Endocrinology/Rheumatology

Question 1

Addisonian Crisis

Answer 1

Fever, N&V, Abd pain Hypotension, Hyperpigmentation in palmar creases Polydipsia

Question 2

What oral hypoglycemic agent is contraindicated for men with Cr >1.5 and women >1.4?

Answer 2

Metformin. Contraindicated in renal dz.

Question 3

MEN I (Wermer’s Syn)

Answer 3

Pituitary tumor Parathyroid hyperplasia Pancreatic Islet cell tumor

Question 4

MEN IIA (Sipple Syn)

Answer 4

Medullary thyroid ca. Pheochromocytoma Parathyroidism

Question 5

MEN IIB

Answer 5

Medullary thyroid ca. Pheochromocytoma Marfanoid

Question 6

Hereditary Angioedema

Answer 6

C1 Inhibitor Deficiency –> non-inflamm. edema of face, limbs, genitals, colic Dx: Dec. C4

Question 7

Familial Hypocalciuric HyPERcalcemia Dx:

Answer 7

AutoDom Ca-sensing-Receptor gene mutation wherein higher Ca2+ concentrations are needed to inhibit PTH release and Ca2+ reabsorption Dx: Ca >10 Hypocalciuria = Ca2+/Cr ratio 2.0

Question 8

Insulinomas are usually suggested by what triad?

Answer 8

Whipple’s triad: 1. hypoglycemia 2. low glucose 3. relief of S&S when glucose is raised

Question 9

Labs seen in Whipple’s triad

Answer 9

1. Low glucose 2. High insulin, C-peptide, and pro-insulin

Question 10

What would C-peptide levels be in surreptitious injection of insulin?

Answer 10

Low C-peptide. (C-peptide means body was making insulin)

Question 11

Hashimoto Thyroiditis (Hypothyroidism) keywords

Answer 11

Enlarged non-tender thyroid Widespread destruction of follicles Anti-TPO, eosinophilic Hurthle cells Inc. risk thyroid lymphoma and papillary thyroid ca.

Question 12

What is it called when the thyroid is functioning normally but does not receive stimulus from the pituitary to produce more hormone?

Answer 12

2ndary hypothyroidism

Question 13

Dermatologically, how would primary adrenal insufficiency manifest? Why does this happen?

Answer 13

Darkening of the skin. Low Na+, High K+ There is an increase in production of ACTH to compensate for lack of aldosterone production.

Question 14

2ndary adrenal insufficiency and 2ndary hypothyroidism together suggests?

Answer 14

Pituitary insufficiency most likely d/t pituitary tumor

Question 15

In Carcinoid Syndrome, what neurotransmitter is most responsible for diarrhea?

Answer 15

Serotonin

Question 16

What is the most common cause of thyroid cancer? Keywords? Tx? AE?

Answer 16

Papillary thyroid carcinoma. Orphan annie eyes, psamomma bodies in follicular cells Tx: Radioactive Iodine AE: drymouth/sialadenitis

Question 17

From where do most carcinoid tumors originate?

Answer 17

Small bowel

Question 18

Lupus nephritis Lab values

Answer 18

normal CRP Elevated ESR Decreased serum C3 and C4

Question 19

Glipizide, Glyburide, Glimepiride, Tolbutamide belong in what class? MOA? Adverse SE?

Answer 19

Sulfonylureas. Increase endogenous insulin secretion ! hypoglycemia, weight gain, sulfa allergy, disulfiram-like rxn for tolbutamide

Question 20

Rosiglitazone, Pioglitazone belong in what class? MOA? Adverse SE?

Answer 20

Thiazolidinediones. Increase insulin sensitivity. ! Edema, weight gain, hepatotoxicity, bone loss, not for heart failure pts.

Question 21

Acarbose, Miglitol belong in what class? MOA? Adverse SE?

Answer 21

Alpha-Glucosidase Inhibitors. Decrease intestinal absorption of carbs ! Flatulence, hypoglycemia

Question 22

Sitagliptin belongs in what class? MOA? Adverse SE?

Answer 22

DPP-4 Inhibitors. Inhibits degradation of GLP-1

Question 23

Exenatide belongs in what class? MOA? Adverse SE?

Answer 23

Incretins. Is a GLP-1 agonist. ! Pancreatitis

Question 24

How would Graves’ Disease appear on RAIU?

Answer 24

diffuse (homogenous) uptake

Question 25

When is methimazole allowable to treat hyperthyroidism in the pregnant woman? What is a serious side effect?

Answer 25

2T (2nd trimester) AE: ***Agranulocytosis***

Question 26

When is PTU allowable to treat hyperthyroidism in the pregnant woman?

Answer 26

1T (1st trimester). Generally, however, PTU is the one you pick in pregnancy.

Question 27

Congenital Hypothyroidism S&S d/t?

Answer 27

poor feeding, constipatioin, large anterior fontanelle, macroglossia, umbilical hernia, MR d/t iodine deficiency, inborn errors of metabolism, thyroid dysgenesis

Question 28

Myxedema Coma S&S Dx Tx?

Answer 28

hypothermia, bradycardia, hypoTN, hyponatremia, hypoglycemia Dx: Check cortisol prior to treating Tx: IV synthroid, Hydrocortisone

Question 29

Thyroid Nodule Workup

Answer 29

Question 30

Medullary Thyroid Ca. keywords

Answer 30

C-(calcitonin) Cells MEN 2A, MEN 2B

Question 31

Milk Alkali Syndrome

Answer 31

ingestion of large amounts of Ca and alkali leading to hypercalcemia, fatigue, confusion, arrhythmias, constipation

Question 32

Cushing's Signs and Symptoms Workup

Answer 32

Question 33

Hypervitaminosis D (d/t granulomas) Labs

Answer 33

Increased Ca, Increased Phosphorus Decreased PTH 1,25 Vit D

Question 34

Diabetes Workup

Answer 34

Question 35

Adrenal Insufficiency Workup

Answer 35

Question 36

Conn Syndrome Workup

Answer 36

Question 37

Giant Cell Arteritis is often associated with what condition? Tx of Giant Cell Arteritis

Answer 37

Polymyalgia Rheumatica Tx: High dose Oral Steroids

Question 38

Subacute (DeQuervain's) Thyroiditis S&S Tx?

Answer 38

Post-URI with tender lump in neck on swallowing Tx: NSAIDS

Question 39

Systemic lupus erythematosus (SLE) is associated with what renal disease? Tx with?

Answer 39

Renal Tubular Acidosis Type I (RTA I), a Non-AGap Met. Acidosis Tx: Sodium Bicarb