First Aid Endo Flashcards
dx? a young pt with family hx of medullary thyroid cancer?
MEN2A or 2B
two contraindications for metformin?
- in the elderly more than 80
2. renal insufficiency
what is 3’ hyperparathyroidism?
long standing 2’ hyperparathyrodism that leads to hyperplasia of the PTH glands and when one ore more gland becomes autonomous.
who often get 3’ hyperparathyroidism?
dialysis pts
what is the cause for 2’ hyperparathyroidism?
inc PTH due to renal insufficiency leading to dec production of 1-25 dihydroxyvitamin D
what is Addison’s dz?
loss of Sodium retaining/K+ and H+ secreting aldosterone
electrolytes abnormalities in Addison?
- hyponatremia
- hyperkalemia
- nonanion gap acidosis
the diff btw 1’ and 2’ adrenal insufficiency?
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
What are the 4S of adrenal crisis management?
Salt (0.9% saline), Steroids (IV hydrocortisone 100 mg every 8 hrs), Support, Search for underlying illness
2 ways to diagnose Adrenal Insufficiency?
- 8 am plasma cortisol levels and ACTH levels –> less than 3 ug/dl is diagnostic
- synthetic ACTH stimulation (cosyntropin) test –> failure of cortisol to rise > 20 ug/dl following ACTH administration confirms the diagnosis
side effects of abrupt withdrawal from steroids?
2’ hypoadrenalism –> unable to amount appropriate response to ACTH –> result in renal failure, hypotension, and hyponatremia
what is Somogyi effect?
reactive hyperglycemia following hypoglycemia
what is the value of A1c for DM?
more than 6.5%
what drug can cause Somogyi effect?
too much NPH insulin given at night –> hypoglycemia –> leads to reflex hyperglycemia (need to dec insulin at night to prevent this)
dx? a boy with normal TSH, but with significant intellectual disability, motor spasticity, and abnormal gait. Also the child is deaf and mute
maternal iodine def during early pregnancy
how do you diagnose diabetes insipidus?
by water deprivation test
what type of malignancy can lead to diabetes insipidus?
breast cancer
what is the work-up for diabetes insipidus?
- water deprivation test
- if urine is still dilute –> desmopressin is given
- If desmopressin leads to diluted urine –> nephrogenic urine (if not, central DI)
zollinger ellison syndrome is associated with what kind of MEN?
MEN1
clinical hallmarks of MEN1?
- pituitary adenoma
- hyperparathyroidism
- pancreatic tumors
features of Sarcoidosis?
GRUELING Granulomas aRthritis Uveitis Erhythema nodosum Lymphadenopathy in hilar Interstitial fibrosis Neg TB test Gammaglobulinemia
what is the definitive test for sarcoidosis?
biopsy –> noncaseating granulomas
imaging features for asbestosis?
linear opacities at lung base and interstitial fibrosis, calcified pleural plaques
imaging features for silicosis?
eggshell calcification
mech of hypercalcemia in sarcoidosis?
hypercalcemia 2’ to inc production 1, 25 (OH)2 vitamin D by macrophages within granulomas
during pregnancy what is the level of TBG, T4, total thyroxine, and T3 resin uptake?
high TBG b/c of high estrogen
inc total thyroxine
normal free T4
dec T3-resin uptake
diagnostic for central DI?
response to exogenous ADH –> resultant increases in urine osmolarity (50% over baseline)
causes for central DI?
head trauma, malignancies that compresses pituitary, granulomatous/inflammatory process
what are the infectious agents that can cause primary adrenal insufficiency?
CMV, TB especially in immunecompromised pts
treatment for primary AI?
hydrocortisone + fludrocortisone
Name some clinical symptoms of hypothyroidism?
carpel tunnel syndrome
cardiovascular manifestations: angina, signs of bradycardia, hypotension, rarely cardiomegaly with associated effusion or “myxedema heart.”
clinical signs for primary hyperparathyroidism?
- pathologic fracture
- subperiosteal erosions
- elevated levels of both calcium and parathyroid hormone
most common cause of primary hyperparathyroidism?
solitary parathyroid adenoma
what are the criteria for parathroidectomy for hyperparathyroidism?
- > 1mg/dL above upper limit
- inc creatinine
- dec Bone Mineral Density
name the 4 antibodies associated with type 1 DM?
- anti-islet cell
- anti-glutamic acid decarboxylase (GAD)
- anti-insulin
- anti-Zn transporter
dx? postprandial hypoglycemia, abdominal bloating in pts with long standing DM?
gastroparesis = autonomic neuropathy
treatment for bilateral adrenal hyperplasia?
medical management with spironolactone
treatment for unilateral adrenal hyperplasia?
surgical resection (adrenalectomy)
clinical symptoms of aldosterone-secreting tumor?
- elevated urine aldosterone level
- hypernatremia
- hypokalemia
dx? a pt with DM and hyperthyroidism comes in with comatose with high fever, flushing, sweating, marked tachycardia, a fib.
thyroid storm
treatment for thyroid storm?
- aggressive cooling: cooling blankets, acetaminophen
- IV esmolol
- corticosteroid
- anti-thyroid drugs (PTU, methimazole)
- high dose potassium iodide
treatments for solitary toxic adenoma (hot nodule)?
radioactive iodine
treatments for toxic adenoma that is cold nodule?
thyroidectomy
clinical symptoms of addison dz?
weight loss, dizziness, dehydration, anorexia, weakness, and increased skin pigmentation
when is high dose dexamethasone suppression test useful?
to confirm Cushing syndrome from ectopic ACTH production (small cell lung cancer)
when is low does dexamethasone suppresstion test useful?
to rule out Cushing. If low dose dexa suppresses cortisol, then it is NOT Cushing.
what are clinical signs of hypocalcemia?
weakness, dry skin, alopecia, circumoral numbness, paresthesia
for diabetes, what is an indication that the pt needs to be started on another 1st line agent?
pts with HbA1c > 7.5 at time of diagnosis after 3 months of metformin monotherapy
other than small cell lung cancer, what other cancer can cause Cushing?
hypercortisolism can be due to ectopic ACTH secretion by a bronchial tumor.
1st and 2nd line treatment for ACTH producing tumor?
- surgical resection
2. adrenal enzyme inhibitors such as ketoconazole, metyrapone, aminoglutethimide
lab features of Pseudohypoparathyroidism?
hypocalcemia, hyperphosphatemia, elevated intact PTH level
explain the reason of subclinical hyperthyroidism in early pregnancy
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
lab findings of familial hypocalciuric hypercalcemia (FHH)?
hypercalcemia, hypocalciuria, mild hypermagnesemia
how can Familial hypocalciuric hypercalcemia (FHH) be differentiated from primary hyperparathyroidism?
- PTH may be elevated or normal, but not to the same degree as in pts with primary hyperparathyroidism
- presence of hypercalcemia in multiple family members, especially young children.
clinical signs for adrenal insufficiency?
- hypovolemic shock –> hypotension, tachcardia, changes in mental status, dry mucous membrane
- nausea, vomiting, flank pain, fever
dx? pts with elevated thyroid hormone levels in the presence of normal thyroid gland
Struma ovarii (ovarian tumor)
what vitamin supplement should an infant being breast fed be given?
Vitamin D
5 indications for urgent hemodialysis?
AEIOU
Acidosis life threatening Electrolyte abnormalities toxic Ingestion fluid Overload symptoms of Uremia
dx? hypothermia, bradycardia, hypotension, hypoglycemia, hyponatremia (can be precipitated by illness, ischemic insult)
myxedema coma
treatment for myxedema coma?
levothyroxine, triiodothyronine
