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Step 2 CK > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Kallman syndrome

A

Decreased FSH and LH from decreased GnRH
Anosmia
Renal agenesis in 50%

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2
Q

how to confirm GH deficiency?

A

no response to arginine infusion

No response to GNRH

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3
Q

Significance of Metyrapone test

A

inhibits 11-beta-hydroxylase. this decreases cortisol output of adrenal. should cause ACTH levels to rise

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4
Q

failure of GH to rise in response to insulin indicates

A

GH deficiency

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5
Q

What electrolyte abnormalities inhibit ADHs affect on the kidney?

A

hypercalcemia and hypokalemia

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6
Q

treatment for nephrogenic DI?

A

treat underlying cause. hydrochlorothiazide, amiloride, NSAIDS

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7
Q

Acromegaly is almost always caused by a ?

A

pituitary adenoma

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8
Q

best initial test to evaluate for acromegaly

A

IGF-1

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9
Q

most accurate test for acromegaly

A

glucose suppression test. glucose should suppress GHs

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10
Q

why are prolactin levels tested with acromegaly work up?

A

cosecretion with GH

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11
Q

Treatment for acromegaly?

A

** PEGVISOMANT: GH receptor antagonist. Inhibits IGF release from liver.

transphenoidal resection of pituitary.

Cabergoline: DA inhibit GH release

Octreotide lanreotide: somatostatin inhibit GH releae

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12
Q

why does hypothyroidism lead to hyperprolactinemia?

A

extremely high TRH levels with stimulate prolactin secretion

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13
Q

only CCB to raise prolactin level?

A

Verapamil

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14
Q

What should you NOT do first in any endocrine disorder

A

MRI of head

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15
Q

When prolactin level is high perform what tests?

A

thyroid
pregnancy
BUN/Cr (kidney disease elevates prolactin)
LFTs (cirrhosis elevates prolactin)

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16
Q

when should MRI be done for high prolactin levels?

A

high prolactin confirmed
medications and other 2ndary causes ruled out
patient not pregnant

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17
Q

Management for (high TSH (double normal) and normal T4?

A

treat with levothyroxine

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18
Q

When TSH is less than double normal what test should you order next?

A

antithyroid peroxidase/antithyroglobulin

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19
Q

TSH receptor antibodies means

A

GRAVES disease

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20
Q

Subacute thyroiditis is treated with?

A

NSAIDS

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21
Q

Painless “silent” thyroiditis treatment?

A

none

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22
Q

which medication is preferred for hyperthyroidism?

A

methimazole

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23
Q

best initial therapy for graves opthalmopathy?

A

steroids. radiation if not responding to steroids. severe cases need compressive surgery

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24
Q

woman presents with thyroid mass. what is first step in management? why?

A

TSH, T4. If nodule is hyperfunctioning, do not need immediate biopsy because less concerning for malignancy.

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25
Q

Thyroid nodules > ____ must be biopsied with FNA if there is normal thyroid function

A

1cm

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26
Q

Do you complete ultrasound or radionucleotide scanning in a euthyroid patient with a nodule? why or why not?

A

No. These tests cannot exclude cancer

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27
Q

What are the 2 mainstays of thyroid nodule management?

A
  1. TSH and T4 levels

2. FNA the nodule

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28
Q

what 2 conditions account for 90% of hypercalcemia patients?

A

primary hyperparathyroidism and cancer

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29
Q

Acute hypercalcemia is treated with?

A
  1. saline hydration at high volume

2. bisphosphonate, pamidronate, zoledronic acid

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30
Q

Plicamycin and gallium are OLD therapies for hypercalcemia that are always WRONG on EXAM

A

always wrong!

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31
Q

When do you use prednisone to treat hypercalcemia?

A

when its from sarcoidosis or granulomatous disease

32
Q

if a patient with cancer prsents with hypercalcemia and fluids and bisphosphonates dont control hypercalcemia, what is your next step of therapy

A

calcitonin

33
Q

What is the best imaging test for effects of high PTH on bone?

A

DEXA densitometry

34
Q

common electrolyte cause of hypocalcemia?

A

hypomagnesemia (mag is necessary for PTH to be released from gland) low mag also leads to increased urine loss of calcium

35
Q

for every 1 decrease in albumin, calcium decreases by?

A

.8

36
Q

cushing syndrome =

A

hypercortisolism

37
Q

cushing disease =

A

pituitary overproduction of ACTH

38
Q

what is more specific, 1 mg dex suppression test or 24 hour urine cortisol?

A

24 hour urine cortisol. there are false positive tests on the 1 mg overnight dex test

39
Q

Once you find hypercortisolism and ACTH elevation but ACTH doesn’t suppress with dex, what do you suspect, what do you do next?

