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Endocrinology Flashcards

1
Q

This is a condition caused by anything that compresses or damages the pituitary gland.

A

Panhypopituitarism

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2
Q

This patient has decreased FSH and LH from decreased GnRH, Anosmia, and renal agenesis. What is the most likely diagnosis?

A

Kallman Syndrome

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3
Q

What findings would you appreciate in an adult with growth deficiency?

A

Central obesity
Increased LDL and Cholesterol levels
Reduced lean muscle mass

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4
Q

How would you go about with the treatment of Panhypopituitarism?

A 
Replace deficient hormone with:
Cortisone
Thyroxine
Testosterone and estrogen
Recombinant human growth hormone
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5
Q

How would you differentiate Central Diabetes Insipidus from Nephrogenic Diabetes Insipidus?

A

Central DI - decrease in amount of ADH from pituitary

Nephrogenic DI - decrease in ADH effect on kidney

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6
Q

How will DI present?

A

Extreme high-volume urine with excessive thirst resulting in volume depletion and hypernatremia

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7
Q

How do you diagnose DI?

A

Vasopressin (Desmopressin) Stimulation Test

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8
Q

What will be the result of Central DI and Nephrogenic DI in vasopressin test?

A

Central DI - urine volume will decrease and urine osmolality will increase

Nephrogenic DI - no effect on urine volume and osmolality

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9
Q

How would you treat Central DI?

A

Long term Vasopressin (Desmopressin) use

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10
Q

How would you treat Nephrogenic DI?

A

Correct underlying casue (hypokalemia or hypercalcemia)

Hydrochlorthiazide, Amiloride, Prostaglandin Inhibitors such as Indomethacin

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11
Q

This is defined as the overproduction of growth hormone leading to soft tissue overgrowth throughout the body

A

Acromegaly

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12
Q

This is almost always the cause of Acromegaly

A

Pituitary Adenoma

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13
Q

Patient came in with complaints of increased shoe size, body odor, pain in flexion of wrist, joint pains. Upon inspection you noticed coarse facial features, deep voice, large tongue, skin tags. What is the most likely diagnosis?

A

Acromegaly

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14
Q

What will laboratory test show in a patient with Acromegaly?

A

Glucose intolerance and Hyperlipidemia

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15
Q

What is the best initial test for Acromegaly?

A

Insulinlike growth factor (IGF-1_

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16
Q

What is the most accurate test for Acromegaly?

A

Glucose Suppression test

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17
Q

What is the most accurate test for Acromegaly?

A

Glucose Suppression test

*Normally, glucose should suppress growth hormone levels

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18
Q

What are your treatment considerations for Acromegaly?

A

Surgery: Transphenoidal resection
Medical: Carbegoline (Dopamine will inhibit GH release), Octreotide or Lanreotide (Somatostatin inhibits GH release), Pegvisomant (GH receptor antagonist, inhibits IGF release from liver)
Radiotherapy: for those who do not respond with surgery/medications

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19
Q

This is the ONLY calcium blocker that raises Prolactin levels.

A

Verapamil

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20
Q

What inhibits prolactin release?

A

Dopamine

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21
Q

Give examples of drugs that increases prolactin levels

A 
Antipsychotic medications
Methyldopa
Metoclopramide
Opiods
Tricyclic Antidepressants
Verapamil
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22
Q

You measured the prolactin level of a patient. After finding it to be high, what should you perform?

A

Thyroid function tests
Pregnancy test
BUN/Crea (Kidney disease elevates prolactin)
Liver function tests (Cirrhosis elevates prolactin)

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23
Q

What are your treatment options for Hyperprolactinemia?

A

Dopamine agonists: Cabergoline is better tolerated than Bromocriptine
Transphenoidal surgery for those not responding in medication

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24
Q

What are the 2 occasional cause of hypothyroidism?

A

Dietary deficiency of iodine

Amidarone

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25
Q

Hypothyroidism is characterized by almost all bodily processes being slowed down–except for _____, which is increased.

A

Menstrual flow

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26
Q

What diagnostic test will you order to determine who needs thyroid replacement when T4 is normal and TSH is high.

