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STEP 3 Uworld > IM ENDO > Flashcards

IM ENDO Flashcards

1
Q

Conn syndrome is…

best screening test

A

1ry hypoaldestorenism

ald / renin ratio

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2
Q

subacute thyroiditis - iodine uptake / treatment

A

decreased

treatment: NSAID, b blockers, steroids if refractory

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3
Q

medications associated with gynecomastia

A
  1. spironoloactone
  2. cimetidine
  3. 5a reductase inhb
  4. ketoconazole
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4
Q

Chronic adrenal insuf - presentation

A

Low Na, high K, hyperchl met acidosis

increased pigmentation

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5
Q

sulfolynurea poisoning - managment

A

dextrose + octreotide (somatostatin analogue –> decreases insulin secr)

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6
Q

subclinical hypothyrodism - treat if

A
  1. antithyroid abs
  2. lipid abnormalities
  3. symptoms
  4. ovulatory or mens dysfunction
  5. TSH > than 10 or 7-10 and younger than 70
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7
Q

start statin if

A
  1. LDL more than 190
  2. Older than 40 + DM
  3. known athero CV risk
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8
Q

suspect diabetic neuropathy - next step

A

turning fork test

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9
Q

diabetic neuropathy - management

A

aggressive glycemic control
if still in pain TCA, SNRIs (duloxetine) or anticonvulsants like Gabapentin or pregabalin
maybe also topical treatments (lidocane etc)
NOT SSRIs

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10
Q

thryroid nodule - FIRST STEP

A

Clinical evaluation, TSH + U/S

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11
Q

thryroid nodule - with cancer suspicion (after U/S) –>

A

FNA

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12
Q

thryroid nodule - low cancer risk –>

A

Normal or elevated TSH –> FNA

Low TSH –> iodine scintigraphy –> if hot treat hyper, if cold or interm cold do FNA

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13
Q

MEN type 1

A
  1. PTH
  2. pancreatic tumor
  3. pituitary
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14
Q

MEN type 2A

A
  1. PTH
  2. Pheo
  3. Medullary Thyroid
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15
Q

MEN type 2B

A
  1. Medullary Thyroid
  2. Pheo
  3. mucosal + interstitial neuromas
  4. Marphanoid habitus
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16
Q

Medullary thyroid carcinoma diagnosis - next step

A

serum calcitonin, CEA, neck US (mets), genetic test for RET, evaluation for coexisting tumors (esp PCC) –> Then surgery

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17
Q

Medullary thyroid carcinoma - before surgery rule out

A

pheochromocytoma

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18
Q

subclinical hyperth - treat if

A
  1. persistent TSH below 0.1
  2. TSH between 0.1-0.5 +
    - age >65
    - heart disease
    - osteoporosis
    - nodular thryoid disease
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19
Q

anabolic steroid abuse -effect in hematology

A

erythorcytosis

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20
Q

anabolic steroid abuse -effect in LIPIDS

A

HIGH LDL / LOW HDL

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21
Q

anabolic steroid abuse -effect in sex

A

normal libido + erectile during use

low libido + impotence during withdrawal

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22
Q

rare but serious complication of metformin

A

lactic acidosis (increased risk with hypovolemia, liver / kidney / heart disease_

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23
Q

Treat megalob anemia with B12 - MONITOR ….

A

K levels (risk of hypo)

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24
Q

Hyperthyr with cardiov symptoms - initial treatment

A

b-blockers

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25
Q

hypercalcemia - next step

A

measure PTH

  1. elevated (PTH depended)
  2. low indipended –> see PTHrp and vitd
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26
Q

