Endocrinology Flashcards
1
Q
Clue for surreptitious vomiting(2)
A
Dental erosions
scars dorsal of hands
2
Q
Normotension and metabolic alkalosis and hypokalemia(4)
A
Surreptitious vomiting
diuretic abuse
barter syndrome
Gitelman syndrome
3
Q
Urine chloride in surreptitious vomiting
A
Low
4
Q
urine chloride in Barter gitelman syndrome
A
High
5
Q
How to differentiate barter from surreptitous vomiting
A
urine chloride concentration
6
Q
How’s urine chloride in diuretic abuse
A
High
7
Q
Treatment of prolactinoma(2) regardless the size
A
bromocriptine or
cabergoline
8
Q
quid of microadenoma
A
Size less than 10 mm
9
Q
first thing to in front of hypercalcemia
A
doser PTH
10
Q
Cause of hypercalcemia with high PTH
A
primary hyperparathyroidism
11
Q
What to do in front of hypercalcemia with low PTH(3)
A
doser 1,25 OH vit D
25 OH vit D
PTHrelated peptide
12
Q
Cause of hypercalcemia with high 1 ,25 OH Vit D(2)
A
Lymphoma
Sarcoidosis
13
Q
Cause of hypercalcemia with high 25 OH vit D
A
vit D toxicity
14
Q
Hypercalcemia with normal vit D and low PTH(7)
A
drug induced Malignancy Immobilization Multiple Myeloma Hyperthyroidism Vit A toxicity Milk alkali syndrome
15
Q
Hypercalcemia with PTHrelated peptide
A
cancer
16
Q
drug causing hypercalcemia(2)
A
HCTZ
Lithium
17
Q
rx of hypercalcemia caused by immobilization(2)
A
hydration
biphosphonate
18
Q
Rx of SIADH what to consider
A
the level of hyponatremia
19
Q
SIADH with mild hyponatremia(2)
A
Fluid restriction
< 800 ml jour
20
Q
Most common type of neuropathy in diabetics
A
symmetric distal polyneuropathy
21
Q
what cause hypercalcemia in immobilization
A
osteoclastic bone resorption
increase osteoclaste activity
22
Q
The onset of hypercalcemia depends on what factors?(2)
A
the magnitude of bone turnover
kidney capacity of excreting calcium
23
Q
control of heart rate in hyperthyroidism
A
propranolol
24
Q
first test to ask in Hyperthyroidism
A
TSH
25
If TSH is low what 's the second test to ask
T4
26
If low TSH and high T4 next step
radioiodine uptake
| scan
27
importance of radioiodine uptake and scan
to Differentiate graves from other forms of hyperthyroidism
28
Physiopatho of Paget
Bone remodeling
29
Clue for Paget
Hearing loss
| High ALP
30
Tumor in Paget(2)
Osteosarcoma
| giant cell tumor
31
In what cases Paget will cause hypercalcemia(2)
Pathologic fracture
| immobilzation
32
More sensitive image test for Paget
Bone scan
33
Plain xray of Paget(2)
```
Lytic lesion
Mixed Lesion (sclerotic and Lytic)
```
34
Rx of Paget
Biphosphonate
35
Cancer producing PTH related peptide
```
SCC of lung
Renal and bladder cancer
ovarian and endometrial
breast
esophageal cancer
Head and neck SCC
```
36
How cancer cause hypercalcemia
PTH related peptide production
ectopic PTH
bone Metastasis
Production of 1,25 OH vit D
37
Cancer producing high 1,25 OH vit D
Lymphoma
38
Action of 1,25 OH vit D
excessive gut absorption of calcium
39
how metastasis cause bone resoprtion
tumor secrete Cytokines causing increase activity of osteoclaste
40
what cytokines are involved in bone resorption in case of metastasis(4)
IL-3
IL-6
TNF Alpha
Macrophage inflammatory factor 1
41
Hyperandrogenism work up in woman(2)
Testosterone
| DHEAS
42
what is the principal source of production of DHEAS
surrenale
43
hyperandrogenism ,high testo and normal DHEAS
ovary problem
44
Hyperandrogenism ,high DHEAS and normal testo
surrenal problem
45
Lieu of formation of DHEA(2)
ovary
| surrenal
46
When to ask for RAIU in case of primary hyperthyroidism
when there is no sign of graves disease
47
If RAIU is high ,what pattern will be suggestive for grave's
diffuse pattern
48
If RAIU is high with nodular uptake dx?(2)
Multinodular goiter
| toxic adenoma
49
What to if RAIU is low
doser thyroglobuline(TG)
50
