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MCCQE1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Patient with Pituitary tumor, hypercalcemia and refractory gastric ulcers. Dx and gene?

A 
MEN 1A
Tumors of…
- Pituitary (functional tumor or not)
- Parathyroid: Hyperparathyroidism
- Pancreas: endocrine tumors like Zollinger Ellison or Insulinoma

Path: disorder of MEN gene

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2
Q

Patient with Pituitary tumor, hypercalcemia and hypoglicemia. Dx and gene?

A 
MEN 1A
Tumors of…
- Pituitary (functional tumor or not)
- Parathyroid: Hyperparathyroidism
- Pancreas: endocrine tumors like Zollinger Ellison or Insulinoma

Path: disorder of MEN gene

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3
Q

Patient with pheochromocytoma, medullary thyroid cancer and hypercalcemia. Dx and gene?

A

MEN 2A

Path: RET protooncogene

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4
Q

Patient with pheochromocytoma, medullary thyroid cancer and neuronal tumor. Dx and gene?

A

MEN 2B

Path: RET protooncogene

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5
Q

Woman with amenorrhea + galactorrhea// Man with ↓libido and bitemporal hemianopsia. History of schizophrenia, tx with haloperidol. Dx?

A

Hyperprolactinemia secondary to dopamine antagonist

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6
Q

Woman with amenorrhea + galactorrhea// Man with ↓libido and bitemporal hemianopsia. ↑↑TSH.
Dx?

A

Hyperprolactinemia secondary to hypothyroidism.

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7
Q

Woman with amenorrhea + galactorrhea// Man with ↓libido and bitemporal hemianopsia. Dx, next step, tx?

A

Hyperprolactinemia

Next step:

  • 1st: Review medications. Dopamine antagonist (anti-psychotic)
  • 2nd: TSH because hypothyroidism can produce hyperprolactinemia
  • 3rd: Prolactine level
  • 4th: MRI

Tx:

  • Dopamine agonist: Cabergoline > bromocriptine
  • Surgery/radiation (rare)
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8
Q

Child with excessive growth of long bones. Dx, next step and tx?

A

Gigantism

Next step:

  • 1st: ILGF-1
  • 2nd: glucose suppression test (GH doesn’t ↓ after a load of glucose)
  • 3rd: MRI

Tx: Surgery +/- octreotide (somatostatin) to suppress the axis

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9
Q

Adults patient with growth of hands, feet, face and visceral organs, diabetes, diastolic CHF. Dx, next step and tx?

A

Acromegalia

Next step:

  • 1st: ILGF-1
  • 2nd: glucose suppression test (GH doesn’t ↓ after a load of glucose)
  • 3rd: MRI

Tx: Surgery +/- octreotide (somatostatin) to suppress the axis

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10
Q

Pregnant patient with prolonged delivery who suddenly has hypotension, tachycardia, Letargy, coma. Dx, next step and tx?

A

Sheehan’s syndrome (Acute Hypopituitarism)

Next step:

  • ABC
  • Cortisol and T4 levels

Tx: Hormone replacement

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11
Q

Patient with pre-existing pituitary tumor Pituitary who has suddlently stupor, nuchal rigidity, headache, N/V.

A

Apoplexy (Acute Hypopituitarism)

Next step:

  • ABC
  • Cortisol and T4 levels

Tx: Hormone replacement

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12
Q

Patient with ↓libido, Fatigue, Problems with menstrual cycle. Failure to increase GH after load of insulin or vasopressin. Next step and tx?

A

Chronic hypopituitarism

Next step: MRI

Tx:

  • Hormone replacement
  • Treat underlying condition (e.g., Autoimmune deposition disease)
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13
Q

Patient whose MRI shows a non-existant pitiutaria. The patient is otherwise asx. Dx and next step?

A

Empty sella syndrome

No treatment required

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14
Q

Patient with pulmonary cancer, hyponatremia, ↑Urinary Na, ↑Urinary Osm, and ↓Serum Osm. Dx, type of pulmonary associated neoplasia and tx?

