE AGONIST(CABERGOLINE/BROMOCRIPTINE), TRANSPHENOIDAL SURGERY, RADIATION (RARE)

TIP- DRUGS THAT INCREASE PROLACTIN

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15
Q

DIAGNOSIS- BODILY ROCESSES BEING SLOWED DOWN

INITIAL TEST-
INITIAL TREAT-

A

HYPOTHYROIDISM

LAB: TSH, T4/T3

IF DOUBLE TSH; THEN= THYROXINE

TIP- COMMON CAUSE OF HYPOTHYROID=HASHIMOTO, DIET, AMIODARONE

TIP- IF TSH IS HIGH BUT NOT DOUBLE RUN? IF POSITIVE THEN WHAT?=ANTITHYROID PEROXIDASE/ANTITHYROGLOBULIN ANTIBODIES THEN TREAT WITH THYROXINE

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16
Q

DIAGNOSIS-EYE PROPTOSIS AND SKIN, HYPERTHYROID, ELEVATED RAID

DIAGNOSIS- TENDER THYROID, HYPERTHYROID

DIAGNOSIS- NONTENDER THYROID, HYPERTHYROID

DIAGNOSIS- INVOLUTED GLAND (NOT PALPABLE), HYPERTHYROID

DIAGNOSIS- HIGH TSH AND HYPERTHYROID

A

GRAVES

SUBACUTE THYROIDITIS

PAINLESS SILENT THYROIDITIS

EXOGENOUS THYROID HORMONE USE

PITUITARY ADENOMA

17
Q 
INITIAL TEST- PITUITARY ADENOMA
INITIAL TREAT- GRAVES
INITIAL TREAT-SUBACUTE THYROIDITIS
INITIAL TREAT-PAINLESS HYPERTHYRIOD
INITIAL TREAT- EXOGENOUS THYROID USE
INITIAL TREAT- PITUITARY ADENOMA 
TIP- METHIMAZOLE VS PROPYLTHIOURACIL
A 
MRI
RADIOACTIVE IODINE
ASPIRIN
NONE
STOP USE
SURGERY
METHIMAZOLE
18
Q

DIAGNOSIS- ANXIETY, PALPITATIONS, FEVER DIARRHEA
INTIAL TREAT- ACUTE HYPERTHYROID
INITIAL TREAT- GRAVES OPHTHALMOPATHY
TIP- AE INCEDIBLY COMMON 5% WOMEN 1% MEN/95% BENIGN (ADENOMA,COLLOID NODULE, CYST)
INITIAL TEST- THYROID NODULE
INITIAL TREAT- THYROID NODULE (FOLICULAR MEDULARY PAPILARY)
TIP-PRIMARY CAUSE OF HYPERCALCEMIA THEN
TIP- OTHER CAUSES OF HYPERCALCEMIA

A

ACUTE HYPERTHYROID(THYROID STORM)

PROPANOLOL, THIOUREA, IODINATED CONTRAST MATERIAL, STEROIDS, RADIOACTIVE IODINE

STEROIDS THEN RADIATION THEN SURGERY

THYROID NODULE

TSH/T4 AFTER NORMAL TSH FINE-NEEDLE ASPIRATE BIOPSY

SURGERY EXCISION

PRIMARY HYPERPARATHYROIDISM (PTH) THEN ECTOPIC PTH (CANCER)

HIGH VIT D, SARCOIDOSIS OR OTHER GRANULOMA, THIAZIDE, HYPERTHYROIDISM*,METASTASIS TO BONE AND MM

19
Q

DIAGNOSIS- ACUTE CONFUSION, STUPOR, LETHARGY AND CONSTIPATION, SHORT QT, HBP,OSTEOPOROSIS*,NEPHROLITHIASIS,DI,RENAL INSUF

INITIAL TREAT-

A

HYPERCALCEMIA

ACUTE HYPERCALCEMIA= HIGH VOL. SALINE, BISPHOSPHONATES + TEMP. CALCITONIN

20
Q

DIAGNOSIS- HYPERCALCEMIA, PEPTIC ULCER, MUSCLE WEAKNESS, ANOREXIA, OSTEOPOROSIS

INITIAL TEST-
INITIAL TREAT-

A

HYPERPARATHYROIDISM

PTH LEVELS, LOW PHOSPHATE LEVELS, HIGH CHLORIDE LEVEL, EKG: SHORT QT, ELEVATED BUN/CR, ALK PHOS. THEN SONOGRAPHY OR NUCLEAR SCANNING