Dx of low RAIU and low TG
intake of exogenous hormone
51
Dx of low RAIU and high TG(3)
Thyroiditis
iodide exposure
extra glandular production
52
When to measure T3
when TSH is low and T4 normal
53
Normal T3 T4 with low TSH(3)
pregnancy
subclinical hyperthyridism
non thyroid illness
54
High TSH and high T3
Pituitary adenoma secreting TSH
55
quid of maladie d'addisson
primary adrenal insufficiency
56
first cause of adrenal insufficiency in Addisson in developped country
autoimmune
57
clue for adrenal insufficiency(5)
```
Hypotension
hyperkalemia
hyponatremia
acidosis metabolic
hypereosinophilia
```
58
why hyperkaliemia maladie d'addison
no aldosterone produced
59
Why hyponatremia
No aldosterone produced
60
Why patient with autoimmune adrenal insufficiency can also has hypothyroidism
because you can have autoimmune destruction of this gland (hashimoto)
61
What other gland can be involved in autoimmune adenal insufficiency(3)
thyroid
parathyroid
ovaries
62
Hallmark of insipidus diabetes
Hyponatremia
63
What is the clue of the management of diabetes insipidus
volemia
64
treatment of insipidus diabetes in hypovemic syptomatic patient
nacl 0,9%
65
Rx of diabtes insipidus in euvolemic patient
free water
66
Rx of diabetes insipidus in hypovolemic asymptomatic patient
DW 5%
67
Rx of insipidus diabetes after becoming euvolemia in a previous symptomatic hypovolemic patient
DW 5%
68
How to correct the hypernatremia in Diabetes insipidus
0,5 meq/dl/hr
| dont exceed 12 meq/dl/24h
69
why hypernatremia should be corrected slowly in insipidus diabetes
to prevent cerebral edema
70
what's the basic level of glucose to have DKA
250 mg/dl
71
what's the basic level to have hyperosmolar hyperglycemic state
>600 mg/dl
72
why you will never have ketosis in type 2 diabetes
because there is sufficient insulin in the body to prevent ketosis
73
thyrotoxycosis with low RAIU uptake(4)
Thyroiditis
levothyroxine overdose
iodine induce thyrotoxicosis
stroma ovarii
74
The 2 types of thyroiditis capable of induce thyrotoxycosis
subacute lymphocytic thyroiditis
| subacute granulomatous thyroiditis(de quervain)
75
in case of hyponatremia what's the 3 first dx to have in mind?
- Hypothyroidism
- adrenal insufficiency
- SIADH
76
Dx test for SIADH
osmolarity plasma
| osmolarity urine
77
Osmolarity urine in SIADH
>100-150
78
Osmolarity plasma in SIAD
<280
79
one cause of SIADH
NSAIDS use
80
Why NSAIDS causes SIADH
because it potentiates action of ADH
81
Differnce between Dequervain and lymphocytic thyroiditis
Pain in Dequervain
82
first step in front of a patient with hypercalcemia and HTA and elevated PTH
plasma metanephrines
83
quid of MEN type 1(3)
Parathyroid adenoma
pituitary adenoma
Pancreatic tumor
84
MEN 2A(3)
Parathyroid Hyperplasia
Pheo
Medularry thyroid cancer
85
MEN 2B(4)
Pheo
medullary thyroid cancer
Mucosal and intestinal neuroma
Marfanoid habitus
86
Screening test for MEN 2
Ret proto-oncogen
87
Erectile dysfunction causes(2)
psychologic
| organic
88
first thing to assess in case of erectile dysfunction
Nocturnal or morning penile tumescence
89
What are the 2 mechanism for liver to create sugar
glycogenolysis
| gluconeogenesis
90
what's the main substrat for gluconeogenesis?(2)
Amino acid
| Alanin
91
Quel est le produit intermediaire entre alanin et glucose
pyruvate
92
how long can last the glycogen storage in case of fasting
12hrs
93
How hypothyroidism causes hypercholesterolemia(2)
decrease number of LDL surface receptor
| decrease activity of LDL receptor
94
how hypothyroidism cause hypertriglycedemia
Decrease of lipoproteine lipase activity
95
What are the five criteria to consider for Metabolic syndrome
```
Waist circumference
HDL
triglyceride
BP
fasting glucose
```
96
how many criteria needed to Dx metabolic syndrome?