A

Antithyroid peroxidase antibodies

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27
Q

What is the best initial test for all thyroid diseases?

A

TSH

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28
Q

How would you treat Hypothyroidism?

A

Replace hormones by thyroxine (synthroid) is sufficient

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29
Q

All forms of hyperthyroidism have an elevated _______.

A

T4 level.

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30
Q

In a patient with an elevated T4 level and high TSH level, what will you suspect?

A

Pituitary Adenoma

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31
Q

Only Graves disease has _________.

A

TSH receptor antibodies

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32
Q

What is the best initial therapy for Graves Ophthalmopathy?

A

Steroids

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33
Q

Patient has low TSH, elevated RAIU with positive antibody testing. What is the most likely diagnosis?

A

Graves disease

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34
Q

Patient has low TSH, decreased RAIU, and tender to touch. What is the most likely diagnosis?

A

Subacute Thyroiditis

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35
Q

Patient has low TSH, decreased RAIU, and no other symptoms. What is the most likely diagnosis?

A

Painless “silent” thyroiditis

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36
Q

Patient has low TSH, decreased RAIU, and there is an history of thyroid hormone intake and involuted, nonpalpable gland. What is the most likely diagnosis?

A

Exogenous thyroid hormone use

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37
Q

Patient has high TSH, and positive MRI findings in the pituitary. What is the most likely diagnosis?

A

Pituitary Adenoma

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38
Q

How would you treat Graves disease?

A

Radioactive iodine

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39
Q

How would you treat Subacute Thyroiditis?

A

Aspirin

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40
Q

Give treatment options for Acute Hyperthyroidism and Thyroid Storm?

A 
Propanolol
Methimazole and Propylthouracil
Iopanoic acid and Ipodate
Steroids (Hydrocortisone)
Radioactive iodine
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41
Q

A 46-year-old woman comes to the office because of a small mass she found on palpation of her own thyroid. A small nodule is found in the thyroid. There is no tenderness. She is otherwise asymptomatic and uses no medications.

What is the most appropriate net step in management of this patient?

a. Fine-needle aspiration
b. Radionuclide iodine uptake scan
c. T4 and TSH levels
d. Thyroid ultrasound
e. Surgical removal (excisional biopsy)

A

C. If the patient has a hyperfunctioning the gland, the patient does not need immediate biopsy

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42
Q

This is the mainstay of thyroid nodule management

A

Needle biopsy

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43
Q

What is the cut-off size of a thyroid nodule that must be biopsied by a fine-needle aspirate if there is normal thyroid function (T4/TSH).

A

> 1.5cm

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44
Q

A 46-year-old woman with a thyroid nodule is found to have a normal thyroid function testing. The fine-needle aspirate comes back as “indeterminant for follicular adenoma.”

What is the most appropriate next step in the management of this patient?

a. Neck CT
b. Surgical removal (excisional biopsy)
c. Ultrasound
d. Calcitonin levels

A

B. A follicular adenoma is a histologic reading that cannot exclude cancer. The only way to exclude thyroid malignancy is to remove the entire nodule. This is an indeterminant finding on fine-needle aspiration. A sonogram cannot exclude cancer. Calcitonin levels are useful if the biopsy shows medullary carcinoma.

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45
Q

What is the most common cause of hypercalcemia?

A

Primary Hyperparathyroidism

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46
Q

A patient came in with symptoms of confusion, stupor, lethargy, and constipation. What electrolyte imbalance is most probably present in the patient?

A

Hypercalcemia

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47
Q

What cardiovascular findings will you find in a patient with Hypercalcemia?

A

Short QT

Hypertension

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48
Q

What bone lesion is associated with Hypercalcemia?

A

Osteoporosis

49
Q

What renal conditions are associated with Hypercalcemia?

A

Nephrolitiasis
Diabetes insipidus
Renal insufficiency

50
Q

How would you treat acute hypercalcemia?

