IM ENDO Flashcards
1
Q
Conn syndrome is…
best screening test
A
1ry hypoaldestorenism
ald / renin ratio
2
Q
subacute thyroiditis - iodine uptake / treatment
A
decreased
treatment: NSAID, b blockers, steroids if refractory
3
Q
medications associated with gynecomastia
A
- spironoloactone
- cimetidine
- 5a reductase inhb
- ketoconazole
4
Q
Chronic adrenal insuf - presentation
A
Low Na, high K, hyperchl met acidosis
increased pigmentation
5
Q
sulfolynurea poisoning - managment
A
dextrose + octreotide (somatostatin analogue –> decreases insulin secr)
6
Q
subclinical hypothyrodism - treat if
A
- antithyroid abs
- lipid abnormalities
- symptoms
- ovulatory or mens dysfunction
- TSH > than 10 or 7-10 and younger than 70
7
Q
start statin if
A
- LDL more than 190
- Older than 40 + DM
- known athero CV risk
8
Q
suspect diabetic neuropathy - next step
A
turning fork test
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
10
Q
thryroid nodule - FIRST STEP
A
Clinical evaluation, TSH + U/S
11
Q
thryroid nodule - with cancer suspicion (after U/S) –>
A
FNA
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
13
Q
MEN type 1
A
- PTH
- pancreatic tumor
- pituitary
14
Q
MEN type 2A
A
- PTH
- Pheo
- Medullary Thyroid
15
Q
MEN type 2B
A
- Medullary Thyroid
- Pheo
- mucosal + interstitial neuromas
- Marphanoid habitus
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
17
Q
Medullary thyroid carcinoma - before surgery rule out
A
pheochromocytoma
18
Q
subclinical hyperth - treat if
A
- persistent TSH below 0.1
- TSH between 0.1-0.5 +
- age >65
- heart disease
- osteoporosis
- nodular thryoid disease
19
Q
anabolic steroid abuse -effect in hematology
A
erythorcytosis
20
Q
anabolic steroid abuse -effect in LIPIDS
A
HIGH LDL / LOW HDL
21
Q
anabolic steroid abuse -effect in sex
A
normal libido + erectile during use
low libido + impotence during withdrawal
22
Q
rare but serious complication of metformin
A
lactic acidosis (increased risk with hypovolemia, liver / kidney / heart disease_
23
Q
Treat megalob anemia with B12 - MONITOR ….
A
K levels (risk of hypo)
24
Q
Hyperthyr with cardiov symptoms - initial treatment
A
b-blockers
25
hypercalcemia - next step
measure PTH
1. elevated (PTH depended)
2. low indipended --> see PTHrp and vitd
26
PTH depended hypercalcemia - causes
primary
familiar
lithium
27
PTH independed hypercalcemia - causes
1. malignancy
2. vit D
3. drugs
4. granuloatous
28
diuretic to increase serum CA2+
thiazides
29
treatment of chronic hypoparathyroidism
1. Vitamin D (over calcitriol the active form because cheaper)
2. Ca2+
3. thiazide (if low serum and high urine
30
hypoglycemia associated autonomic failure - presentation
1. reduced neurogenic hypoglycemic symptoms (tremor sweeting etc)
2. increased risk for neuroglycopenic (confusion, LOC)
31
hypoglycemia associated autonomic failure - RF
1. long-standing DM1
| 2. recurrent or severe hypoglycemia
32
hypoglycemia associated autonomic failure - management
1. avoid hypoglycemia
2. reduce insulin dose
3. less strict glycemic targets
33
C - peptide: low vs high
low: exogenus insulin
high: insulinoma or oral hypoglycemic ageints
34
hypoglycemia - with high c peptide - next step
screen for oral hypogl agents --> if neg --> abd ct scan
35
whipple triad
1. symptoms
2. low gl
3. symptom resolution after gl
36
pheo screen
plasma free metanephrine or 24h urine catecholamine and metanephrine
37
pheo classic triad
1. headache
2. sweating
3. tachycardia
38
pheo b vs a block
alpha FIRST
39
surgical complications of pheo removal (mechanism)
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
surgical complications of pheo removal (treatment)
1. hypertensive crisis (IV nitroprusside, phentol or nicardipine)
2. hypotension (normal saline bolus)
3. tachycardia (IV lidocane or esmolol)
4. hypoglycemia (dextrose)
41
Nelson syndrome
patients with Cushing's disease patients as a result of removing both adrenal glands
(pigmentation, pituitary enlargement, visual defects)
42
if non pregnant with hyperthyr - PTU or methimazol
methimazole (no liver toxicity)
43
toxic thyroid nodule
if large or obstructive or suspect cancer --> surgery
