Endocrinology

Question 1

lab findings in hashimoto’s thyroiditis

Answer 1

high TSH, low T4, and anti-TPO antibodies

Question 2

lab findings in hashimoto’s thyroiditis

Answer 2

high TSH, low T4, and anti-TPO antibodies

Question 3

stones, bones, groans, and psychiatric overtones

Answer 3

hypercalcemia

Question 4

pt complains of HA, weakness, and polyuria; exam reveals HTN and tetany; labs show hypernatremia, hypokalemia, and metabolic alkalosis

Answer 4

primary hyperaldosteronism (due to conn’s syndrome or bilateral adrenal hyperplasia)

Question 5

pt complains of tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic

Answer 5

pheochromocytoma

Question 6

first line of tx for pheo

Answer 6

a-antagonists (phentolamine or phenoxybenzamine) as b-antagonists first will cause unopposed rise in BP

Question 7

pt w/ hx of lithium use presents w/ copious amounts of dilute urine

Answer 7

nephrogenic DI

Question 8

tx of central DI

Answer 8

DDAVP

Question 9

anti-diabetic agent associated w/ lactic acidosis

Answer 9

metformin

Question 10

pt complains of weakness, N/V, weight loss, and new skin pigmentation. lab shows hyponatremia and hyperkalemia. Dx? Tx?

Answer 10

primary adrenal insufficency (Addison’s dz). tx w/ glucocorticoids, mineralocorticoids, and IVF

Question 11

goal HA1c for pt w/ DM

Answer 11

less than 7

Question 12

tx of DKA

Answer 12

IVF, insulin, and electrolyte repletion (ie. K)

Question 13

why are b-blockers contraindicated in DM?

Answer 13

mask symptoms of hypoglycemia

Question 14

stones, bones, groans, and psychiatric overtones

Answer 14

hypercalcemia

Question 15

pt complains of HA, weakness, and polyuria; exam reveals HTN and tetany; labs show hypernatremia, hypokalemia, and metabolic alkalosis

Answer 15

primary hyperaldosteronism (due to conn’s syndrome or bilateral adrenal hyperplasia)

Question 16

pt complains of tachycardia, wild swings in BP, HA, diaphoresis, AMS, and sense of panic

Answer 16

pheochromocytoma

Question 17

first line of tx for pheo

Answer 17

a-antagonists (phentolamine or phenoxybenzamine) as b-antagonists first will cause unopposed rise in BP

Question 18

pt w/ hx of lithium use presents w/ copious amounts of dilute urine

Answer 18

nephrogenic DI

Question 19

tx of central DI

Answer 19

DDAVP

Question 20

anti-diabetic agent associated w/ lactic acidosis

Answer 20

metformin

Question 21

pt complains of weakness, N/V, weight loss, and new skin pigmentation. lab shows hyponatremia and hyperkalemia. Dx? Tx?

Answer 21

primary adrenal insufficency (Addison’s dz). tx w/ glucocorticoids, mineralocorticoids, and IVF

Question 22

goal HA1c for pt w/ DM

Answer 22

less than 7.0

Question 23

tx of DKA

Answer 23

IVF, insulin, and electrolyte repletion (ie. K)

Question 24

why are b-blockers contraindicated in DM?

Answer 24

mask symptoms of hypoglycemia

Question 25

chronic GI disease can cause vit D def due to malabsorption --> what electrolyte imbalances?

Answer 25

hypocalcemia, hypophosphatemia, and elevated PTH

Question 26

pt w/ HTN and low renin levels. dx?

Answer 26

primary hyperaldosteronism - elevated aldosterone suppresses renin secretion through feedback inhibition

Question 27

pt w/ HA, deafness, bone pain + isolated elevated AP, normal calcium, phosphorus, and other liver enzymes

Answer 27

pagets dz of the bones - characterized by increased bone remodeling (increased AP) and abnormal osteoid formation

Question 28

DKAs effects on K?

Answer 28

"paradoxical hyperK" - DKA is characterized by an osmotic diuresis that reduces total body K stores even though the serum K level may be elevated

Question 29

proximal muscle weakness can be seen w/ what hormone imbalance?

Answer 29

hyperthyroidism

Question 30

G6PD def causes hemolytic anemia due to ...

Answer 30

oxidative injury to RBCs precipitated by infection or medications

Question 31

symptom mgmt in hyperthyroidism?

Answer 31

propranolol

Question 32

diabetic autonomic neuropathy can affect the GU tract causing...

Answer 32

neurogenic bladder --> overflow incontinence (dribbling, poor urinary stream, high post-void residual volume)

Question 33

pregnant women (increased estrogen) effects on TBG, thyroxine, T3, free T4, and TSH

Answer 33

increased TBG, increased thyroxine and T3, normal free T4, and normal THS

Question 34

MEN-2 genetic testing

Answer 34

RET proto-oncogene

Question 35

electrolyte abnormalities associated w/ alcoholics

Answer 35

hypoMg, which causes hypoCa (hypoMg causes decreased release of PTH and PTH resistance)

Question 36

hypoCa, hyperphosphatemia, and increased PTH indicate...

Answer 36

secondary hyperparathyroidism in chronic renal failure

Question 37

high serum osmol + low urine osmol (dilute urine)

Answer 37

DI - inability to produce concentrated urine as a result of ADH dysfunction

Question 38

labs for DI: water depreivation test... DDAVP...

Answer 38

water depreivation test shows no increase in urine osmol (distinguishes from primary polydipsia) DDAVP shows central having decreased urine output and increased urine osmol vs nephrogenic no change

Question 39

low plasma osmol + high urine osmol > 100 - 150 (concentrate urine)

Answer 39

SIADH - persistent ADH release independent of serum osmol (retention of free water)

Question 40

OTC med that can cause SIADH

Answer 40

NSAIDs

Question 41

diabetic neuropathy DOC

Answer 41

TCAs; gabapentin is alternative

Question 42

tx options for diabetic gastroparesis

Answer 42

prokinetic agents such as metoclopramide, erythromycin, cisapride can sometimes help

Question 43

tx for pagets

Answer 43

bisphosphonates; calcitonin is usually reserved for pts intolerant to bisphosphonates

Question 44

differentation of follicular thryoid adenomas vs follicular thyroid cancers

Answer 44

histopath demonstration of invasion of the capsule and blood vessels = cancer

Question 45

when is FNA of the thyroid recommended?

Answer 45

pts w/ normal or high TSH, cold nodules (hot are usually benign), thyroid cancer family hx, or suspicious thyroid on US

Question 46

two important causes of hypoglycemia in non-DM pts w/ elevated insulin levels. dx? differentiate?

Answer 46

insulinoma (beta cell tumor) vs surreptitious use of insulin or sulfonylurea. c-peptide is high in insulinoma vs low in surreptitious use of insulin