A
  1. Saline hydration at high volume

2. Biphosphonates: Pamidronate, Zoledronic acid

51
Q

A 75-year-old man with a history of malignancy is admitted with lethargy, confusion, and abdominal pain. He is found to have a markedly elevated calcium level. After 3 liters of normal saline and pamidronate, his calcium level is still markedly elevated the following day.

What is the most appropriate next step in management?

a. Calcitonin
b. Zoledronic acid
c. Plicamycin
d. Gallium
e. Dialysis
f. Cinacalcet

A

A.

Calcitonin inhibits osteoclasts. The onset of action of calcitonin is very rapid, and it wears off rapidly. Bisphosphonates take several days to work. Plicamycin and gallium are older therapies for hypercalcemia that no longer have any place in management. When they are given as choices for therapy, plicamycin and gallium are always wrong. Zolendronic acid is a bisphophonate and does not add anything to the use of pamidronate. Cinacalcet is an inhibitor of PTH release. If the hypercalcemia is from malignancy, PTH should already be maximally suppressed. Dialysis would be used only for those in renal failure.

52
Q

What is the standard of care for patients with Hyperparathyroidism?

A

Surgical removal of the involved parathyroid glands

53
Q

For patients with parathyroidism where you cannot perform surgery, what would you give?

A

Cinicalcet - inhibits release of PTH

54
Q

Give the indications for surgical removal of parathyroids.

A

Bone disease
Renal involvement
Age under 50 years
Calcium level consistently 1 point above normal

55
Q

This is most often a complication of prior neck surgery such as thyroidectomy.

A

Primary hypoparathyroidism

56
Q

This electrolytes is necessary for PTH to be released from the gland.

A

Magnesium

57
Q

Low levels of this electrolyte leads to increased urinary loss of Calcium.

A

Magnesium

58
Q

Patient came in with Chovestek sign, carpopedal spasm, perioral numbness, mental irritability, seizures, and tetany. What electrolyte imbalance does he have?

A

Hypocalcemia

59
Q

What will you see in an EKG of a patient with hypocalcemia?

A

Prolonged QT

60
Q

How would you treat Hypocalcemia?

A

Replace calcium and activated Vitamin D

61
Q

This is defined as pituitary overproduction of ACTH.

A

Cushing disease

62
Q

What is the best initial test for the presence of hypercotisolism?

A

24-hour urine cortisol

63
Q

What is the best initial test to determine the source or location of hypercortilosim?

A

ACTH testing

64
Q

Low ACTH mean than hypercortisolism’s source is?

A

Adrenal

65
Q

Elevated ACTH mean that the hypercortisolism’s source is from?

A

Pituitary or ectopic production (lung cancer, carcinoid)

66
Q

What are the effects of hypercortisolism?

A 
Hyperglycemia
Hyperlipidemia
Hypokalemia
Metabolic alkalosis
Leukocytosis
67
Q

Aside from 24-hour urine cortisol, what else can you do to diagnose Hypercortisolism?

A

Late-night salivary cortisol

*If normal, excludes hypercotisolism

68
Q

This is a somatostatin analog that can be used if surgery was not successful for hypercortisolism.

A

Pasireotide

69
Q

You found an incidental mass on adrenal scan. Patient is asymptomatic. What should you do?

A

Metanephrines of blood or urine to exclude pheochromocytoma
Renin and aldosterone levels to exclude hyperaldosteronism
1 mg overnight dexamethason suppresion test

70
Q

This is also called chronic hypoadrenalism

A

Addison disease

71
Q

What is the most common cause of Addison disease

A

Autoimmune destruction of the gland

72
Q

What electrolyte imbalance will you expect in acute and chronic presentation of Addison disease?

A

Hyponatremia and Hyperkalemia

73
Q

This is the most specific test of adrenal function.

A

Cosyntropin Stimulation Test

(You measure the cortison level before and after the administration of cosyntropin. In a patient whose health is otherwise normal, there should be a rise in cortisol level after giving cosyntropin)

74
Q

You suspect the patient to have Addison Disease. You did an Cosyntropin Stimulation Test and there is no rise in cortisol levels. Further tests revealed High ACTH and Low Aldosterone. What is your diagnosis?