SURGERY (REMOVE AFECTED GLANDS) CINACALCET WHEN SURGERY NOT POSSIBLE

TIP- SOLITARY ADENOMA 80%, HYPERPLASIA 15-20%, PARATHYROID MALIGNANCY 1%= HYPERPARATHYROIDISM

21
Q

DIAGNOSIS- CHVOSTECK SIGN, CARPOPEDAL SPASM,PERIORAL NUMBNESS, MENTAL IRRITATBILITY, SEIZURES, TETANY

INTIAL TEST-
INITIAL TREAT-

A

HYPOCALCEMIA

EKG:PROLONGED QT, SLIT LAMP SHOWS CATARACTS

SEVERE: IV CALCIUM AND VIT D, MILD: ORAL CALCIUM AND VIT D

TIP- MAIN CAUSES OF HYPOCALCEMIA=HYPOPARATHYROIDISM(THYROIDECTEM) HYPOMAGNESEMIA(HELPS SEC. PTH), RENAL FAILURE

TIP- OTHER CAUSES OF HYPOCALCEMIA=VIT D, GENETIC, FAT MALABSORPTION AND LOW ALBUMIN .1 DECREASES .8 IN CALCIUM

22
Q

DIAGNOSIS-FAT REDISTRIBUTION, SKIN: STRIAE, EASY BRUISING, THIN SKIN, OSTEOPOROSIS,

DIAGNOSIS- HYPERTENSION, MENSTRUAL DISORDER, ED,BAD COGNITION,POLYURIA(HYPERGLYCEMIA)

INITIAL TEST- 1-2-3
INITIAL TREAT-

A

CUSHING SYNDROME

CUSHING SYNDROME

FIND HIGH CORT.:#1—-24 HOUR URINE CORTISOL, IF NOT POSSIBLE 1MG OVERNIGHT DEXAMETHASONE SUPPRESSION TEST-#2—FIND CAUSE: ACTH TESTING (NARROWS IT TO TWO) AND CUSHING DISEASE IS SUPPRESSED WITH DEX(NARROW TO ONE), MRI OR PETROSAL ACTH-#3—-FIND P.ASS: HYPERGLYCEMIA, HYPERLIPIDEMIA, HYPOKALEMIA, METABOLIC ALKOLOSIS, LEUKICYTOSIS

SURGERY

TIP- LOW CALCIUM= TWITCHY AND HYPER; HIGH CALCIUM-SLOW AND LETHARGIC

TIP- ETIOLOGY: CUSHING DISEASE»>ADRENAL HYPER>ECTOPIC ACTH>UNKNOWN ACTH SOURCE

TIP- FALSE POSSITIVE FOR 1MG DEXAMETHASONE SUPPRESSION TEST= DEPRESSION, ALCOHOLISM, OBESITY

23
Q

TIP- ANTI-INSULIN HORMONES?

A

GH, CORTISOL, GLUCAGON

24
Q

TIP- INCIDENTALOMA ARE 5% COMMON TEST FOR:

A

METANEPHRINES, RENIN, ALDOSTERONE, SUPPRESSION TEST

25
Q

DIAGNOSIS- WEAKNESS, FATIGUE, ALTERED MENTAL STATUS, NAUSEA, VOMITING, ANOREXIA, HYPOTENSION, HYPNATREMIA, HYPERKALEMIA

INITIAL TEST:
INITIAL TREAT:

A

HYPOADRENALISM (CHRONIC: HYPERPIGMENTATION)

COSYNTROPIN (ACTH) TEST (NORMAL: RISE IN CORTISOL AFTER) OR LESS SP. TEST FOR PRIMARY OR SECONDARY: ACTH HIGH OR LO W SERUM:HYPOGLYCEMIA,HYPERKALEMIA, MET ACIDOSIS, HYPONATREMIA, HIGH BUN.

HYDROCORTISONE AND FLUDROCORTISONE( GOOD ALDOSTERONE EFFECT)

26
Q

TIP: ETIOLOGY OF HYPOADRENALISM (ADDISON)
TIP: ETIOLOGY OF ACUTE HYPOADRENALISM
TIP- EOSINOPHILIA IS FOUND IN HYPOADRENALISM? TRUE OR FALSE
TIP- IN ACUTE ADRENAL INSUFFICIENCY ALWAYS?