A

Syndrome of inappropriate ADH (SIADH)

Type of cancer: small cell carcinoma

Tx:

  • Water restriction
  • Demeclocycline (antibiotic) to block ADH receptor in kidney and eliminate water
  • Hypertonic saline if sever hypoNa
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15
Q

Patient with hyponatremia and suspiction of Syndrome of inappropriate ADH (SIADH). Next step and tx?

A

Next step:

  • ↑Urinary Na
  • ↑Urinary Osm
  • ↓Serum Osm

Tx:

  • Water restriction
  • Demeclocycline (antibiotic) to block ADH receptor in kidney and eliminate water
  • Hypertonic saline if sever hypoNa
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16
Q

Patient with Polydipsia and polyuria. Normal glucose and no glucose in urine. Dx and next step?

A

Diabetes insipidus

Next step: Water deprivation test to differentiate betwen central, nephrogenic and Psychogenic polydipsia

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17
Q

Patient with Polydipsia and polyuria. Normal glucose and no glucose in urine.
Water deprivation test: Improvement of urinary Osm after ADH administration.
Dx and tx?

A

Central Diabetes insipidus

Tx: DDAVP (desmopressin) intranasally

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18
Q

Patient with Polydipsia and polyuria. Normal glucose and no glucose in urine.
Water deprivation test: Not improvement of urinary Osm after ADH administration.
Dx and tx?

A

Nephrogenic Diabetes insipidus

Tx: gentle diuresis with HCTZ or amiloride

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19
Q

Patient with Polydipsia and polyuria. Normal glucose and no glucose in urine.
Water deprivation test: Improvement of urinary Osm after water deprivation, even before administration of ADH.
Dx and tx?

A

Psychogenic polydipsia

Tx: Stop drinking water

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20
Q

Patient with Tachycardia, Diarrhea, Heat intolerant,↑ Deep tendon reflexes, Weight loss. on physical, exophthalmos, pretibial myxedema, universal enlargement of the thyroid.
• ↓TSH, ↑T4
• Diffuse Radioactive iodine uptake (RAIU) test

Dx, next step and tx?

A

Grave’s

Next step: Thyroid stimulating antibodies

Tx: Propylthiouracil (PTU) or methimazole. Surgery

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21
Q

Patient with hyperthyroidism sx, painless thyroid, followed by hypothyroidism sx.
Thyroid peroxidase antibody (TPO) positive
Dx, tx?

A

Hashimoto’s

Tx: levothyroxine

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22
Q

Patient with hyperthyroidism sx, painful thyroid, then resolution of sx.
Dx?

A

De Quervain’s thyroiditis

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23
Q

Patient with Tachycardia, Diarrhea, Heat intolerant,↑ Deep tendon reflexes, Weight loss.
• ↓TSH, ↑T4
• Multiple nododules lighted up on Radioactive iodine uptake (RAIU) test

Dx and tx?

A

Multinodular goiter

Tx: Radioactive iodine ablation

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24
Q

Patient with Tachycardia, Diarrhea, Heat intolerant,↑ Deep tendon reflexes, Weight loss.
• ↓TSH, ↑T4
• One big nodule lighted up on Radioactive iodine uptake (RAIU) test

Dx and tx?

A

Toxic adenoma

Tx: Radioactive iodine ablation

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25
Q

Woman on multiple diets, lots of exercise, body-image issues.
• ↓TSH, ↑T4
• Cold thyroid on Radioactive iodine uptake (RAIU) test

Differential and next step?

A

Facticious vs Stroma ovari

Next step: RAIU of the ovaries

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26
Q

Woman on multiple diets, lots of exercise, body-image issues.
• ↓TSH, ↑T4
• Cold thyroid on Radioactive iodine uptake (RAIU) test
• RAIU of ovaries is negative
Dx?