at least 3
97
waist circumference in men for MS
>40
98
waist circumference in women for MS
>35
99
HDL in men for MS
<40
100
HDL in women for MS
<50
101
triglycerides in MS
>150
102
fasting glucose
>100 -110
103
what's the most pathogenic factor in MS(2)
insulin resistance or
| Central type obesity
104
what are the 3 forms of existence of calcium in the body
ionised
bound to albumin
bound to anions
105
What's the active form of calcium
ionised form only
106
Why respiratory alkalosis causes hypocalcemia
because of increase extracellular PH level
107
what happen to calcium when extracellualr PH is high
calcium becomes highly bound to albumin
108
cause of respiratory alkalosis
hyperventilation
109
cause of hyperventilation without any disease
high altitude
110
clue for hyporcalcemia(3)
cramps
paresthesia
carpopedal spasm
111
Patient on diet develops constipation ,thirst and polutria and polydypsia
hypercalcemia cause by excess of vit D intake
112
why vit supplement can cause hypercalcemia
because fat soluble(vit D eg.) vit are stored in body for long periods of time
113
what are the 3 hormones most commonly involved in hypopituitarism
ACTH
TSH
Gonadotrophin releasing hormone
114
causes of hypopituitarism(7)
```
Infection
infarction
infiltrative
immunologic
iatrogenic
empty sella syndrome
apoplexy
```
115
Infarction of pituitary gland
sheehan syndrome
116
the first disease to infiltrate the pituitary gland
hemochromatosis
117
iatrogenic cause(2)
surgery
| radiation
118
hypothalmic problem causing hypopituitarism(6)
```
infection
infiltrative
iatrogenic
tumeur
injury
metastasis
```
119
first tumor causing hypothalamic hypopituitarism
cranipharyngioma
120
Infection causing hypothalamic hypopituitarism
TB
121
first cause of secondary adrenal insufficiency
pituitary adenoma
122
difference between primary and secondary adrenal insufficiency(3)
IN SECONDARY ADRENAL INSUFFICIENCY
no hyperkaliemie
no salt wasting
no hyperpigmentation
123
trauma causing hypothalamic hypopituitarism
skull base
124
in secondary adrenal insufficiency how's aldosterone
normal
125
clue for DKA(4)
blood glucose >250
PH <15-20
Anion gap acidosis
126
4 things to in DKA
Nacl 0,9%
Insulin
antibio
rx hyperkalemia
127
Hypercalcemie with high or normal PTH Dx?(3)
Primary hyperparathyroidism
familial hypocalciuric hypercalcemia
tertiary hyperparathyroidism
128
How to differentiate primary hyperparathyroidism and FHH
urinary excretion of calcium
129
quid urinary excretion of ca++ in FHH
< 100/24 h
130
quid urinary excretion of calcium in primary hyperparathyroidism?
> 250/24 h
131
first test to in front of hypercalcemia
PTH dosage
132
hallmark of SIADH
hypernatremia
133
rx of SIADH rules
depend on severity of symptom
134
symptom for mild SIADH
forgetfulness
135
rx for asymptomatic patient or mild symptoms
fluid restricton < 800 ml/day
136
Syptoms for moderate SIADH(2)
Confusion
| lethargy
137
Rx for moderate SIADH
Hypertonic saline jusqu'a augmenter Nacl 120 meq/l
138
symptoms for severe SIADH(2)
convulsions
| coma
139
Rx of severe SIADH
Bolus of Hypertonic saline jusqu'a resoultion des symptomes
| Conivaptan
140
quid of conivaptan
vasopressin receptor antagonist
141
physiopatho of exophtalmos in Grave's desease(2)
periorbital lymphocytic infiltration
| retro orbital tissue expansion
142
why renin is high in fibromxar dysplasia
decrease renal perfusion
143
work up for fibro muscular dysplasia(2)
ct angiography of abdomen or
| duplex U/S
144
in addition of renal arteries what other arteries can be involved in fibromuscular dysplasia
Cerebral arteries
145
mechanism of stroke in fibro muscular dysplasia
cerebral arteries involvement
146
what's the most common testicular cancer
Leydig cell tumor
147
clue for leydig cell tumor(3)
gynecomastia
High testo
high estrogen
148
role of leydig cells(2)
testo
| oestrogen formation
149
role of aldosterone(3)
regule pompe Na+K+
sortie de K+ couple avec H+
entree de Na+ couple avec HCO3_
150
best way to slow progression of diabetic nephropathy
ACE inhibitor
151
clue for primary hyperaldosteronism(4)
HTA
NA high
K+ low
metabolic alkalosis
152
work up of primary hyperaldosteronism?(3)
low plasma renin
high plasma aldosterone
rapport plasma aldosterone /plasma renin >20
153
Confirmatory dx of primary hyperaldosteronism?
