Endocrinology

Question 1

CC: Amenorrhea
PE:Hirsutism and body acne. Serum testosterone on upper limit.
DX and Meds?

Answer 1

PCOS
Metformin will improve menses
Encourage exercise, weight loss
May use low dose oral contraceptives; NOT HIGH dose

Question 2

SIADH
Presentation?
Meds that can cause it?

Answer 2

Hyponatremia + low serum osmolality and high urine osmolality
Meds that can cause it: SSRI - Sertraline (Zoloft)

Question 3

Patient with Turners

• Presentation?
• Diagnoisis?

Answer 3

• Web neck, short stature, low hair line, no signs of pubertal dev
• Do Karyotyping!

Question 4

50 y/o male with elevated BP and Hypokalemia in spite of oral potassium supplement
DX?
Test?

Answer 4

Hyperaldosteronism

• resistant HTN
• Hypokalemia

Order an Aldosterone suppression test; if abnormal
Order a peripheral aldosterone concentration and peripheral renin activity

Question 5

Patient with Panhypopituitarism due to pituitary tumor will undergo surgery
Perioperative meds?

Answer 5

Hydrocortisone q 8 hrs due to adrenal insufficency

Question 6

Low TSH, HIGH T4, T3, elevated Radioactive iodine uptake scan
DX?

Answer 6

Graves

Question 7

Patient on testosterone replacement

What to monitor

Answer 7

Hematocrit due to erythrocytosis

Question 8

Cause of Osteoporosis in Men?

Answer 8

1. MM
2. AIDS
3. Hyperparathyroidism
4. Hypotestosteronism

Question 9

Addisons -

Presentation?

Answer 9

Low Na, high K

HYPERPIGMENTATION!

Question 10

Complications of Hypoparathyroidism?

Answer 10

Hypocalcemia, Heart failure, tetany and seizures

Question 11

DM medication that causes weight loss?

How?

Answer 11

GLP-1 receptor agonist like Exenatide (Byetta)

Increase insulin secretion causing dec in Glucagon decreasing gastric emptying

Question 12

Patient with Pre diabetes.

What medication can you use to decrease the risk of of developing DM?

Answer 12

Thiazolidinediones( Actos)
Metformin
Alpha Glucosidase inhibitors(Acarbose)
Orlistat

*US diabetic prevention program outcomes study

Question 13

65 y/o female with 1.5 cm thyroid nodule.

What test to order?

Answer 13

1. TSH
2. If TSH is low –> radionucleotide scan
3. If TSH is high or normal –> US –> FNAB
4. If nodule is large and firm –> FNAB

Question 14

30 y/o F , 3 months post party me
Recent URTI now with neck pain, anxiety and palpitation
T4 high and TSH low
DX?

Answer 14

Sub acute thyroiditis – painful, followed by URTI

- give NSAIDS or corticosteroids

Question 15

Lab test results for 2nd hyperparathyroidism?

Tx?

Answer 15

Low vitamin D and high alkaline phosphatase with normal calcium
Vit D supplementation

1-25 Dihydroxy vitamin D (calcitriol) only on renal failure

Question 16

A1C goal of an elderly in nursing home?

Answer 16

Between 8-9%

Question 17

59 y/o F with HTN on HTCZ and amlodipine
BMP showed high Ca
Hx of Stones
After stopping HCTZ, what lab to order

Answer 17

Rpt BMP with iCa
Order Vit d level if PTH is low
Order 25 hr urine calcium if PTH is normal or high

Question 18

When is TSH unreliable for patient with Hypothyroidism

Answer 18

If the hypothyroidism in due to pituitary disease –> Secondary centrally mediated hypothyroidism

Question 19

32 Male with type 1 DM
With tender, scaly lesion on the shin
Reddish brown plaque with well defined boarders with yellowish deposits on the center
DX?

Answer 19

Necrobiosis - seen in 0.3% with DM

Question 20

Adverse reaction of Pioglitazone? (Actos)

Answer 20

Fluid retention causing weight gain and edema

Question 21

42 y/o with ELEVATED BP even on 3 meds

Lab test?

Answer 21

Aldosterone: renin ratio –> screen for primary aldosteronism; elevated aldosterone in suppressed renin levels