A

Facticious (exogenous T4 being ingested)

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27
Q 
Woman hyperthyroidism sx
•	↓TSH, ↑T4
•	Cold thyroid on  Radioactive iodine uptake (RAIU) test
•	RAIU of ovaries is positive
Dx and tx?
A

Stroma ovari (Ovarian lesion (dermoid cyst/teratoma) producing T4)

Tx: Radioactive iodine ablation

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28
Q

Patient Afib, tachycardia, shock, fever, hypotensive, delirium.

  • ↓TSH
  • ↑T4

Dx and tx?

A

Thyroid storm

Tx:
•	1st: IVF, cooling blankets
•	2nd: B-blocker
•	3rd: PTU/methimazole
•	4th: steroids
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29
Q

Patient with Bradycardia, Constipation, Cold intolerance, ↓Deep tendon reflexes, Weight gain.
- ↑TSH
- ↓T4
Dx and tx?

A

Hypothyroidism

levothyroxine

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30
Q

Definition of subclinical hypothiroidism. When to treat?

A

↑TSH, normal T4

Treat subclinical if TSH >10 or Sx are present

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31
Q

Patient Coma, hypothermic, hypotension.
- ↑TSH
- ↓T4
Dx and tx?

A

Myxedema coma

Tx:
• Warm IVF, warm blankets
• IV T4

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32
Q

Patient Hodgkin lymphoma survivor, who consults with hoarseness. On physical exam he has a thyroid nodule that is Fixed, Firm, and Hard. Next step?

A

TSH

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33
Q

Patient who has a thyroid nodule that is Fixed, Firm, and Hard.
↓TSH
Next step?

A

Radioactive iodine uptake (RAIU) test

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34
Q

Patient who has a thyroid nodule that is Fixed, Firm, and Hard.
↓TSH
The nodule is hot on the Radioactive iodine uptake (RAIU) test

Dx and next step?

A

Functioning thyroid nodule

Next step: Treat the hyperthyroidism with Radioactive iodine ablation

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35
Q

Patient who consults with hoarseness. On physical exam he has a thyroid nodule that is Fixed, Firm, and Hard.
↓TSH
The nodule is cold on the Radioactive iodine uptake (RAIU) test

Dx and next step?

A

Nonfunctioning thyroid nodule

Next step: FNA

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36
Q

Patient Hodgkin lymphoma survivor, who consults with hoarseness. On physical exam he has a thyroid nodule that is Fixed, Firm, and Hard.
↑TSH

Dx and next step?

A

High-risk thyroid nodule

Next step: U/S

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37
Q

Patient Hodgkin lymphoma survivor, who consults with hoarseness. On physical exam he has a thyroid nodule that is Fixed, Firm, and Hard.
↑TSH
U/S shows a nodule > 1cm

Next step?

A

High-risk thyroid nodule

Next step: FNA

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38
Q

Patient Hodgkin lymphoma survivor, who consults with hoarseness. On physical exam he has a thyroid nodule that is Fixed, Firm, and Hard.
↑TSH
U/S shows a nodule < 1cm

Next step?

A

Repeat U/S in 6-12 months

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39
Q

Patient with a thyroid nodule and “inconclusive” results on FNA. Next step?

A

Repeat FNA immediately

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40
Q

Patient with thyroid nodule.
FNA results: Orphan annie nuclei and psammoma bodies.
Dx and Tx?

A

Papillary thyroid cancer

Tx: Srugery

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41
Q

Patient with thyroid nodule.
FNA results: Thyroid tissue
Dx and Tx?

A

Follicular thyroid cancer

Tx: Radioactive iodine ablation

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42
Q

Patient with thyroid nodule.
FNA results: Medullary thyroid cancer
What is this cancer associated with?