A

Primary adrenal insufficiency

75
Q

You suspect the patient to have Addison Disease. You did an Cosyntropin Stimulation Test and there is no rise in cortisol levels. Further tests revealed Low ACTH and high Aldosterone. What is your diagnosis?

A

Secondary adrenal insufficiency; Adrenal atrophy from pituitary insufficiency

76
Q

This is a symptom that develops over a long period of time in a patient with chronic adrenal insufficiency.

A

Hyperpigmentation

77
Q

How would you treat Addison disease?

A
  1. Replace steroids with hydrocortisone
  2. Fludrocortisone is a steroid hormone that is particularly high in mineralocorticoid or aldosterone-like effect. Fludrocortisone is most useful if the patient has evidence of postural instability. Mineralocorticoid supplements should be used in primary adrenal insufficiency when the patient is on oral steroids such as cortisone.

TREATMENT is more important than testing in acute renal crisis

78
Q

A patient is brought to the emergency department after a motor vehicle accident in which he sustains severe abdominal trauma. On the second hospital day, the patient becomes markedly hypotensive without evidence of bleeding. There is fever, a high eosinophil count, hyperkalemia, hyponatremia, and hypoglycemia.

What is the most appropriate next step in management?

a. CT scan of the adrenals
b. Draw cortisol level and administer hydrocortisone
c. Cosyntropin stimulation testing
d. ACTH level
e. Dexamethasone suppression testing

A

B. In a patient with suspected acute adrenal insufficiency

79
Q

Patient presents with high blood pressure associated with hypokalemia. What is the most likely diagnosis?

A

Primary aldosteronism

80
Q

Secondary Hypertension in Primary Hyperaldosteronism are most likely in those whose onset:

A
  1. is under age 30 or above 60

2. is not controlled by 3 antihypertensive medications

81
Q

What is the best initial test for Primary Hyperaldosteronism?

A

Plasma Aldosterone : Plasma Renin (>20:1)

*an elevated plasma renin excludes primary hyperaldosteronism

82
Q

What is the most accurate test to confirm the presence of unilateral adenoma in a patient with Primary Hyperaldosteronism?

A

Get a sample of the venous blood draining the adrenal. It will show a high aldosterone level.

83
Q

Biochemical test results you would expect in a patient with Primary Hyperaldosteronism?

A

Low potassium
High aldosterone despote a high-salt diet
Low plasma renin level
Aldosterone-to-renin ratio >20:1 and aldosterone >15

84
Q

How would you treat Unilateral adrenal adenoma?

A

Resect by laparoscopy

85
Q

How would you treat Bilateral adrenal hyperplasia?

A

Eplerenone or

Spironolactone

86
Q

This is a nonmalignant lesion of the adrenal medulla autonomously overproducing catecholamines despite a high blood pressure.

A

Pheochromocytoma

87
Q

Patient came in with episodic hypertension, headache, sweating, and palpitations and tremor. What is the most likely diagnosis?

A

Pheochromocytoma

88
Q

What is the best initial test for Pheochromocytoma?

A

check the levels of free metanephrines in plasma

89
Q

What is the confirmatory test for Pheochromocytoma?

A

24-hour urine collection for metanephrines

90
Q

This is a nuclear isotope scan that detects the location of pheochromocytoma that originates outside the adrenal gland.

A

MIBG scanning

91
Q

This is an alpha blocker that is the best initial therapy of pheochromocytoma

A

Phenoxybenzamine

  • Use Calcium blockers and beta blockers afterwards
  • Surgery/ Laparoscopy to remove Pheochromocytoma
92
Q

What is the definition of Diabetes Mellitus?

A

persistently high fasting glucose levels greater than 125 on at least 2 separate occasions;

single glucose level above 200 mg/dL with polyphagia, polydipsia, polyuria

increased glucose level on oral glucose tolerance testing

93
Q

This is a diagnostic criterion for DM and is the the best test to follow response to therapy over the last several months

A

Hemoglobin A1C > 6.5%

94
Q

What is the best initial drug therapy for DM?

