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Medicine > ITE Endocrinology > Flashcards

ITE Endocrinology Flashcards

1
Q

What is the full dose for levothyroxine initiation? What does would you start in someone who is older, or has heart disease?

A

A) 100 micrograms/d (1.6 micrograms/kg lean body)

B) 25-50 microgram/d

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2
Q

What is the treatment regimen for opioid-related hypogonadism?

A

STOP opioids; consider testosterone replacement in hypogonadism secondary to chronic opioid abuse

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3
Q

Overt presentation of what common endocrinology condition can cause hyperprolactinemia?

A

Hypothyroidism

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4
Q

How to treat hyperprolactinemia and hypothyroidism?

A

treat hypothyroidism first to see if hyperprolactinemia resolves

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5
Q

Screening for pheochromocytoma is initiated if the unenhanced attenuation of an adrenal mass is greater than what?

A

10 Hounsfield units

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6
Q

When is adrenalectomy indicated?

A

1) functioning tumors - Pheo, aldosterone producing tumor, hypercortisol, or suspicion for adrenal carcinoma
2) Suspicious tumor - 4cm greater, 60% or less contrast washout at 10 minutes, 10 hounsfield units

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7
Q

Markedly elevated DHEAS and mildly elevated serum testosterone suggests what in someone with signs including deep voice, facial hair, frontal hair loss

A

adrenal source; consider CT Scan when DHEAS is above 700

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8
Q

If testosterone levels exceed above 150 in a patient with hyperandrogenism, consider what imaging modality?

A

pelvic ultrasound

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9
Q

Patients with Type I diabetes mellitus and gastrointestinal manifestations should be screened for what?

A

Celiac disease (esp if rash appears) by way of IgA tissue transglutaminase antibody

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10
Q

What condition can develop with people who have pituitary surgery?

A

SIADH (low sodium); manipulation of posterior pituitary gland causes increase release of ADH

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11
Q

What is the treatment/management of thyroid storm?

A

Transferred to ICU; treat with IV beta-blockers (esmolol); thionamides, typically propylthiouracil, transitioning to methimazole when more stable; IV high-dose glucocorticoids and potassium iodide.

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12
Q

What lab should be monitor in a transgender male undergoing masculinizing testosterone therapy?

A

H/H; screening for erythrocytosis; PSA should be monitored and genetic males taking testosterone therapy to treat hypogonadism because testosterone therapy can accelerate prostate cancer cell growth.

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13
Q

What condition is associated with suppressed parathyroid hormone level, hypercalcemia, a high/high normal serum phosphorus level, and an elevated 1, 25 dihydroxy vitamin D level?

A

Vitamin D dependent hypercalcemia which can be seen in sarcoidosis, fungal infection, tuberculosis, and lymphoma.

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14
Q

The combination of neurologic findings and anemia in a patient taking metformin for several years is consistent with what?

A

Vitamin B12 deficiency

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15
Q

Prolonged metformin use can cause a deficiency and what vitamin?

A

B12

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16
Q

What endocrinology condition is characterized by diffuse signs and symptoms of skeletal disease, as well as, a progressive rise in total alkaline phosphatase preceding overt hypercalcemia or hyperphosphatemia?

A

Osteomalacia

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17
Q

Osteonecrosis typically occurs in what areas of the body? How to differentiate from osteomalacia?

A

Osteonecrosis typically occurs in the shoulders, knees, and hips. Is often bilateral but is not a diffuse disease as reflected in a whole-body bone scan

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18
Q

With drug is typically related to drug-induced hyperprolactinemia? What are the signs and symptoms of hyperprolactinemia?

A

Risperidone, metoclopramide and phenothiazines; amenorrhea and some cases galactorrhea

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19
Q

What is the treatment of drug-induced hyperprolactinemia?

A

stop the drug if possible; if not, estrogen-progesterone supplementation is necessary to avoid estrogen deficiency

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20
Q

Patient is receiving anabolic therapy for osteoporosis, what must be started within 1 month to complete the course of antibiotic treatment to prevent the loss of newly formed bone?

A

Bisphosphonate, alendronate

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21
Q

Generally speaking, how long should a course of teriparatide and other anabolic agents last? What are the procedure risk?