A 
Associated with MEN 2a and MEN 2b
-MEN 2a
•	Pheochromocytoma 
•	Medullary thyroid cancer
•	Parathyroid

MEN 2b
• Pheochromocytoma
• Medullary thyroid cancer
• Neuronal tumors

Associated with RET oncogene

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43
Q

What is the most fatal thyroid cancer?

A

Anaplastic thyroid cancer

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44
Q

Lawers of adrenal gland?

A

Glomerulosa (salt): aldosterone
Fasciculata (sugar): cortisol
Reticularis (sex): testosterone
Medulla: catecholamines

45
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae. Next step?

A

Late-night saliva cortisol OR 24-hr free urine cortisol
AND
Low-dose overnight Dexamethasone suppression test

46
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae.

  • 24-hr free urine cortisol (high)
  • Low-dose overnight Dexamethasone suppression test fails to suppress high cortisol

Dx and next step?

A

Cushing’s

Next step: ACTH

47
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae.

  • 24-hr free urine cortisol (high)
  • Low-dose overnight Dexamethasone suppression test fails to suppress high cortisol
  • ↓ACTH

Dx and next step?

A

Primary Cushing’s (ACTH-secreting tumor in the adrenals)

Next step: MRI/CT of abdomen and resect

48
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae.

  • 24-hr free urine cortisol (high)
  • Low-dose overnight Dexamethasone suppression test fails to suppress high cortisol
  • ↑ACTH

Next step?

A

Adrenals are ok, the problem is an overproduction of ACTH either from pituitary or paraneoplastic syndrome

Next step: High dose Dexamethasone suppression test

49
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae.

  • 24-hr free urine cortisol (high)
  • Low-dose overnight Dexamethasone suppression test fails to suppress high cortisol
  • ↑ACTH
  • Successful High dose Dexamethasone suppression test (lowers cortisol)

Dx and Next step?

A

Cushing disease (ACTH-secreting tumor in anterior pituitary)

Next step: MRI of brain and resect

50
Q

Patient with HTN, DM, Obese, Moon facies, Bad acne, Truncal obesity, Buffalo hump and Purple striae.

  • 24-hr free urine cortisol (high)
  • Low-dose overnight Dexamethasone suppression test fails to suppress high cortisol
  • ↑ACTH
  • High dose Dexamethasone suppression test fails to suppress high cortisol

Dx and Next step?

A

Paraneoplastic Syndrome: Ectopic ACTH-secreting tumor

Next step: CT lungs/abdomen/pelvis

51
Q

Patient witn orthostatism, hypotension, hyperpigmentation, ↓Na, ↑K.
- ↓3 am cortisol < 3

Dx and next step?

A

Adrenal insufficiency

Next step: Give exogenous ACTH to see response of cortisol and distinguish between primary and secondary

52
Q

Patient witn orthostatism, hypotension, hyperpigmentation, ↓Na, ↑K.

  • ↓3 am cortisol < 3
  • Increase of cortisol 60 mins after cosyntropin test.

Dx, next step and Tx?

A

Secondary (central) Adrenal insufficiency

Next step: MRI brain

Tx: Prednisone

53
Q

Patient witn orthostatism, hypotension, hyperpigmentation, ↓Na, ↑K.

  • ↓3 am cortisol < 3
  • No response of cortisol after cosyntropin test.

Dx, next step and Tx?

A

Addison’s disease (primary adrenal insufficiency)

Next step: MRI/CT abdomen

Tx:
Prednisone (replaces cortisol)
AND
Fludrocortisone (replaces aldo)

54
Q

Patient with refractory HTN after 3 meds and hypokalemia.

Differential and next step?

A

Hyperaldosteronism

Next step: calculate aldo : renin

55
Q

Patient with refractory HTN after 3 meds and hypokalemia.
↑Aldo
↑Renin
Aldo : Renin < 10

Dx?

A 
Secondary hyperaldosteronism
(renovascular HTN due to CHF, cirrhosis, nephrotic syndrome, etc.)
56
Q

Patient with refractory HTN after 3 meds and hypokalemia.
↑Aldo
↓Renin
Aldo : Renin > 20

Next step?

