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Step 2 CK > First Aid Endo > Flashcards

First Aid Endo Flashcards

1
Q

dx? a young pt with family hx of medullary thyroid cancer?

A

MEN2A or 2B

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2
Q

two contraindications for metformin?

A
  1. in the elderly more than 80

2. renal insufficiency

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3
Q

what is 3’ hyperparathyroidism?

A

long standing 2’ hyperparathyrodism that leads to hyperplasia of the PTH glands and when one ore more gland becomes autonomous.

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4
Q

who often get 3’ hyperparathyroidism?

A

dialysis pts

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5
Q

what is the cause for 2’ hyperparathyroidism?

A

inc PTH due to renal insufficiency leading to dec production of 1-25 dihydroxyvitamin D

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6
Q

what is Addison’s dz?

A

loss of Sodium retaining/K+ and H+ secreting aldosterone

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7
Q

electrolytes abnormalities in Addison?

A
  1. hyponatremia
  2. hyperkalemia
  3. nonanion gap acidosis
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8
Q

the diff btw 1’ and 2’ adrenal insufficiency?

A

1’ AI is associated with inc skin pigmentation, low glucocorticoids, and low mineralocorticoids, whereas 2’ AI is only associated with low glucocorticoids and does not have skin pigmentation or hyperkalemia

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9
Q

What are the 4S of adrenal crisis management?

A

Salt (0.9% saline), Steroids (IV hydrocortisone 100 mg every 8 hrs), Support, Search for underlying illness

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10
Q

2 ways to diagnose Adrenal Insufficiency?

A
  1. 8 am plasma cortisol levels and ACTH levels –> less than 3 ug/dl is diagnostic
  2. synthetic ACTH stimulation (cosyntropin) test –> failure of cortisol to rise > 20 ug/dl following ACTH administration confirms the diagnosis
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11
Q

side effects of abrupt withdrawal from steroids?

A

2’ hypoadrenalism –> unable to amount appropriate response to ACTH –> result in renal failure, hypotension, and hyponatremia

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12
Q

what is Somogyi effect?

A

reactive hyperglycemia following hypoglycemia

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13
Q

what is the value of A1c for DM?

A

more than 6.5%

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14
Q

what drug can cause Somogyi effect?

A

too much NPH insulin given at night –> hypoglycemia –> leads to reflex hyperglycemia (need to dec insulin at night to prevent this)

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15
Q

dx? a boy with normal TSH, but with significant intellectual disability, motor spasticity, and abnormal gait. Also the child is deaf and mute

A

maternal iodine def during early pregnancy

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16
Q

how do you diagnose diabetes insipidus?

A

by water deprivation test

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17
Q

what type of malignancy can lead to diabetes insipidus?

A

breast cancer

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18
Q

what is the work-up for diabetes insipidus?

A
  1. water deprivation test
  2. if urine is still dilute –> desmopressin is given
  3. If desmopressin leads to diluted urine –> nephrogenic urine (if not, central DI)
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19
Q

zollinger ellison syndrome is associated with what kind of MEN?

A

MEN1

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20
Q

clinical hallmarks of MEN1?

A
  1. pituitary adenoma
  2. hyperparathyroidism
  3. pancreatic tumors
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21
Q

features of Sarcoidosis?

A 
GRUELING
Granulomas
aRthritis
Uveitis
Erhythema nodosum
Lymphadenopathy in hilar
Interstitial fibrosis
Neg TB test
Gammaglobulinemia
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22
Q

what is the definitive test for sarcoidosis?

A

biopsy –> noncaseating granulomas

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23
Q

imaging features for asbestosis?

A

linear opacities at lung base and interstitial fibrosis, calcified pleural plaques

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24
Q

imaging features for silicosis?

A

eggshell calcification

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25
Q

mech of hypercalcemia in sarcoidosis?

A

hypercalcemia 2’ to inc production 1, 25 (OH)2 vitamin D by macrophages within granulomas

26
Q

during pregnancy what is the level of TBG, T4, total thyroxine, and T3 resin uptake?

A

high TBG b/c of high estrogen
inc total thyroxine
normal free T4
dec T3-resin uptake

27
Q

diagnostic for central DI?

A

response to exogenous ADH –> resultant increases in urine osmolarity (50% over baseline)

28
Q

causes for central DI?

A

head trauma, malignancies that compresses pituitary, granulomatous/inflammatory process

29
Q

what are the infectious agents that can cause primary adrenal insufficiency?

A

CMV, TB especially in immunecompromised pts

30
Q

treatment for primary AI?

A

hydrocortisone + fludrocortisone

31
Q

Name some clinical symptoms of hypothyroidism?

A

carpel tunnel syndrome
cardiovascular manifestations: angina, signs of bradycardia, hypotension, rarely cardiomegaly with associated effusion or “myxedema heart.”

