Lecture 3: Endocrine - History and Exam

Question 1

Viscerosomatic reflex for thyroid is what levels?

Answer 1

T1-4

Question 2

Most common cause of hypocalcemia?

Answer 2

Hypoparathyroidism

Question 3

Chvostek Sign vs. Trousseau’s Sign?

Answer 3

Chvostek Sign = tapping on the Cheek near facial nerve and eliciting twitching at the corner of mouth

Trousseau’s Sign = when you use a Torniquet like BP cuff and as you inflate the cuff the wrist will flex and fingers come together

*Both signs of hypoparathyroidism: hypocalcemia!

Question 4

What is most common cause of 1° hyperparathyroidism?

Answer 4

Adenomas - may be associated with MEN 1

Question 5

What leads to 2° hyperparathyroidism?

Answer 5

Low Ca2+ causes high PTH (i.e., renal failure, vit D defeciency, malabsorption)

Question 6

What’s the mnemonic for Hyperparathyroidism: Hypercalcemia?

Answer 6

Stones: renal or biliary

Bones: bone pain

Groans: abdominal pain, nauseau, vomting

Thrones: polyuria resulting in dehydration

Psychiatric overtones: depression, anxiety, cognitive dysf., insomnia)

Question 7

What is the most common cause of Hypothyroidism?

Answer 7

Hashimoto’s thyroiditis (autoimmune)

Question 8

What is the most common cause of Hyperthyroidism?

Answer 8

Grave’s disease (autoimmune)

Question 9

What is the USPSTF recommendation for screening people for thyroid dysfunction?

Answer 9

No recommendation - Grade: I statement (insufficient evidence)

Question 10

What is Primary vs. Secondary Adrenal Insufficiency?

Answer 10

Primary: cortisol underproduction from adrenal gland

• Autoimmune, TB, cancer cells

Secondary: due to lack of ACTH

• Suddenly stopping exogenous glucocorticoids

Question 11

Symptoms of Addison’s disease?

Answer 11

• Skin darkening (hyperpigmentation)
• N/V/D in about 50% of cases
• Salty food craving
• Hypotension

Question 12

What condition is this usually seen in?

Answer 12

• Addison disease
• Adrenal Insufficiency

Question 13

What is Addisonian Crisis/Acute Adrenal Insufficiency?

Answer 13

• Usually appears at time of stress (illness, surgey, etc.)
• Sudden penetrating pain of back, extremities, vomiting, diarrhea

Question 14

What is Cushing’s; what forms are there?

Answer 14

• Adrenal (cortisol) overproduction
• Has both endogenous and exogenous causes

Question 15

What is the most common cause of endogenous adrenal (cortisol) overproduction?

Answer 15

• Cushing’s disease
• Often times a Pituitary tumor

Question 16

Signs and Symptoms of Cushing Syndrome?

Answer 16

• A round (moon-shaped) and/or red face
• Purplish streaks across the skin (“striae”)
• Buffalo hump
• Unusual buildup of fatty tissue in the abdominal area
• Easy bruisiing
• Excess facial/body hair growth (hirsutism)

Question 17

What is the differene between Cushing’s syndrome and Cushing’s disease?

Answer 17

• Cushing’ Syndrome refers to the condition causes by excess cortisol in the body, regardless of the cause

- Cushing’s Disease refers to Cushing’s Syndrome caused by a pituitary tumor

Question 18

Cushing’s Syndrome vs. Addison’s Disease?

Answer 18

Cushing’s: Adrenal (cortisol) overproduction

Addison’s: Adrenal insufficiency (cortisol underproduction)

Question 19

What are TSH, T3, and T4 levels like in hyperthyroidism vs hypothyroidism?

Answer 19

Hypothyroidism: High TSH, Low T3, and T4

Hyperthyroidism: Low TSH, High T3 and T4

Question 20

Type I vs. Type II DM?

Answer 20

Type I: Pancreas doesn’t produce enough insulin

Type II: Body’s cells can’t let the insulin in to use it (insulin resistant)

Question 21

Common presenting signs/symptoms of DM?

Answer 21

• Urinating often
• Feeling very thirsty
• Extreme fatigure
• Blurry vision
• Feeling very hungry - even though you are eating
• Weight loss - even when eating more

Question 22

What are some of the consequences of untreated DM?

Answer 22

• Frequent infections (UTI, vaginal, skin)
• Retinopathy –> blindness
• Nephropathy –> kidney failure
• Neuropathy of feet and hands –> ulceration, infection, gangrene
• Vascular changes

Question 23

What is this and what condition is it associated with?

Answer 23

• Acanthosis nigracans
• Diabetes

Question 24

How do you screen for diabetic neuropathy?

Answer 24

• Using a 10g monofilament x every 6 months