A

Sal supression test (to confimr Conn’s syndrome, i.e., primary hyperaldosteronism)

57
Q

Patient with refractory HTN after 3 meds and hypokalemia.
↑Aldo
↓Renin
Aldo : Renin > 20
Aldo remaing elevated after salt supression test

Dx and Next step?

A

Conn’s syndrome (primary hyperaldosteronism)

Next step:

  • CT/MRI of abdomen
  • Adrenal vein sampling
58
Q

Patient with Pain (headache), Pressure (refractory HTN), Palpitations (tachycardia), Perspiration (sweating), Pallor.

Dx and next step?

A

Pheochromocytoma

Next step: Plasma free catecholamines or 24-hour urine Vanillylmandelic acid (VMA)

59
Q

Patient with Pain (headache), Pressure (refractory HTN), Palpitations (tachycardia), Perspiration (sweating), Pallor.

↑Plasma free catecholamines
↑24-hour urine Vanillylmandelic acid (VMA)
MRI of abdomen shows mass in adrenal gland.

Dx and tx?

A

Pheochromocytoma

Tx:

  • 1st: a-blocker
  • 2nd: b-blocker
  • 3rd: resection
60
Q

Incidental finding of an adrenal mass on a MRI in an otherwise ASx patient.

Dx, next steps and tx?

A

Incidentaloma

Next steps:

  • To rule out cushing: low dose overnight DST
  • To rule out Coon’s: renin:aldo
  • To rule out pheochromocytoma: 24-hr urine metanephrines

Tx:

  • Not functioning and < 4cm: watch and wait
  • Functioning or > 4cm: resect
61
Q

Screening of DM with Random blood glucose

A

Random blood glucose x 1

• DM if > 200 + Sx of DM

62
Q

Screening of DM with Fasting blood sugar

A

Fasting blood sugar x 2
• DM if > 126
• Insulin insensitivity/pre-DM 100-126
• Normal < 100

63
Q

Screening of DM with 2-hr oral glucose tolerance test

A

2-hr oral glucose tolerance test x 1
• DM if > 200
• Insulin insensitivity/pre-DM 140-200
• Normal < 140

64
Q

Screening of DM with HgbA1C

A

HgbA1C
• DM if > 6.5%
• Insulin insensitivity/pre-DM 5.7%-6.5%
• Normal < 5.7%

65
Q

Patient at the ER with Polyuria, polyphagia, polydipsia, weigh loss, ↑↑ blood glucose. Dx and Dx test?

A

DM type 1

Dx test:

  • GAD antibody test (best)
  • IA-2 antibody test
66
Q

Patient with
Fasting blood sugar of 115
2-hr oral glucose tolerance test of 160
HgbA1C 6%

Dx and tx?

A

Pre-DM

Tx: Lifestyle modifications and metformin

67
Q

Patient with
Fasting blood sugar of 130
2-hr oral glucose tolerance test of 210
HgbA1C 6.8%

Dx, tx and next step?

A

DM type 2

Tx: Lifestyle modifications and metformin

Follow-up in 3 months with HgbA1C

68
Q

Patient with
HgbA1C 9.5%

Dx, tx and next step?

A

DM type 2

Tx: Lifestyle modifications and Insulin right away

Follow-up in 3 months with HgbA1C

69
Q

Patient with DM type 1. After 3 moths of metformin and lifestyle modifications has a HgbA1C of 7.5%

Next step?

A

Add second agent, e.g., Glyburide (sulfonylurea)

70
Q

Patient with DM type 1. After 3 moths of metformin and lifestyle modifications has a HgbA1C of 7.5%.
BMI 35

Next step?

A

Add second agent, e.g., Exentaide or Liraglutide (GLP-1 analogs) because produces wight loss

71
Q

Patient with DM type 1. After 3 moths of metformin and lifestyle modifications has a HgbA1C of 7.5%.
BMI 23

Next step?

