Endocrinology - TopHat

Question 1

You are seeing a 3 year old FS Standard Poodle for a waxing and waning history of inappetence. A minimum database (CBC/Chemistry/UA) is unremarkable. Baseline cortisol comes back as <1. What does this tell you?

a. Addison’s disease is ruled out
b. this patient most likely has Addison’s disease. Since electrolytes are normal, begin treating with prednisone alone.
c. ACTH stimulation test is needed before conclusions about Addison’s disease can be made

Answer 1

c. . ACTH stimulation test is needed before conclusions about Addison’s disease can be made

Question 2

Glucagon promotes which of the following?

a. Glycogenesis (glycogen synthesis)
b. Increased tissue utilization of glucose, amino acids, and electrolytes
c. Lipolysis
d. Gluconeogenesis

Answer 2

c. Lipolysis and d. gluconeogenesis

Question 3

A 3-year old intact female mixed breed dog presents for severe lethargy and anorexia of 24 hours duration. On exam, she has injected mucous membranes, tachycardia, a temperature of 104.5 F, weak pulses, and abdominal pain. Labwork shows an inflammatory leukogram with a left shift, severe pyuria and bacteriuria, and a blood glucose of 54 mg/dl (repeatable). Name the most likely differential for her hypoglycemia.

a. Addison’s disease
b. Insulinoma
c. Sepsis
d. Xylitol toxicity

Answer 3

c. Sepsis

Question 4

A middle-aged male neutered mixed breed dog (weight: 10 kg) presents for PU/PD and unexplained weight loss. He is otherwise acting normally at home: he has a good appetite, normal stools, normal energy, and no vomiting. His exam is unremarkable with the exception of early cataracts. You perform a minimum database and diagnose diabetes mellitus (glucose 475 mg/dl; 3+ glucose and 1+ ketones on urine dipstick). Select the most appropriate therapy for this dog.

a. 3 U NPH (Humulin-N) insulin SC every 12 hours
b. Treat as an inpatient with a DKA protocol
c. 10 U lente (vetsulin) insulin SC every 12 hours
d. 4 U glargine (Lantus) insulin SC every 12 hours

Answer 4

a. 3 U NPH (Humulin-N) insulin SC every 12 hours

Question 5

Mrs. Cat is an 11 year old female spayed DSH presenting for a 6-month history of weight loss and diarrhea. On physical exam, you note thin body condition and a gallop rhythm on auscultation. You submit a CBC, chemistry, urinalysis, and T4 with the following abnormalities noted:

• CBC-no significant findings
• Chemistry-ALT 147 (RI: 40-110)
• UA-no significant findings
• TT4-6.1 (R1:1-4)

Select the correct statement:

a. Mrs. cat has hyperthyroidism
b. Mrs. Cat does not have hyperthyroidism
c. A TSH and/or fT4ed are needed to confirm the diagnosis
d. a fT4ed and/pr T3 suppresion test are needed to confirm the diagnosis

Answer 5

a. Mrs. Cat has hyperthyroidism

Question 6

Which of the following clinical signs would not be suggestive of Cushing’s?

a. Polyphagia
b. Polyuria
c. Alopecia
d. Anorexia
e. Panting

Answer 6

d. Anorexia

Question 7

Which of the following would not be typical of a dog with Cushing’s?

a. Elevated ALP
b. Hypercholesterolemia
c. Proteinuria
d. Glucosuria
e. thrombocytosis

Answer 7

d. Glucosuria

Question 8

Dogs with undiagnosed Cushing’s can present with complications secondary to the disease. Which of the following would not be an expected complicated presentation of a dog with Cushing’s?

a. Urinary obstruction from calcium oxalate stones
b. Pruritus from Demodex skin infection
c. Bradycardia from hyperkalemia
d. Hindleg paralysis from a clot to the iliac artery
e. Acute abdomen from a ruptured gall bladder mucocele

Answer 8

c. Bradycardia from hyperkalemia

Question 9

Hercules is an 11 year old Dachshund presenting fro increased thirst and urination, panting, and failure of fur to regrow since his hemilaminectomy 6 months ago. On PE you find that he has thin skin, still shaved at the site of the previous hemilaminectomy, he has a pot belly and cranial organomegaly, and there are residual proprioceptive deficits in the hindlimbs.