A

Oral Metformin

95
Q

This drug is contraindicated in those with renal dysfunction because it can accumulate and cause metabolic acidosis.

A

Metformin

96
Q

This is a group of drugs that block the metabolism of incretins (GIP and GLP).

A

DPP-IV inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin)

97
Q

Give the functions of GIP and GLP (incretins).

A

increase insulin and decrease glucagon release from the pancreas

98
Q

These is a group of drugs that slow gastrointestinal motility and decrease weight. They are generally not given before DPP -IV inhibitors.

A

Incretin mimetics (exenatide, liraglutide, albiglutide, dulaglutide)

99
Q

This group of drug is contraindicated in CHF because they increase fluid overload.

A

Thiazoladinediones

100
Q

This group of drugs are added when 2 or 3 other oral hypoglycemic medications have not been effective. They inhibit the reabsorption of glucose in the proximal convoluted tubule after it has been filtered.

A

SGLT2 inhibtors (empagliflozin, dapagliflozin, canagliflozin)

101
Q

What is the adverse effect of SGLT2 inhibitors?

A

Inc. the likelihood of urinary tract infections and fungal vaginitis

102
Q

This drugs are stimulators of insulin release in a similar manner to sulfonylureas, but do not contain sulfa. They do not add any therapeutic benefit to sulfonylureas.

A

Nateglinide and Repaglinide

103
Q

This group of drugs are agents that block glucose absorption in the bowel. They add half a point decrease in HgA1C. They cause flatus, diarrhea, and abdominal pain. They can be used with renal insufficiency,

A

Alpha glucosidase inhibitors (acarbose, miglitol)

104
Q

This is an analog of a protein called Amylin that is secreted normally with insulin. Amylin decreases gastric emptying, decreases glucagon levels, and decrease appetite.

A

Pramlintide

105
Q

What will you expect in the potassium level in a patient with Diabetic Ketoacidosis?

A

Hyperkalemia in blood but

decrease total body potassium because of urinary spillage

106
Q

What acid-base imbalance will you expect in a patient with DKA?

A

Metabolic acidosis with increased anion gap

107
Q

How would you treat DKA?

A

Large volume saline and insulin replacement

108
Q

A 57-year old man is admitted to the ICU with altered mental status, hyperventilation, and a markedly elevated glucose level.

Which of the following is the most accurate measure of the severity of his condition?

a. Glucose level
b. Serum bicarbonate
c. Urine ketones
d. Blood ketones
e. pH level on blood gas

A

B. If the serum bicarbonate is low, the patient is at risk of death. If it is high, it does not matter how high the glucose level is, in terms of severity. Serum bicarbonate level is a way of saying ‘anion gap’. If the bicarbonate level is low, the anion gap is increased.

109
Q

DM patients should receive this vaccine.

A

Pneumococcal vaccine

110
Q

What medication will you give as maintenance for DM patients with BP greater than 140/90 and urine tests positive for microalbuminuria?

A

ACEI or ARBs

111
Q

What medication will you give as maintenance if the LDL of DM patients is above 100 mg/dL?

A

Statin medications

112
Q

This medication is used regularly in all diabetic patients above the age of 30.

A

Aspirin

113
Q

What can you give for Severe Retinopathy in DM?

A

VEGF inhibitors (Bevacizumab)

114
Q

How would you treat Proliferative DM Retinopathy?

A

Laser Photocoagulation

115
Q

How would you treat neuropathic pain in DM?

A

Pregabalin, Gabapentin, or Tricyclic Antidepressants

116
Q

This is the most common cause of oligomenorrhea.

A

Polycystic Ovary Syndrome (PCOS)

117
Q

Give the criteria to diagnose PCOS.

A
  1. Clinical hirsutism and/or high testosterone/DHEA
  2. Irregular menstruation
  3. 10 cysts on pelvic sonogram with enlarged ovary (>10 cm)

2 out of 3 needed to diagnose PCOS

118
Q

What can you give a patient with PCOS suffering from irregular menstruation?

A

Oral contraceptive containing progesterone

Medicine (15 decks)

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