A

Add second agent, e.g., Sitagliptin (DDP-4-inhibitors) because it maintains weight

72
Q

Contraindications of metformin?

A

CHF, CKD, liver disease (risk of Lactic acidosis)

73
Q

Secondary effect of Sulfonylurea (Glyburide, Glipizide)

A

Hypoglicemia (use with caution in CKD patients)

74
Q

Secondary effect of Thiazolidinediones (TZDs)?

A

CHF, Weight gain

75
Q

Continual assessment of DM type 1 patient?

A

HgbA1C q 3 months: goal < 7%

Annual screening for…

  • Retinopathy with retinal exam (tx with laser)
  • Nephropathy with microalbuminuria : creatinine (tx of proteinuria with ACE-i)
  • Neuropathy with monofilament screen (tx with gabapentin)
76
Q

Patient with DM type 1. After 3 months of metformin + Glyburide (sulfonylurea) + lifestyle modifications has a HgbA1C of 7.5%.

Next step?

A

Start with long-acting insulin (e.g., Lantus (glargine), Levemir (detemir)) at 0.1UI/Kg qOnce
• Take morning glucose to titrate until morning sugar is normal or until 50UI.

77
Q

Patient with DM type 1. After 3 months with 50UI of lantus (glargine) has a HgbA1C of 7.5%.

Next step?

A

Add rapid insulin (e.g., Humalog (lispro), Novolog (aspart)) on biggest meal

78
Q

How is the basal-bolus regimen for insulin management?

A
  1. Calculate Total daily insulin (TDI)
    o 0.5 UI/Kg
    o 0.3 UI/Kg if Creatinine > 1.5, age > 65
    o Then 50% basal (Lantus (glargine), Levemir (detemir))
    o 50% prandial (Humalog (lispro), Novolog (aspart)): 1/3 breakfast, 1/3 lunch, 1/3 dinner.
  • Before each meal or before going to bed–> take blood glucose and give the corresponding insulin.
  • The glucose I’m measuring right now is depended on how much I eat in the previous moment of the day and how much insulin I had.
79
Q

Patient in basal-bolus regimen 40UI Lantus (glargine) qHS and 13UI of prandial Humalog (lispro). The patient has high blood glucose at noon.

Next step?

A

Increase AM Humalog (lispro)

80
Q

Patient in basal-bolus regimen 40UI Levemir (detemir) qHS and 13UI of prandial Novolog (aspart). The patient has high blood glucose before breakfast.

Next step?

A

Increase lLevemir (detemir) given qHS

81
Q

Patient with failure of oral diabtic management, bad support network, scared of needles. You expect a failure of basal-bolus regimen.

Next step?

A

Mixed regimen (AKA, idiot insulin) with either Novolin or Humulin

Calculate Total daily insulin (TDI)
• 0.5 UI/Kg
• 0.3 UI/Kg if Creatinine > 1.5, age > 65
• Then 2/3 AM; 1/3 PM

82
Q

Diabetic patient with Palpitations, Diaphoresis, and Presyncope. Glucose of 70.

Tx?

A

PO glucose

F/U: Find causes

83
Q

Diabetic patient with Palpitations, Diaphoresis, Presyncope, and coma. Glucose of 70.

Tx?

A

IV D50

F/U: Find causes

84
Q

Non-diabetic with Palpitations, Diaphoresis, and Presyncope. Glucose of 60.

Next step?

A

o C-peptide
o Pro-insulin
o Secretagogue screen

85
Q

Non-diabetic with Palpitations, Diaphoresis, and Presyncope. Glucose of 60.
↓ C-peptide

Dx?

A

Factitious disorder

Patient is faking hypoglycemia by injecting exogenous insulin

86
Q

Non-diabetic with Palpitations, Diaphoresis, and Presyncope. Glucose of 60.
(+) secretagogue screen

Dx?