PTH depended hypercalcemia - causes

A

primary
familiar
lithium

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27
Q

PTH independed hypercalcemia - causes

A
  1. malignancy
  2. vit D
  3. drugs
  4. granuloatous
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28
Q

diuretic to increase serum CA2+

A

thiazides

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29
Q

treatment of chronic hypoparathyroidism

A
  1. Vitamin D (over calcitriol the active form because cheaper)
  2. Ca2+
  3. thiazide (if low serum and high urine
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30
Q

hypoglycemia associated autonomic failure - presentation

A
  1. reduced neurogenic hypoglycemic symptoms (tremor sweeting etc)
  2. increased risk for neuroglycopenic (confusion, LOC)
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31
Q

hypoglycemia associated autonomic failure - RF

A
  1. long-standing DM1

2. recurrent or severe hypoglycemia

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32
Q

hypoglycemia associated autonomic failure - management

A
  1. avoid hypoglycemia
  2. reduce insulin dose
  3. less strict glycemic targets
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33
Q

C - peptide: low vs high

A

low: exogenus insulin
high: insulinoma or oral hypoglycemic ageints

34
Q

hypoglycemia - with high c peptide - next step

A

screen for oral hypogl agents –> if neg –> abd ct scan

35
Q

whipple triad

A
  1. symptoms
  2. low gl
  3. symptom resolution after gl
36
Q

pheo screen

A

plasma free metanephrine or 24h urine catecholamine and metanephrine

37
Q

pheo classic triad

A
  1. headache
  2. sweating
  3. tachycardia
38
Q

pheo b vs a block

A

alpha FIRST

39
Q

surgical complications of pheo removal (mechanism)

A
  1. hypertensive crisis (gland mamipu)
  2. hypotension (low catecholamines or persistent alpha block)
  3. tachycardia (gland manip)
  4. hypoglycemia (insulin secr: catch suppress insulin)
40
Q

surgical complications of pheo removal (treatment)

A
  1. hypertensive crisis (IV nitroprusside, phentol or nicardipine)
  2. hypotension (normal saline bolus)
  3. tachycardia (IV lidocane or esmolol)
  4. hypoglycemia (dextrose)
41
Q

Nelson syndrome

A

patients with Cushing’s disease patients as a result of removing both adrenal glands
(pigmentation, pituitary enlargement, visual defects)

42
Q

if non pregnant with hyperthyr - PTU or methimazol

A

methimazole (no liver toxicity)

43
Q

toxic thyroid nodule

A

if large or obstructive or suspect cancer –> surgery
otherwise iodine ablation
ALWAYS B blockers and Methimazol before

44
Q

postpartum thyroditis

A

similar to silent thyroiditis

  • up to 1 year after delivery
  • both positive for anti-peroxidase (both variants of hashimoto
  • transient hyper before return to normal
45
Q

thyroid cancer - total thyroidectomy vs lobectomy

A

lobectomy if smaller than 1 cm

total if larger than 1, extension outside, metastasis, history of neck or head radiation

46
Q

glucagonoma rash

A

rash with clear center, erythematous, PAINFUL, does not respond to cortisone
necrolytic migratory erythema

47
Q

Lithium induced hypothyroidism - next step

A

start levothyr

no need to stop lithium

48
Q

effect of intensive glycemic control in mascular complications

A
  • macrovascular (stroke, heart etc): no change

- microvascular (nephropathy, retinopathy etc): improved

49
Q

subclinical hypoth increases the risk for

A

pregnancy complications (miscarriages, preeclampsia, preterm, low birth weight and abruptuin)

50
Q

thyroid - pregnancy

A

increase of thyroxine binding globulin –> elavated T3/T4 –> Normal TSH
patient euthyroid

51
Q

TSH secreting adenoma - lab charachteristic

A

secretion of inactiva a-subunit + other pituitary hormones (eg. GH leading to acromegaly)

52
Q

acromegaly - increased risk for

A
  • cardiovascular disease

- colon cancer

53
Q

iodine-induced hyperthyroidism - predisposition

A
  1. nodular thyroid disease

2. chronic iodine def

54
Q

iodine-induced hyperthyroidism - clinical features

A
  • symptomes following iodine exposure (radioctonrast etc)