oral saline load suppression test
154
interpretation of oral saline load test
adrenal supression=primary hyper aldosteronism
155
Why CT and adrenal venous sampling are important
to help differentiate adrenal adenoma from bilateral adrenal hyperplasia
156
two causes of primary aldosteronism
Bilalateral adrenal hyperpalsia
| adrenal adenoma
157
rx for adrenal adenoma
surgery (prefered)
| aldosterone antagonist
158
Rx of bilateral adrenal hyperplasia
aldosterone antagonist
159
what's the most drug used in primary hyperaldosteronism
epleronone
| spironolactone
160
quid of urinary dribbling
incontinence
161
cause of incontinence in diabetic patient
neurogenic bladder
162
organ targeted by autonomic diabetic neuropathy(4)
cardio vascular
peripheral nerves
gastro intestinal
genito urinary
163
Manif of cardio vascular autonomic diabetic neuropathy(2)
tachycardia
| postural hypotension
164
Manif of gastrointestinal autonomic diabetic neuropathy(3)
esophageal dysmotility and dyspepsia
gastroparesis
intestinal involvement
165
Manif of peripheral nerves autonomic diabetic neuropathy(3)
foot ulcer
poor wound healing
charcot arthropathy
166
Manif of genitourinary autonmic diabeticneuropathy(3)
reccurent infection
overflow incontinence
erectile dysfonction
167
why you can't give blocker initially in Pheochromocytoma
BP will rise dramatically
168
First anti hypertensor to give in case of pheo
alpha blocker
169
why beta blocker is dangerous in first intention(2)
you block the bete receptor vascular
| unopposed stimulation of alpha receptor by catecholamines
170
what's the only beta that can be used in Pheo
Labetalol
171
Why labetalol can be used in Pheo
it blocks both alpha and beta blocker
172
primary adrenal insufficiency cause in developping country Dx(3)
TB
fungus infection
cytomegalovirus
173
calcification on CT for primary adrenal insufficiency Dx?
TB
174
Primary adrenal insufficiency in developed country
autoimmune
175
most common of death in patient with acromegaly?
CHF
176
how much fluid patient with hyperosmolar hyperglycemic state needs
8-10 liters
177
first cause of acromegaly
somatotroph adenoma
178
in the rehydration of patient of hyperglycemia why add glucose whe glycemia 250 mg/dl
to prevent cerebral edema
179
first agent used in diabetes type 2
biguanide (metformin)
180
second line if metformin fails in case of diabetes type 2
sulfonyluree(glyburide)
181
when you can use insulin in diabetes type 2
when metformin fails can be used as a second agent if A1C> 8,5
182
only oral hypoglycemiant associated with weight loss
GLP-1 agonist receptor
183
Example of GLP-1 agonist receptor
exenatide
184
oral hypoglycemiant with neutral action on weight
Metformin
| DPP_iv inhibitor
185
example of DPPIV inhibitor
sitagliptin
186
oral hypoglycemiant associated with weight gain
insulin
pioglytazone
glyburide
187
family of pyoglitazone
thiazolidonedione(TZD)
188
oral hypoglycemiant can be used in renal insufficiency
dpp-iv inhibitor
| Pyoglitazone
189
oral hypoglycemiant associated with bladder cancer
pyoglitazone
190
med with the greater efficacy to decrease A1C
insulin
191
effect of acidosis on respiration in case of DKA
kusmall
192
quid of kusmaull
deep and rapid respiration
193
how to differentiate primary hyperthyroidism and FHH in a context of hypercalcemia
Urinary calcium creatinin clearance ratio(UCCCR)
194
How 's UCCCR in FHH
<0,01
195
HoCR in primary hyperparathyroidism
>0,02
196
Physiopatho of FHH(2)
defect in calcium sensing receptor in kidney
| excess reabsorption of calcium
197
specificity of HCTZ induce hypercalcemia
it's less than 11
198
rx which can worsen exophtalmy in grave's
RAI
199
the only medication given in first trimester of pregnancy in graves
PTU
200
drugs used in hyperthyroidism causing agranulocytosis(2)
PTU
| MM
201
permanent rx of hyperthyroidism(2)
surgery
| RAI
202
drugs used in hyperthyroidism causing vasculitis
PTU
203
procedures used in hyperthyroidism causing hypothyroidism(2)
surgery
| RAI
204
when to use statin in diabetics patient
any diabetics aged 40-45 ans regardless lipid profile
205
quid of high intensity statin(2)
atorvastatin 80 mg
| rosuvastatin 20-40 mg
206
quid of moderate intensity statin
simvastatin 20-40 mg
207
indication blocker in pheochromocytoma
tremor
208
physio patho of hta in thyrotoxicosis