What do you want to do next for Hercules?

a. ACTH stimulation test
b. minimum database
c. Urine cortisol to creatinine ratio
d. Thoracic radiographs

Answer 9

b. Minimum database and d. Thoracic radiographs

Question 10

Hercules is an 11 year old Dachshund presenting fro increased thirst and urination, panting, and failure of fur to regrow since his hemilaminectomy 6 months ago. On PE you find that he has thin skin, still shaved at the site of the previous hemilaminectomy, he has a pot belly and cranial organomegaly, and there are residual proprioceptive deficits in the hindlimbs.

You find lymphopenia on the CBC, elevated ALP and ALT on chemistry, and your UA shows isosthenria, 2+ protein, and rare WBC.

Now what test do you want to do next?

a. LDDS
b. ACTH stimulation test
c. Urine cortisol to creatinine ratio

Answer 10

a. LDDS

Question 11

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 2 mcg/dl; 8 hours: 1.2 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not Cushingoid

Answer 11

d. not cushingoid

Question 12

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 1.3 mcg/dl; 8 hours: 10 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not cushingoid

Answer 12

a. PDH

Question 13

LDDS results are: Baseline: 12 mcg/dl; 4 hours: 11 mcg/dl; 8 hours: 8 mcg/dl. How do you interpret his test results?

a. PDH
b. ADH
c. HAC but don’t know what type
d. Not Cushing’s

Answer 13

c. HAC, but don’t know what type

Question 14

What if Hercules was also a long-term diabetic. What would be the best test for Cushing’s?

a. LDDS
b. ACTH stimulation test
c. Urine cortisol creatinine

Answer 14

b. ACTH stimulation test

Question 15

Hercules is in the hospital for pancreatitis and DKA and you think he might be Cushingoid. What would be the best screening test for HAC in Hercules?

a. LDDS
b. Urine cortisol to creatinine ratio
c. ACTH stimulation ratio
d. none of the above

Answer 15

d. none of the above

Wait until the pancreatitis and DKA are treated

Question 16

What are classic clinical pathologic findings on the minimum database of a dog with Cushing’s?

a. Stress leukogram, significantly elevated ALT, dilute urine
b. Stress leukogram, elevated BUN, dilute urine
c. Thrombocytosis, elevated ALP, glucosuria
d. Thrombocytosis, elevated ALP, dilute urine
e. Anemia, elevated cholesterol, proteinuria

Answer 16

d. Thrombocytosis, elevated ALP, dilute urine

Question 17

In a dog with classic signs of Cushing’s (PU/PD, polyphagia, panting, elevated ALP, dilute urine) and no concurrent illness, which screening test for Cushing’s would you perform?

a. Urine cortisol to creatinine ratio
b. ACTH stimulation test
c. Low dose dexamethasone suppression test

Answer 17

c. Low dose dexamethasone suppression test

Question 18

Going back to Hercules… LDDS results were: Baseline - 12 mcg/dl, 4 hours- 8 mcg/dl, and 8 hours- 8 mcg/dl

What is your diagnosis?

a. Not Cushingoid
b. PDH
c. ADH
d. HAC, but don’t know what type

Answer 18

d. HAC, but don’t know what type

Question 19

What do you want to do next to determine what type of HAC Hercules has?

a. MRI
b. CT scan
c. Abdominal x-rays
d. Abdominal US
e. ACTH stimulation test

Answer 19

d. Abdominal US

Question 20

After ultrasound, you find an adrenal tumor. How do you want to treat him?

a. Unilateral adrenalectomy
b. Mitotane which works by inhibiting 3 beta hydroxy steroid dehydrogenase
c. Trilostane which works by causing selective necrosis of the zona fasciculata and reticularis
d. Trilostane which works by inhibiting 3 beta hydroxy steroid dehydrogenase

Answer 20

d. Trilostane which works by inhibiting 3 beta hydroxy steroid dehydrogenase