32
Q

clinical signs for primary hyperparathyroidism?

A
  1. pathologic fracture
  2. subperiosteal erosions
  3. elevated levels of both calcium and parathyroid hormone
33
Q

most common cause of primary hyperparathyroidism?

A

solitary parathyroid adenoma

34
Q

what are the criteria for parathroidectomy for hyperparathyroidism?

A
  1. > 1mg/dL above upper limit
  2. inc creatinine
  3. dec Bone Mineral Density
35
Q

name the 4 antibodies associated with type 1 DM?

A
  1. anti-islet cell
  2. anti-glutamic acid decarboxylase (GAD)
  3. anti-insulin
  4. anti-Zn transporter
36
Q

dx? postprandial hypoglycemia, abdominal bloating in pts with long standing DM?

A

gastroparesis = autonomic neuropathy

37
Q

treatment for bilateral adrenal hyperplasia?

A

medical management with spironolactone

38
Q

treatment for unilateral adrenal hyperplasia?

A

surgical resection (adrenalectomy)

39
Q

clinical symptoms of aldosterone-secreting tumor?

A
  1. elevated urine aldosterone level
  2. hypernatremia
  3. hypokalemia
40
Q

dx? a pt with DM and hyperthyroidism comes in with comatose with high fever, flushing, sweating, marked tachycardia, a fib.

A

thyroid storm

41
Q

treatment for thyroid storm?

A
  1. aggressive cooling: cooling blankets, acetaminophen
  2. IV esmolol
  3. corticosteroid
  4. anti-thyroid drugs (PTU, methimazole)
  5. high dose potassium iodide
42
Q

treatments for solitary toxic adenoma (hot nodule)?

A

radioactive iodine

43
Q

treatments for toxic adenoma that is cold nodule?

A

thyroidectomy

44
Q

clinical symptoms of addison dz?

A

weight loss, dizziness, dehydration, anorexia, weakness, and increased skin pigmentation

45
Q

when is high dose dexamethasone suppression test useful?

A

to confirm Cushing syndrome from ectopic ACTH production (small cell lung cancer)

46
Q

when is low does dexamethasone suppresstion test useful?

A

to rule out Cushing. If low dose dexa suppresses cortisol, then it is NOT Cushing.

47
Q

what are clinical signs of hypocalcemia?

A

weakness, dry skin, alopecia, circumoral numbness, paresthesia

48
Q

for diabetes, what is an indication that the pt needs to be started on another 1st line agent?

A

pts with HbA1c > 7.5 at time of diagnosis after 3 months of metformin monotherapy

49
Q

other than small cell lung cancer, what other cancer can cause Cushing?

A

hypercortisolism can be due to ectopic ACTH secretion by a bronchial tumor.

50
Q

1st and 2nd line treatment for ACTH producing tumor?

A
  1. surgical resection

2. adrenal enzyme inhibitors such as ketoconazole, metyrapone, aminoglutethimide

51
Q

lab features of Pseudohypoparathyroidism?

A

hypocalcemia, hyperphosphatemia, elevated intact PTH level

52
Q

explain the reason of subclinical hyperthyroidism in early pregnancy

A

b/c human chorionic gonadotropin is a weak stimulator of the TSH receptor, causing excess production of thyroid hormone and subsequent decline in TSH due to neg feedback on the pituitary

53
Q

lab findings of familial hypocalciuric hypercalcemia (FHH)?

A

hypercalcemia, hypocalciuria, mild hypermagnesemia

54
Q

how can Familial hypocalciuric hypercalcemia (FHH) be differentiated from primary hyperparathyroidism?

A
  1. PTH may be elevated or normal, but not to the same degree as in pts with primary hyperparathyroidism
  2. presence of hypercalcemia in multiple family members, especially young children.
55
Q

clinical signs for adrenal insufficiency?

A
  1. hypovolemic shock –> hypotension, tachcardia, changes in mental status, dry mucous membrane
  2. nausea, vomiting, flank pain, fever
56
Q

dx? pts with elevated thyroid hormone levels in the presence of normal thyroid gland

A

Struma ovarii (ovarian tumor)

57
Q

what vitamin supplement should an infant being breast fed be given?

A

Vitamin D

58
Q

5 indications for urgent hemodialysis?

A

AEIOU

Acidosis
life threatening Electrolyte abnormalities
toxic Ingestion
fluid Overload
symptoms of Uremia
59
Q

dx? hypothermia, bradycardia, hypotension, hypoglycemia, hyponatremia (can be precipitated by illness, ischemic insult)

A

myxedema coma

60
Q

treatment for myxedema coma?

A

levothyroxine, triiodothyronine

Step 2 CK (20 decks)

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