hyperdynamic circulation
209
How's HTA in thyrotoxycosis
Systolic
210
HTA and low renin activity with high plasma aldosterone
conn tumor
211
Quid of conn tumor
tumor or corticosurrenale
212
Clue for conn syndrome(4)
HTA
Hypokaliemie
Low renin activity
high plasma aldosterone
213
cause of secondary hyperaldosteronism
everything which can decrease flux sanguin renal
| high renin secretion
214
cause of secondary hyperaldosteronism(7)
```
Diuretic use
cirrhosis
CHF
renin producing tumor
reno VX HTA
Malignant HTA
aorta coarctation
```
215
best test to confirm primary hyperaldosteronism
adrenal ct scan
216
screening test for primary hyperaldosteronism
ratio plasma aldosterorone concentration sur plasma renin activity
217
value for PAC/PRA in primary hyperaldosteronism
>20
| aldosterone > 15 ng/dl
218
Hta plus hypokaliemie and low PAC and PRA(5)
```
congenital adrenal hyperplasia
glucocorticoid resistance
exogenous mineralocorticoid
cushing's syndrome
altered aldosterone metabolism
```
219
Mechanism of Hypocalcemia in renal failure(2)
hyperphospahtemia
220
cause hyperphosphatemia in renal failure
retention of phosphate
221
how hyperphosphatemia causes hypocalcemia
by binding to calcium in blood
| by interfering with 1.25 oH vit D in kidney
222
why secondary hyperparathyroidism in renal failure
hyperphosphatemia stimulates parathyroid to produce more PTH
223
clue for hyperosmolar hyperglycemic state(2)
non anion gap acidosis
| Bicarb> 18
224
why you dont have ketosis in diabete type 2
sufficient insulin to prevent ketosis
225
why coma in hyperosmolar state
because of hyperosmolarity
226
how's bicarb in DKA
< 18
227
Marker for paget(2)
ALP
| N-telopeptide
228
signification of Ntelopeptide
bone resorption
229
signification of ALP
bone formation
230
Mechanism of Paget disease
abnormal bone remodeling
231
initial work up for primary adrenal insufficiency(3)
doser
cortisol
ACTH
cosyntropin stimulation test
232
What's the normal reaction of the body during cosyntropin stimulation test to rule out addison disease
increase of cortisol> 20 mcg when giving 250 mcg of cosyntropin
233
clue for secondary or tertiary adrenal insufficiency(2)
Low ACTH
| low cortisol
234
screening test for diabetic nephropathy
ramdom urine microalbumine sur creatinine ratio
235
normal protein excretion in 24 hr
<30 mg
236
quid of microalbuminuria
30-300 mg of protein excretion par 24 h
237
effect of T3 T4 on bone
increase osteoclastic activity
238
risk in hyperthyroidism regarding bone(2)
bone loss---------->hypercalcemia
239
most common risk factor for diabetic foot ulcer
neuropathy
240
method of screening diabetic peripheral neuropathy
pressure sensation by 10 g monofilament
241
interperetation of 10 g monofilament test
loss of monofilament sensation is associated with the risk of foot ulceration
242
risk factor for foot ulceration(6)
```
diabetic neuropathy
smoking
PAD
Bony abnormalities in foot
diabetes > 10 ans
sexe male
```
243
when beginning diabetic screening
45 years old
244
Test to screen for diabetes(4)
A1C
fasting glucose
OGTT
random glucose
245
Abnormal A1C=diabetes
> 6,5
246
Abnormal OGTT
> 200 mg/dl
247
abnormal random glucose
> 200 mg /dl
248
best test to sreen diabetes
A1C
249
FBG tellig diabetes =is Dx
> 126 mg/dl
250
quid of impaired fasting glucose
100-125 mg/dl
251
Normal FBG
70-99mg/dl
252
Normal A1C
Less 5.7%
253
A1C telling you are at high risk of diabetes
5,7-6,4%
254
Rx of diabetic peripheral neuropathy(3)
TCA
or Gabapentin
or NSAIDS
255
Danger of TCA in the rx of diabetic peripheral neuropathy(2)
can worsen hypotension in diabetes
| urinary symptom
256
what causes Hypotension in diabetics
autonomic dysfunction
257
marker of androgen producing tumor in woman
DHEAS
258
symptom of hyperandrogenism in woman
Masculinisation
259
lieu of production of DHEAS
adrenal gland
260
Lung malignancy causing hyper calcemia
SCC
261
causes of hypercalcemia in malignancy(4)
oeteolytic malignancy
PTH related peptide
increase production of 1,25 OHvit D
increase interleukin 6
262
difference of hypercalcemia causing by ca and primary hyperparathyroidism
calcemia >13 mg in Cancer
263
best long term rx of grave's
radio active iodine
264
contrindication of RAI(2)
pregnancy
| severe ophtalmopathy
265
Most common cause of Vit D deficiency?