- no extrathyroidal manifestation of GRAVES

55
Q

iodine-induced hyperthyroidism MANAGEMENT

A
  • bet blockers

- antithyroid medication

56
Q

adverse effect of SLGT2 - inh

A
  1. Genitourinary infections (candida, UTI, fourier gangrene)
  2. osm diuresis (volume depletion etc)
  3. metabolic: euglygenic diabetic ketoacidosis)
  4. orthopedic complications (low trauma fracture, foot ulcers)
57
Q

euglygenic diabetic ketoacidosis - triggers

A
  1. prolonged fasting
  2. major illness
  3. intense exercise
  4. alcohol
  5. abrupt reduction of insulin dose
58
Q

combined estrogen/progesterone menopausal hormone therapy - benefits

A

menopausal symptoms

59
Q

combined estrogen/progesterone menopausal hormone therapy - problems

A
  • Venous thromboemb
  • breast cancer
  • Coronary heart disease if >60
  • gall bladder disease
60
Q

DM2 + obesity + lipis - what to give, what not to give

A

give metformin

do not give sulfonoulyrias

61
Q

DM medication that worsens HF

A

pioglitazonE

62
Q

Levo treatment for thyroid cancer - TSH goal

A

small, low risk tumor –> 0.1 - 0.5 for 6 months, then low normal
interm risk tumor –> 0.1-0.5
large, aggressive tumors –> less than. 0.1 for several years

63
Q

Euthyroid sick syndrome

A 
during acute illness
normal TSH/T4
LOW T3 (decreased conversion)
high reverse t3
No treatment unless pesiststs
64
Q

hypercalcemia due to immobilization - treatment

A

biphosphonates

65
Q

rapid progression of renal failure in DM - management

66
Q

diagnosis of DM

A
  1. H1Ac 6.5 or higher
  2. fasting (8 hours) gl 126 or higher
  3. Random gl 200 or higher + SYMPTOMS
    oral gl tolerance (2h after 75gr): 200 or higher
67
Q

Most sensitive test for DM diagnosis

A

oral gl tolerance

68
Q

1ry hyperPTH - indications for parathyredectomy

A
  1. younger than 50
  2. symptomatic hypercalcemia
  3. complications (osteoporosis, CKD, stones etc)
  4. elevated risk of complications (Ca2+ more than 1 above normal, more than 400 per day in urine etc)
69
Q

Hyperthyroidism with low Iodine uptake - next step

A

check thyroglobulin

  • high: iodine exposure or thyroiditis
  • exogenous hormone
70
Q

Graves - when surgery

A
  1. very large goiter (or obstructive)
  2. suspicion of cancer
  3. coexisting 1ry hyperPTH
  4. severe opthalmopathy
  5. pregnant who cannot tolerate medication
71
Q

Start a thyroid medication - how to assess response

A

With T4/T3 (NOT TSH)

72
Q

DKA treatment (only names)

A
  1. Fluids
  2. insulin
  3. K+
  4. Biocarbonate
73
Q

DKA - fluids

A

initial: isotonic
Subsequent: Isotonic if Na less than 135
half normal saline if more than 135
Add dextrose when gl less than 200

74
Q

DKA - insulin

A

Reduce infusion when gl less than 200
Hold infusion if serum k+ less than 3.3
switch to SC on DKA resolution

75
Q

DKA - K+

A

if less than 5.3

76
Q

DKA - Biocarbonate

A

IF PH LESS THAN 6.9

77
Q

Stop metformin before CT?

A

Only if GFR less than 30

78
Q

The predisposition of thyroid lymphoma

79
Q

Pembertson sign

A

facial plethora or neck vein distention when arms are raised and confirms enlarged thyroid glands the cause of esophageal obstructive symptoms

80
Q

Osteoporosis / osteopenia - T score

A

Normal:more than -1

osteopenia: -1 to -2.5
osteoporosis: less than 2.5

81
Q

osteporosis - indications for bisphosphnates

A
  1. Low bone mass with a history of fragility fracture
  2. bone density criteria for osteoporosis (less than 2.5)
  3. osteopenia with 10-year probability for major osteoporotic fractures
82
Q

biphosphonate in postmenopausal women if

A
  1. low bone mass + history of fragility fracture
  2. osteoporosis (Less than -2.5)
  3. osteopenia + 10 year probability 20% for major and 3% for hip

STEP 3 Uworld (14 decks)

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