A

Factitious disorder

Patient is faking hypoglycemia by consuming Sulfonylurea

87
Q

Non-diabetic with Palpitations, Diaphoresis, and Presyncope. Glucose of 60.
(-) secretagogue screen
↑ C-peptide

Dx next step?

A

Possible insulinoma

o 72-hr fast glucose
o CT/MRI Abd

88
Q

Patient with type I DM in coma and dehydration.

  • Blood glucose 300-500
  • Urine: Positive ketones
  • ABG: acidosis
  • Positive anion gap

Dx and tx?

A

Diabetic Keto Acidosis (DKA)

  • 10UI of insulin IV, Followed by insulin drip
  • Vigorous hydration with NS or LR (When the glucose normalizes, change IVF to D5 1/2 NS)
  • Replace K if < 4 (insulin produces hyperkalemia)

When glucose is normal and gap closes–> bridge to long-acting insulin and look for possible cause of DKA

89
Q

Patient with type II DM in coma and dehydration.

  • Blood glucose 800-1000
  • Urine: NO ketones
  • ABG: no acidosis
  • BMP: no gap

Dx and tx?

A

Hyperosmolar Hyperglycemic Nonketotic Coma

  • 10UI of insulin IV, Followed by insulin drip
  • Vigorous hydration with NS or LR
  • Replace K if < 4 (insulin produces hyperkalemia)

Bridge to long-acting insulin when glucose is normal and look for cause (NSTEMI or infection)

90
Q

The most common cause of hypothyroidism.

A

Hashimoto’s thyroiditis.

91
Q

Lab findings in Hashimoto’s thyroiditis.

A

High TSH, low T4, antimicrosomal antibodies

92
Q

Exophthalmos, pretibial myxedema, and ↓ TSH.

A

Graves’ disease.

93
Q

The most common cause of Cushing’s syndrome.

A

Iatrogenic corticosteroid administration. The second most common cause is Cushing’s disease.

94
Q

A patient presents with signs of hypocalcemia, high

phosphorus, and low PTH.

A

Hypoparathyroidism.

95
Q

“Stones, bones, groans, psychiatric overtones.”

A

Signs and symptoms of hypercalcemia.

96
Q

A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveal hypernatremia, hypokalemia, and metabolic alkalosis.

A

1° hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia).

97
Q

A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

A

Pheochromocytoma.

98
Q

Should α- or β-antagonists be used fi rst in treating

pheochromocytoma?

A

α-antagonists (phentolamine and phenoxybenzamine).

99
Q

A patient with a history of lithium use presents with copious amounts of dilute urine.

A

Nephrogenic diabetes insipidus (DI).

100
Q

Treatment of central DI.

A

Administration of DDAVP ↓ serum osmolality and free water restriction.

101
Q

A postoperative patient with significant pain presents with hyponatremia and normal volume status.

A

SIADH due to stress.

102
Q

An antidiabetic agent associated with lactic acidosis.

A

Metformin.

103
Q

A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?

A

1° adrenal insuffi ciency (Addison’s disease). Treat with
replacement glucocorticoids, mineralocorticoids, and IV
fluids.

104
Q

Goal HbA1c for a patient with DM.

A

< 7.0.

105
Q

Treatment of Diabetic ketoacidosis (DKA).

A

Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+).

106
Q

Why are β-blockers contraindicated in diabetics?

A

They can mask symptoms of hypoglycemia.

107
Q

Patient with multiple episdes of hypoglicemia.

↑ Insuline levels
↑ C-peptide
(-) Sulfonylurea screen

Dx, next step, tx?

A

Insulinoma

Next step: CT scan

Tx: resection

108
Q

Patient with Migratory necrolytic dermatitis.

Dx, next step and tx?

A

Glucogonoma

Next steps: Glucagon levels and CT scan

Tx: Resect

MCCQE1 (19 decks)

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