gastrointestinal malabsorption
266
electrolytic abnormality of vit D decficiency(3)
low calcemie
low phosphatemie
High PTH
267
cause of hypocalcemia(5)
```
respiratory alkalosis
vit d deficiency
hypoparathyroidism
renal failure
low albumin
```
268
cause of hypoparathyroidism(4)
post surgery
congenital of absence of parathyroid gland
autoimmune destruction
defective calcium sensing receptor on parathyroid receptor
269
congenital cause of hypoparathyroidism
di george syndrome
270
what syndrome cause autoimmune destruction of parathyroid gland
APECED syndrome
271
quid of APECED syndrome(6)
```
autoimmune
polyglandular
endocrinopathy
candidiasis
ectodermal
dysplasia
```
272
target of neuropathy(3)
nerve
GI
hypotension
273
patient diabetic with early satiety
gastroparesis
274
rx of gastroparesis(2)
metochlopramide or
| erythromycine
275
why they don't use cisapride anymore in gastroparesis
cardiac aryhtmia
276
consequence of gastroparesis in diabetic patient(3)
delayed gastric emptying
decrease Gut absorption
risk of hypoglycemia
277
how's potassium ion DKA
high
278
why hyperkaliemie in DKA is called paradoxal
because total body K is depleted
279
why blood potassium level is high in DKA
extra cellular shift
280
cause of paradoxical hyperkaliemie in DKA(2)
extra cellular shift with ion H+
| insulin dependent impaired entry of ion k+inside of cells
281
best way to lower the risk of of nephropathy caused by diabetes
tight blood pressure control
282
causes of erectil dysfunction in diabetes(3)
neuropathy
impaired penile circulation
gonadotrophic hypogonadism
283
quid of FS/LH in secondary hypogonadism
normal or
| low
284
first step in secondary hypogonadism
ask for serum prolactine level
285
indication of MRI of head in the context of secondary hypogonadism(4)
high prolactine
testosterone< 150 ng/ml
visual fiel defect
other pituitary hormonal defect
286
indication of surgery in asymptomatic hyperparathyroidism(4)
young age1mg above the upper normal limit
287
anapath characteristics of medullary thyroid cancer
Invasion of capsule and blood vessel
288
characteristic of medullary thyroid cancer
produces calcitonin
289
what's the most common type of thyroid cancer
papillary
290
clue for papillary thyroid cancer
psammoma body
291
thyroid cancer whoth the best prognosis
papillary carcinoma
292
complication of invading blood vessel by medullary thyroid cancer
rapidly metastasizes
293
initial aproach to patient with hypoglycemia
doser insulin
294
cause of hypoglycemia with high insulinemia(2)
insulinoma
| surreptitious hypoglycemia
295
cause of surreptitious hypoglycemia(2)
voluntary intake of insuline or
| sulfonylurea
296
clue for b cell tumor(2)
c peptide
| proinsuline more than 5 pg
297
Screening of MEN 2A 2b
Dna testing
| ret proto-oncogen positif
298
If Ret protooncogen positif CAT
thyroidectomie
299
Causes of osteomalacia(3)
digestive malabsorption
liver disease
kidney disease
300
digestive cause of malabsorption giving osteomalacia(2)
celiac sprue
| crhron
301
complication of osteomalacia?
pseudo fracture
302
erectile dysfunction treatment(2)
sildenafil and
| doxazocin
303
how to give sildenafil and doxazocin
we have to give them 4 hours interval each
304
sildenafil and nitrate risk?