A

Approximately 24 months; most concerning adverse effect of teriparatide therapy is a theoretical increase in bone osteosarcoma rates

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22
Q

What test are used to confirm diagnosis of Cushing syndrome? What follow-up tests will be necessary once diagnosis has been confirmed?

A

Overnight low-dose dexamethasone suppression test, 24-hour urine free cortisol measurement, and late-night salivary cortisol measurement

Once diagnosis is made, ACTH is measured; if ACTH dependent then you would get a a milligram dexamethasone suppression test

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23
Q

How to differentiate between ACTH dependent Cushing’s syndrome?

A

High-dose dexamethasone suppression test; if ACTH is suppressed, location of hormone is likely pituitary by way of negative feedback loop; if high-dose dexamethasone suppression test fails, ACTH is likely coming from an ectopic source

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24
Q

In otherwise healthy, young adults, a low energy fracture is not an indication for bone mineral density measurement. What would be the appropriate management?

A

Lifestyle modifications

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25
Q

How is PCOS characterized?

A

Hyperandrogenemia, ovulatory dysfunction, and polycystic ovarian morphology on imaging; diagnosis is met when other causes of hyper androgenism are excluded

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26
Q

What drug do you start after stopping denosumab therapy?

A

Alendronate (or other antiresorptive therapy)

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27
Q

Mental status changes ranging from lethargy to psychosis and coma, coupled with hypothermia, bradycardia, hypotension, or decreased respiration rate with resultant hypoxia/hypercapnia are present and what endocrinology emergency?

A

Myxedema coma

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28
Q

In a patient with acquired hypothyroidism from transsphenoidal resection, what laboratory levels should be monitored?

A

Free T4; TSH cannot be relied upon since pituitary would be removed in the scenario

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29
Q

What is the target range for free T4 in a patient with hypothyroidism seeking pregnancy?

A

Greater than 2.0

30
Q

Radioactive iodine uptake is high or inappropriately normal and hyperthyroidism due to Graves’ disease. In what condition can radioactive iodine uptake be low (less than 10%)?

A

Thyrotoxicosis due to destructive thyroiditis

31
Q

How do you treat destructive thyroiditis?

A

Depends on symptoms and signs. For palpitations and elevated heart rate, use atenolol/other beta-blocker; if thyroid is tender, use prednisone for anti-inflammatory effects

32
Q

With treatment modalities considered for patients with differentiated thyroid cancer at an intermediate to high risk for recurrence after thyroidectomy?

A

Postop radioactive iodine

33
Q

What is a long-term medical treatment of intermediate to high risk differentiated thyroid cancer?

A

TSH suppression with levothyroxine

34
Q

What differential must be considered in a patient with a pituitary adenoma who developed signs and symptoms consistent with severe headache, diplopia, and change in vision?

A

Pituitary apoplexy with mass-effect; if pituitary apoplexy is companied by visual loss, urgent neurosurgical consultation should be obtained regarding the need for decompression

35
Q

What is a common side effect/response to IV Zoledronic acid?

A

acute phase response (fever, chills, myalgia, arthralgia)

36
Q

What can change total calcium concentrations?

A

Serum protein (albumin), anion content, or blood pH

37
Q

What lab do you check to confirm levels of calcium that may be falsely elevated (due to volume loss for instance)?

A

serum calcium

38
Q

What is the most appropriate diabetes screening for patient with PCOS?

A

Screen at time of positive pregnancy test and then again at 24-28 weeks if negative

39
Q

Administration of what drug/substance could cause thyrotoxicosis in some patients with multinodular goiter?

A

Iodinated contrast material (usually occurs 1-2 weeks after administration)

40
Q

What drugs are indicated in suspected thyrotoxicosis?

A

Methimazole (antithyroid drug that blocks further uptake and synthesis of thyroid hormone)
Propranolol (controls heart rate)

41
Q

How to diagnose primary adrenal insufficiency?

A

low morning cortisol level; elevated ACTH levels

42
Q

What drug has been used to treat Grave’s opthalmopathy?

A

teprotumumab

43
Q

Normal range of PTH?

A

10-55

43
Q

Normal range of PTH?

A

10-55

44
Q

In patients with primary hyperparathyroidism, or bone related indications for parathyroidectomy?