A

80% AUTOIMMUNE THEN INFECTION(TB), ADRENOLEUKODYSTROPHY, MET. CANCER

ACUTE:HEMORRHAGE, SURGERY, HYPOTENSION REMOVE CHRONIC HIGH DOSE STERIODS

TRUE

TREAT AND TEST AFTER HX AND GEN. LABS

27
Q

DIAGNOSIS- UNDER AGE 30 OR OVER 60, HYPERTENSION( PHARM: DOES NOT WORK), HYPOKALEMIA

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

HYPERALDOSTERONE, CONNS SYNDROME

HIGH ALDOSTERONE=RATIO: ADOSTERONE TO PLASMA RENIN (HIGH RENIN EXCLUDES PRIMARY HYPERALD.)

PRIMARY ADENOMA=VENOUS BLOOD DRAIN: HIGH ALDOSTERONE LEVEL THEN SERUM:K,ADOSTERONE, RENIN THEN CT

HYPERADRENALISM= SURGERY ( UNILATERAL ADENOMA) OR EPLERENONE OR SPIRONOLACTONE(BILATERAL HYPERPLASIA)

28
Q

TIP- ETIOLOGY- OR HIGH ALDOSTERONE

A

SOLITARY ADENOMA OR HYPERPLASIA

29
Q

TIP- NEVER START WITH SCAN IN ENDOCRINOLOGY? TRUE OR TRUE

A

TRUE

30
Q

DIAGNOSIS- EPISODIC HYPERTENSION, HEADACHE, SWEATING, PALPITATIONS TREMOR

INITIAL TEST-
INITIAL TREAT-

A

PHEOCHROMOCYTOMA

24 HOUR URINE FREE METANEPHRINES COLLECTION (VANILLYLMANDELIC ACID LESS SENSITIVE)THEN CT OR MRI THEN MIBG(NUCLEAR ISOTOPE)

PHENOXYBENZAMINE, CCB AND BETA BLOCKERS THEN SURGERY

31
Q

DIAGNOSIS: GLUCOSE: >125MG/DL TWICE, YOUNG, POLYURIA-PHAGIA-DIPSIA

A

DM 1

32
Q

DIAGNOSIS- GLUCOSE: >125MG/DL TWICE, ADULT, OBESITY, POLY:URIA-PHAGIA-DIPSIA

A

DM 2

33
Q

INITIAL TEST- DM

INITIAL TREAT- 1-2-3

A

GLUCOSE (TWICE: >125 FASTING) GLUCOSE (SINGLE: >200 NON-FASTING) HIGH GLUCOSE (TOLERANCE TESTING) HBA1C >6.5% (ALSO CONTROL)

1.(DIET, EXERCISE, WEIGHT LOSS)

  1. ORAL HYPOGLYCEMIC: METFORMIN>INCRETINS>SULFONYLUREAS/GLINIDES (NO CHF)>GLITAZONES>PRAMLINTIDE(AMYLN)>ALPHA GLU INH
    TRUE
3. INSULIN: 
LONG ACTING (GLARGINE OR NPH) + SHORT ACTING: (LISPRO, ASPART,GLULISINE AND SOMETIMES REGULAR)

TIP: INSULIN-ONSET-PEAK-DURATION: FOR SHORT AND LONG ACTING=

SHORT: 1-15MIN(30-60REG)-1 HR(2HR REG)-3-4HR(6-8HRS REG)

LONG: 1-2HR(2-4NPH)-NO PEAK(6-7NPH)-24HRS(10-20NPH)

TIP: REVIEW PHARM NAMES

34
Q

DIAGNOSIS-ABDOMINAL PAIN, HYPERVENTILATION,DEC. MENTAL STATE,METABOLIC ACID,HYPERKALEMIA,INC ANION

INITIAL TREAT-
INTIAL TEST-

A

DKA

LARGE VOLUME SALINE + INSULIN THEN POTASSIUM WHEN GLUCOSE IS APPROACHING NORMAL

BICARB (VERY LITTLE CAN KILL YOU)

35
Q

TIP- DM CONTROL

TIP- DM COMPLICATIONS-1-2-3-4-5 AND TX

A

PNEUMO VACCINE, EYE EXAM YEARLY, LIPIDS, BP (>130/80), ACEi FOR MICROALBUMINURIA OR BP, FOOT EXAM AND ASPIRIN

CARDIO:(MI,STROKE,CHF, LIPIDS)

RENAL: MICROABLBUMINURIA 30-300MG PER 24HRS

GI: PARESIS(METOCLOPROMIDE AND ERYTHROMYCIN)

EYE: RETINOPATHY

NEUROPATHY:(DAMAGE TO VASONERVORUM-TX:PREGABALIN,GABAPENTIN OR TRICYCLICS)

USMLE Step 2 CK (9 decks)

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