Hypotension
305
risk if sildenafil is given with erytromycin or cimetidine(2)
increase half life of sildenafil
| priapism
306
patient on PTU or Methimazole develops sore throat next step?
wbc count
307
patient on PTU or methimazole develops wbc < 1000 what to do?
stop meds
308
patient on PTU or MM develops fever with blood cell >1500 ?
continue the drug
309
side effect of PTU or MM
agranulocytosis
310
first thing to do in thyroid nodule
sono to search sign of malignancy
311
in case of thyroid noduleif sono doen't show sign of malignancy what to
TSH
312
Thyroid nodule with low TSH
iode 123 scyntigraphy
313
quid of cold nodule
hypofunctionning nodule with iode 123
314
Management of cold nodule
FNA
315
quid of hot nodule
hyperfunctioning nodule on iode 123
316
Management of hot nodule
rx hyperthyroidism
317
if sono shows sign of malignancy next step
FNA
318
thyroid nodule with no sign of malignancy on sono but normal or high TSH
FNA
319
patient on prednisone develops hyponatremia Why
central adrenal insufficiency
320
why hyponatremia during prednisone
because of low cortisol
321
action of cortisol on ADH(2)
cortisol inhibits release of ADH by post hypophise
| low cortisol ,more ADH
322
why cortisol is low whe taking prednisone(2)
prednisone blocks hypothalamo pituitary axis
| low ACTH--->low cortisol
323
work up of acromegaly
Measure insulin grothw like factor -1
324
In acromegaly in IGLF-1 positive next step
oral glucose suppression test
325
interpretation of oral glucose suppression test in acromegaly
GH suppression
326
if you have an inadequate GH suppression during oral glucose suppression test next step?
brain MRI
327
adequate glucose suppression
no acromegaly
328
what cause of hyperthyroidism can cause hypothyroidism after RAI
grave's
329
what can cause false decrease of calcium
low albumin
330
how to measure the right calcium level in case of low albumin
coreected calcium=measeured calcium+0,8(4-measured albumin)
331
what to do in front of all hypocalcemia
look albumin level
332
clue for MEN 2B(4)
Medullary thyroid ca
Pheo
marfanoid habitus
neuroma
333
hyperplasia parathyroid MEN?
2A
334
Parathyroid adenoma MEN?
1
335
what's the most common pituitary tumor?
lactotroph adenoma
336
cause of high cortisol
cushing syndrome
| cushing disease
337
cause of florid cushing disease
hypophyse tumor
338
screening test for cushing?(2)
24 hour urine free cortisol
| low dose dexamethasone suppression test
339
florid cushing syndrome
adenoma surrenal
340
cause of ectopic ACT production(4)
SCC
pancreatic ca
bronchial carcinoma
neuroendocrine tumors
341
link between cushing disease and ectopic ACTH production
high ACTH
342
indication of high dose dexamethasone suppression test?
to differentiate ectopic ACTH syndrome from cushing disease
343
high dose dexamethasone suppression test in favor of ectopic production of ACTH(2)
Failure to suppress 24 Hr urine free cortisol
| failure to decrease serum cortisollevel from 50%of its baseline
344
abnormal 24 h urine free cortisol
> 90 mcg/24 h
345
Normal ACTH
9-52 pg/ml
346
Marker of hashimoto
TPO antibodies
347
risk for hashimoto
thyroid lymphoma
348
first test to in hyperthyroidism suspected
TSH
| T4
349
most common cause of thyroid nodule
colloid nodule
350
low TSH and high T4
hyperthyroidism
351
in case of hyperthyroidismnext step
RAIU
352
RAUI with diffuse uptake in a context of hyperthyroidism
grave's
353
RAIU with nodular pattern in a context of hyperthyroidism(2)
Nodular goiter
| Multinodular goiter
354
high t4 with normal or high TSH
secondary hyperthyroidism
355
next step in secondary hyperthyroidism
Brain MRI
356
T4 normal and low TSH in a context of hyperthyroidism?