A

Fragility fractures, vertebral fractures, and a dual-energy x-ray absorptiometry T score less than -2.5

45
Q

Nonthyroidal illness, such as sepsis, resultant hypothyroidism. What is the mechanism of action?

A

Illnesses can suppress thyrotropin releasing hormone which typically result in suppressed but detectable thyroid-stimulating hormone; thyroxine is typically low normal

46
Q

Prediatbetes is always treated with what?

A

intensive lifestyle management

47
Q

How to rule out pituitary hypersecretion in pituitary incidentaloma?

A

Measurement of prolactin and insulin-like growth factor 1

48
Q

In addition to hypersecretion, patients with pituitary incidentaloma should also be screen for what?

A

Hypopituitarism; check TSH, LH, FSH, T4, and total testosterone in men

49
Q

The most appropriate next step in a patient with obesity, decreased libido, and a low total testosterone level is to obtain what lab?

A

Free testosterone level

50
Q

Drugs including immune checkpoint inhibitors (anti-PD-1: nivolumab, pembrolizumab), and (anti-CTL-4: ipilimumab, pembrolizumab) can cause what endocrinology pathology?

A

Hypophysitis: Headache and fatigue; findings of low cortisol and low ACTH; treat with hormone replacement and high-dose glucocorticoids

51
Q

When TSH is high and T4 is normal in a patient with minimal symptoms, what should you do?

A

don’t treat subclinical hypothyroidism; repeat thyroid function tests in 6-8 weeks

52
Q

How to choose a test for hypoglycemia?

A

If fasting, choose a 72-hour fast

If after eating meals, choose mixed meal test

53
Q

Whenever patients develop thyroid disease while on amiodarone, what is the diagnostic test of choice?

A

Thyroid U/S with doppler

54
Q

How to distinguish Type 1 vs Type 2 Amiodarone induced thyrotoxicosis?

A

Type 1: occurs in patients with Graves disease (increased vascularity)
Type 2: occurs in patients without underlying thyroid disease (decreased vascularity)

55
Q

What is the appropriate treatment for primary adrenal insufficiency?

A

Hydrocortisone plus fludrocortisone

56
Q

How to diagnose adrenal insufficiency?

A

Morning cortisol level less than 3 or cosyntropin stim test

57
Q

Clinical history of what medical conditions warrant workup for Vitamin D malnutrition/malabsorption?

A

Bariatric surgery, celiac disease

58
Q

In women with PCOS, what drug can be added if patient continues to have evidence of hirsutism?

A

Spironolactone; must be on combined oral contraceptive for at least 6 months before initiation

59
Q

What should women be counseled on if diagnosed with PCOS and started on spironolactone?

A

They HAVE to be on oral contraceptive since spironolactone can cause demise for male fetus

60
Q

Mild hypercalcemia, low 24 hour urine calcium excretion (esp if Ca/Cr clearance ratio is less than 0.01), familial history of parathyroidectomy without resolution of hypercalcemia

A

Familial hypocalciuric hypercalcemia

61
Q

What is the first step in the workup of female infertility associated with normal menstrual cycles?

A

Midluteal phase serum progesterone level

62
Q

The diagnosis of hypercalcemia due to immobilization can be supported by what?

A

elevated bone alkaline phosphatase; confirmed with durable remission of hypercalcemia with antiresorptive therapy

63
Q

What is the test of choice for pheochromocytoma if there is a high suspicion of diagnosis?

A

plasma free metanephrines

64
Q

What is the test of choice if there is a low suspicion for pheochromocytoma?

A

urine fractioned metanephrines and catecholamines

65
Q

In patients with suspected primary hyperaldosteronism taking an ACE/ARB, what excludes the diagnosis?

A

elevated serum renin level (if suppressed, think primary hyperaldosteronism)

66
Q

In a patient with type 2 DM and severe kidney disease, what agent is preferred?

A

DPP-4 (-liptin)

67
Q

What vaccines should DM patients receive?

A

yearly influenza, 23-valent pneumococcal, and hepatitis B (18-59)

68
Q

What is the best screening biomarker for acromegaly? What confirms diagnosis?

A

insulin-like growth factor 1; oral glucose tolerance test

69
Q

Drug of choice to treat primary hyperaldosteronism ?

A

spironolactone/eplerenone

Medicine (7 decks)

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