Endocrinology MFM questions

Question 1

Symptoms of hyperparathyroidisum

Answer 1

hypercalcemia
decreased serum phosphorus
increased gastrin production ( Peptic ulcer)
Cardiac arrythmias

Question 2

Antibody in Hashimoto

Answer 2

TPO

Question 3

Symptoms of thyroid storm

Answer 3

fever, tachycardia, altered mental status, vomiting, diarrhea, cardiac arrythmias
Inciting event- labor, delivery, infection, or surgery

Question 4

Treatment of thyroid storm

Answer 4

PTU, iodine, dexamethasone, beta blockers,

Cooling blankets, IV fluid administration, oxygen and tele

Question 5

Sodium homeostasis during pregnancy

Answer 5

sodium retention of about 950 mg during pregnancy

Question 6

Calcium homeostasis during pregnancy

Answer 6

increased excretion but increased absorption, unbound calcium remains nuteral. Due to decrease in albumin bound calcium does decrease.

Question 7

Glucose excretion during pregnancy

Answer 7

glucose excretion increased 10-100 fold due to impaired reabsorption.

Question 8

Uric acid levels during pregnancy

Answer 8

decrease by about 25% until 24 weeks and than increase to normal values by term.

Question 9

calculate an anion gap

Answer 9

sodium- chloride+ bicarb

Question 10

Management of DKA

Answer 10

r/o infection, consider fetal monitoring( LUD and oxygen),

NS @ 1 liter/hour x2 hour than 1/2 NS @ 250 cc/hr
When sugar <200 convert to D5 1/2 NS@ 250 cc

Regular IV 0.1-0.2 u/kg ( 10-15 units) with insulin infusion. (0.1 unit/kg/hr). If sugar does not decrease by 50 double infusion rate. When glucose is <200 decrease to 0.05 u/kg/hr.

Potassium
less than 3.3- hold insulin and give K
Greater than 5.3 repeat every 2 hours
Between 3.3 and 5.3 20-30 mEq to each liter

Bicarb- consider if maternal pH is <7

Question 11

Presentation of DKA

Answer 11

ketonuria, acidosis (7.3), anion gap >12, decreased serum bicarb

Question 12

Advanages/risks of peritoneal diaylsis

Answer 12

less acute fluculations, liberal fluid intake, less anemia, can be used for insulin or magnesium.

Risks: peritonitis, catheter obstruction

Question 13

Symptoms of Pheochromocytoma

Answer 13

hypertension, orthostatic hypotension, headache, abdominal and chest pain, palpitations

Question 14

Diagnosis of Pheo

Answer 14

24 hour urine collection with metanephrines and catecolamines
and plasma levels

• methyldopa and betablockers must be discontinued for adequate diagnosis

MRI imaging of the adrenal glands
bilateral in 10%, malignant in 10%

Question 15

Complications of pheo during pregnancy

Answer 15

fetal loss rate of 50%

if unrecognized maternal mortality of 50%

Question 16

Treatment of pheo

Answer 16

surgical removal with alpha blockade ( phenoxybenzamine or phentolamine)

Beta blockers should not be used until alpha blockade is given.