doser T3
357
High T3 low TSH normal T4
Hyperthyroidism
358
Low TSh with normal T3 T4(3)
pregnancy
subclinical hyperthyroidism
non thyroid illness
359
indication of dosage of thyroglobulin
low raiu
360
Low RAIU and high thyroglobulin in a context af hyperthyroidism(3)
thyroiditis
iodide exposure
extra glandular production
361
Low RAIU,high T4,low thyroglobulin
exogenous hormone
362
best way to monitor response of rx in case diabetes DKA(2)
serum anion gap
| arterial PH
363
what can explain biochemically low raiu in a context of hyperthyroidism(2)
Low TG
| high TG
364
Marker for graves
TSI
365
quid of isolated low T3 syndrome
sick euthyroid syndrome
366
what causes sick euthyroid syndrome(2)
increase level of
IL-1
IL-6
367
cardiogenick shock patient or any hosptilaisede patient with serious illness with isloated low t3
sick euthyroid syndrome
368
how's the RAIU in Multinodular toxic goiter
patchy pattern
369
Raiu in toxic adenoma
one lobe pattern
370
what's the first test to do in low calcium(3)
doser MG++
ask for blood transfusion
check drug
371
drugs causing low calcium(3)
phenytoin
biphosphonate
ca++ chelator
372
cause of low calcium with high PTH(4)
vit d deficiency
renal failure
inflammatory cause(sepsis,pancreatitis)
tumor lysis syndrome
373
causes of low calcium and low PTH(4)
surgery
radiation of neck
APCED
infiltrative disease
374
infiltrative disease causing low calcium and low PTH(3)(primary hypothyroidism)
wilson
hemochromatosis
ca metastatic
375
what'sthe next step in patient presenting low calcium and elevated PTH
doser 25 OH vit D
376
causes of polyurie(3)
diabetes melitus
diabete insipide
primary polydipsia
377
first thing to in a context of polyuria with low osmolarity of urine
water deprivation test
378
if urine osmolarity increases during water deprivation test
primary polydypsie
379
if there 's no changes in water deprivation test in a context of low urine osmolarity next step
desmopressin
380
when given desmopressin if osmolarity of urine increases of 50% a 100%
central diabetes insipidus
381
when given desmopressin if osmolarity of urineshows small change
nephrogenic diabetes
382
urine osmolarity
50-1400 mosm/kg
383
serum osmolarity
275-295 mosm/kg
384
rx of central diabetes insipidus
desmopressin intranasal(vasopressin)
385
drug of choice of SIADH
demeclocyclin
386
illaic bone fracture and impotence why?(2)
neurogenic cause
| parasympathic fibers are cut
387
hypothyroidism symptom in a context of Normal thyroid bilan
receptor problem in peripheral tissues
388
Rx of Paget
biphosphonates
389
quid of non funvtionning adenoma
pituitary adenoma producing alpha unit of LH and FSH
390
biochemistry of FSH LH(3)
dimeric
alpha et B unit
Beta units are more active
391
why non functionning pituitary adenoma causes hypogonadism?
because only alpha unit is produced for LH/FSH
392
why prolactine is elevated in non functionning pituitary adenoma
mass destroys the dopaminergic neurone inhibiting normally secretion of prolactine
393
what should be the level of prolactinemia to think of prolactinome
more than 200
394
how's t3 t4 in non functionning adenoma in hypophyse
low
395
central hypogonadism ,low t3 t4 ,increase prolactin level mildly?
non functionning pituitary adenoma
396
cause of bone pain in osteomalacia
impaired osteoid matrix mineralization
397
role of vit D(2)
absorption of calcium
| and phosphate
398
foot ulcer grade 1 and management(2)
superficial ulcer
| debridement and wound dressing
399
foot ulcer grade 2 and management(3)
deep ulcer
Mx and ligament are seen
debridement and wound dressing
400
foot ulcer grade 3 and management(5)
```
bone involvement
osteomyelitis/abcess
hospitalisation
antibio
debridement
```
401
foot ulcer grade 4
local gangrene
402
foot ulcer grade 5
whole foot gangrene
403
management of grade 4 et 5 foot ulcer
amputation
404
first test to do in primary hyperaldosteronism
plasma renin activity and aldosterone concentration
405
high plasma aldosterone concentration ,next step in a context of primary hyperaldosteronism
adrenal suppresion test
406
si adrenal suppression test is positive next step in a context of primary hyperaldosteronism
CT adrenal
407
positive CT in a context of primary hyperaldosteronism in 40 rx?
surgery
408
if CT is negative next step in a context of primary hyper aldosteronism
venous sampling
409
quid of venous sampling(3)
to differentiate adrenal adenoma from bilateral adrenal hyperplasia in a context of negative CT
patient > 40 ans
venous sampling can also reveal adenoma CT
410
cause of proximal MX weakness(7)
```
Polymyositis
dermatomyositis
hypo or hyperthyroidism
cushing
Myasthenie gravis
Lambert eaton syndrome
steroids
```
411
Patient taking prednisone develops mx weakness
steroid myopathyy
412
patient 45 yo with no protinuria normal blood pressure diabetes on metformin ,what meds should be added in medication choix Rosuvastatin,lisinopril
rosuvastatin