otherwise iodine ablation
ALWAYS B blockers and Methimazol before
44
postpartum thyroditis
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
thyroid cancer - total thyroidectomy vs lobectomy
lobectomy if smaller than 1 cm
| total if larger than 1, extension outside, metastasis, history of neck or head radiation
46
glucagonoma rash
rash with clear center, erythematous, PAINFUL, does not respond to cortisone
necrolytic migratory erythema
47
Lithium induced hypothyroidism - next step
start levothyr
| no need to stop lithium
48
effect of intensive glycemic control in mascular complications
- macrovascular (stroke, heart etc): no change
| - microvascular (nephropathy, retinopathy etc): improved
49
subclinical hypoth increases the risk for
pregnancy complications (miscarriages, preeclampsia, preterm, low birth weight and abruptuin)
50
thyroid - pregnancy
increase of thyroxine binding globulin --> elavated T3/T4 --> Normal TSH
patient euthyroid
51
TSH secreting adenoma - lab charachteristic
secretion of inactiva a-subunit + other pituitary hormones (eg. GH leading to acromegaly)
52
acromegaly - increased risk for
- cardiovascular disease
| - colon cancer
53
iodine-induced hyperthyroidism - predisposition
1. nodular thyroid disease
| 2. chronic iodine def
54
iodine-induced hyperthyroidism - clinical features
- symptomes following iodine exposure (radioctonrast etc)
| - no extrathyroidal manifestation of GRAVES
55
iodine-induced hyperthyroidism MANAGEMENT
- bet blockers
| - antithyroid medication
56
adverse effect of SLGT2 - inh
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
euglygenic diabetic ketoacidosis - triggers
1. prolonged fasting
2. major illness
3. intense exercise
4. alcohol
5. abrupt reduction of insulin dose
58
combined estrogen/progesterone menopausal hormone therapy - benefits
menopausal symptoms
59
combined estrogen/progesterone menopausal hormone therapy - problems
- Venous thromboemb
- breast cancer
- Coronary heart disease if >60
- gall bladder disease
60
DM2 + obesity + lipis - what to give, what not to give
give metformin
| do not give sulfonoulyrias
61
DM medication that worsens HF
pioglitazonE
62
Levo treatment for thyroid cancer - TSH goal
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
Euthyroid sick syndrome
```
during acute illness
normal TSH/T4
LOW T3 (decreased conversion)
high reverse t3
No treatment unless pesiststs
```
64
hypercalcemia due to immobilization - treatment
biphosphonates
65
rapid progression of renal failure in DM - management
biopsy
66
diagnosis of DM
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
Most sensitive test for DM diagnosis
oral gl tolerance
68
1ry hyperPTH - indications for parathyredectomy
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
Hyperthyroidism with low Iodine uptake - next step
check thyroglobulin
- high: iodine exposure or thyroiditis
- exogenous hormone
70
Graves - when surgery
1. very large goiter (or obstructive)
2. suspicion of cancer
3. coexisting 1ry hyperPTH
4. severe opthalmopathy
5. pregnant who cannot tolerate medication
71
Start a thyroid medication - how to assess response
With T4/T3 (NOT TSH)
72
DKA treatment (only names)
1. Fluids
2. insulin
3. K+
4. Biocarbonate
73
DKA - fluids
initial: isotonic
Subsequent: Isotonic if Na less than 135
half normal saline if more than 135
Add dextrose when gl less than 200
74
DKA - insulin
Reduce infusion when gl less than 200
Hold infusion if serum k+ less than 3.3
switch to SC on DKA resolution
75
DKA - K+
if less than 5.3
76
DKA - Biocarbonate
IF PH LESS THAN 6.9
77
Stop metformin before CT?
Only if GFR less than 30
78
The predisposition of thyroid lymphoma
Hashioto
79
Pembertson sign
facial plethora or neck vein distention when arms are raised and confirms enlarged thyroid glands the cause of esophageal obstructive symptoms
80
Osteoporosis / osteopenia - T score
Normal:more than -1
osteopenia: -1 to -2.5
osteoporosis: less than 2.5
81
osteporosis - indications for bisphosphnates
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
biphosphonate in postmenopausal women if
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