A

ectopic production of ACTH + cancer

40
Q

what tests should you order if you come across an adrenal adenoma incidentally?

A

metanephrines of blood or urine to exclude pheo
renin/aldo to exclude hyeraldo
1 mg overnight dex suppress

41
Q

What if you have an ACTH dependent cushing syndrome that is suppressed by high dose dex, you do an MRI and you see nothing?

A

Petrosal sinus sampling for ACTH (some tumors are too small to see on MRI)

42
Q

What is the most common cause of hypoadrenalism (addison disease) ?

A

autoimmune destruction of adrenal gland

43
Q

causes of acute adrenal crisis?

A

hemorrhage, surgery, hypotension, trauma, sudden removal of chronic high dose prednisone

44
Q

common myeloid change in hypoadrenalism?

A

Eosinophilia

45
Q

most specific test of adrenal function?

A

Cosyntropin stim test (synthetic ACTH). measure cortisol level before and after admin of cosyntropin

46
Q

high BP and hypokalemia =

A

primary hyperaldo

47
Q

most accurate test to confirm presence of unilateral adenoma?

A

sample of venous blood draining the adrenal (should show high aldo)

48
Q

how do you treat unilateral adenoma of adrenal?

treatment of bilateral adrenal hyperplasia?

A
  • unilateral: surgery laparoscopic

- bilateral hyperplasia: epleronone, spironolactone (aldo antagonists)

49
Q

side effects of spironolactone

A

gynecomastia, decreased libido

50
Q

MIBG scanning is used for?

A

nuclear isotope scan used to detect location of pheo that originates outside of the adrenal gland

51
Q

best measure of severity of DKA?

A

serum bicarb (AKA anion gap)

52
Q

most common thyroid cancer?

A

papillary

53
Q

papillary thyroid cancer spreads by?

A

lymphoid

54
Q

follicular thyroid cancer spreads by?

A

hematologic

55
Q

type of thyroid cancer found in calcitonin producing C cells.

A

medullary

56
Q

diagnosis of osteoporosis is made when?

A

T score is 2 standard deviations away from a young persons bone mineral density (T score)

57
Q

Osteopenia

A

between 1 and 2.5 SDS below normal of a young person

58
Q

Lab values in osteoporosis

A

normal calcium, phosphate, parathyroid hormone

59
Q

Treatment of osteoporosis?

A

calcium and vitamin D supplementation. smoking cessation and weight bearing exercises . bisphosphonates.

60
Q

% mortality in the year following a hip fracture?

A

50%

61
Q

“mosaic” lamellar bone pattern on x-ray?

A

Pagets

62
Q

aching bone or joint pain, headaches, fractures, nerve entrapment, loss of hearing?

A

Paget disease

63
Q

lab values of increased alk phos with normal Ca and Phos suggest?

A

Pagets

64
Q

causes of hypoparathyroidism

A

iatrogenic (postsurgical), autoimmune, DiGeorge, Hemochromatosis, Wilsons (infiltrative)

65
Q

secondary hyperPTH is?

A

physiologic increase of PTH in response to renal insufficiency. decreased production of 1-25 dihydroxyvitamin D), calcium deficiency or Vit D deficiency.

66
Q

Tertiary hyperPTH is?

A

seen in dialysis patients with long standing secondary hyperparathyroid-> parathyroid glands hyperplasia and become autonomous

67
Q

Weird hand finding in pseudohypoparathyroidism?

A

Albright hereditary osteodystrophy (shortened fourth metatarsal or metacarpal)

68
Q

pseudohypoparathyroidism

A

PTH resistance. Elevated PTH that is ineffective at target organs

69
Q

Lab values in secondary hyperPTH

A

elevated PTH, decreased calcium, increased phosphate (when etiology is renal failure)

70
Q

lab values in 3 hyperPTH

A

everything elevated

71
Q

familial hypocalciuric hypercalcemia

A

inherited disorder due to mutations in calcium sensing receptor in parathyroid and kidneys. Elevated serum Ca levels. But low Ca in urine.

72
Q

patient is found to have medullary thyroid cancer. what must you test for before performing surgery

A

VMA and metanephrines as medullary carcinoma of thyroid is associated with MEN2A/2B

73
Q

MEN 1 is characterized by?

3 Ps

A

Pancreatic (VIPoma, Gastrinoma, Insulinoma), Pituitary, Parathyroid adenomas

74
Q

MEN 2A is characterized by?

2 Ps

A

Parathyriod, Pheo, med thyroid cancer (Ret-proto-oncogene)

75
Q

MEN 2B is associated with?

1 P

A

Neuroma, Med thyroid, Pheo

Ret-proto-oncogene

Step 2 CK (26 decks)

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