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UW3 (2020) > UW3 (08 Endo) > Flashcards

UW3 (08 Endo) Flashcards

1
Q

HyperCalcemia

Lab tests? 3
Treatment? 2
When to add thiazide?

A
  • Repeat test
  • PTH
  • PTHrp + Vit D
  • Calciferol / Calcitriol
  • Calcium

• If U-Ca ↓ + PTH ↑ Add Thiazide

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2
Q

Anabolic steroid

Symptoms? 3
Withdrawal symptoms? 2
Labs? 6

A
  • Testicular atrophy
  • Acne
  • Gynecomastia
  • Libido ↓
  • Erectile dysfunction
  • FSH ↓ + LH ↓
  • LDL ↑ + HDL ↓
  • Hb ↑ / RBC ↑
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3
Q

Thiazolidinedione
Pioglitazone (actos)
Rosiglitazone (Avandia)

Effects? 2

A
  • ↑ Na reabsorption @ kidney

* ↑ Fluid retention

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4
Q

Subclinical HypoThryoid (Hashimoto Thyroiditis)

Diagnostic lab?
Treatment indication based on TSH?
Treatment indication based on TPO Ab?

A

• TSH↑, T4 n, TPO Ab ⊕

  • TSH > 10
  • TSH 7-10 + Age < 70
  • TSH 7-10 + Age > 70 + Symptoms
  • TSH < 7 + Age < 70 + Symptoms
  • TPO Ab ⊝ with:
  • Goiter
  • Pregnancy
  • Cholesterol ↑
  • Ovulatory dysfunction
  • Infertility
  • Symptomatic

• TPO Ab ⊕

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5
Q

Euthyroid Sick Syndrome
Lab results

Early / Mid
Late / Severe?

A
  • T4 n + T3 ↓ + TSH n

* T4 ↓ + T3 ↓ + TSH ↓

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6
Q

HyperThyroidism @ pregnancy (treatment)

A
  • PTU @ T1 (MM = teratogen)

* MM @ T2-3 (PUT ↑ liver failure)

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7
Q

DM2

Starting insulin treatment indication? 2

A
  • Failed 2 oral agent

* A1c > 9%

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8
Q

SulfonylUrea toxicity

2 medication therapy?

A
  • Glucose / Dextrose

* Octreotide (↓ insulin)

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9
Q

Pheochromocytoma

3 classic symptoms?
Diagnosis? 6
Treatment? 3
4 surgery complications + management?

A

• Headache, Sweating, HR ↑

  • 24h U-metanephrine
  • 24h U-catecholamine
  • Plasma Metanephrine
  • CT / MRI
  • MIBG
  • Octreotide scan
  • Wide body MRI
  • PET
  • Alpha blocker
  • Beta blocker
  • Resection
  • BP ↑ (Nitroprusside, Phentolamine, Nicardipine)
  • BP ↓ (NS, Vasopressor)
  • Gluc ↓ (Dextrose)
  • HR ↑ / Arrhythmia (Lidocaine, Esmolol)
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10
Q

Rapid thyroid enlargement
Arm raise causes: Facial Plethora, Neck vein engorgement

Diagnosis?

A

Thyroid Lymphoma

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11
Q

CanaGliflozin / DapaGliflozin

Mediation class?
5 side effects?

A

• SGLT-2 inhibitor

  • UTI
  • Vaginal candida
  • K ↑ / Lipid ↑
  • KetoAcidosis
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12
Q

HyperParaThyroidism

Causes? 2 major
Labs? 3
Surgery indication? 3
Surgery complications? 3

A
  • Parathyroid Adenoma / Carcinoma
  • MEN 1, 2A
  • Ca ↑, PTH n↑, U-Ca ↑
  • Age < 50, Symptomatic, U-Ca > 400
  • Osteoporosis, Kidney stone, CKD
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13
Q

Bilateral Tempral Hemiagnosia & HyperPigmentation – after L+R adenomectomy

Diagnosis?
Management?

A
  • Nelson’s syndrome
  • Pituitary adenoma development after bilateral adenoectomy for cushing syndrome
  • If ACTH ↑↑ –> MRI brain
  • Surgery / Radiation
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14
Q

PostPartum Thyroiditis

PE?
Labs?
Study findings?

A
  • Non-tender goiter
  • T4 ↑ / TSH ↓ / TPO Ab ⊕
  • RAIU ⊝
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15
Q

1° hyperthyroidism pituitary adenoma

Labs? 4
Treatment? 2

A
  • TSH n↑
  • T3 ↑ / T4 ↑
  • α-sub ↑
  • Somatostatin
  • Surgery
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16
Q

Thyroid Nodule

Evaluation / Diagnostic?

A

1) US
a. US suspicious / Cancer risk –> FNA
b. No US finding / No cancer risk –> TSH

2) TSH
a. If TSH n↑ –> FNA
b. If TSH ↓ –> I123 Scintigraph

3) Iodine Scintigraph
a. Cold –> FNA
b. Hot –> Treat hyperthyroidism

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17
Q

Differentiated thyroid cancer

What types are differentiated? 2
Initial diagnostic? Why?
When to do thyrodetomy? 4
When to do neck dissection?
When to do thyroid lobectomy?
A
  • Papillary & Follicular
  • US neck / Lymph (to stage cancer)
  • Large papillary thyroid cancer
  • Extra thyroid tumor extension
  • Distant metastasis
  • History of radiation @ neck / head
  • Involvement of adjacent neck structure or regional lymph nodes.
  • Papillary cancer < 1cm + No lymph node involvement
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18
Q

Patient has Weight ↓, Weakness, HyperPigmentation
Suspicious for adrenal failure

Lab tests & results? 4
Diagnostic test? 3

A
  • Eosinophil ↑
  • K ↑
  • Na ↓
  • Gluc ↓
  • Cortisol
  • Consyntropin
  • CT
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19
Q

Class of mediation? Side effects?

1) SulfonylUrea, Glyburide, Glipizide, Glimepiride
2) Maglitnide, Nataglinide, Repaglinide,
3) Metformin
4) Pioglitazone, Rosiglitazone
5) Exenatide, Liraglutide
6) Sitagliptin, Saxagliptin
7) Acabose, Miglitol
8) Canaflifloxin, Dapagliflozin

A

1) Insulin ↑ (Weight↑, Avoid @ CKD)
2) Insulin ↑ (Gluc ↓)
3) Biguanides (LA, Diarrhea, Avoid @ Liver / CKD / CHF)
4) Thiazolidindones (Weight ↑, Fluid retention)
5) GLP-1 (Weight ↓, Pancreatitis)
6) DDP4-I (Weight ∅, NasoPharyngitis)
7) α-gluc-I (Diarrhea, Flatulence)
8) SGLT2-I (Gluc ∅, DKA , UTI, BP ↓)

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20
Q

Amiodarone effects @ thyroid

Which is more common, Hypo or Hyper?
Frequency of monitoring?

A

HypoThyroidism more common than HyperThyroidism

Monitor TSH q3m

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21
Q

Amiodarone effects @ thyroid

What effect can it have it on conversion?
What effect can it have on thyroid hormone production?
What effect can it have on thyroid gland?

Lab test & treatment for each type?

A
  • Conversion [T4–>T3] ↓
  • TSH n↑/ T4 ↑ / T3 ↓
  • Euthyroid, No treatment
  • High I2 causes Thyroid hormone production ↓
  • TSH ↑ / T4 ↓
  • LevoThyroxine
  • High I2 casues Thyroid hormone production ↑
  • TSH ↓ / T4 ↑ / T3 ↑ / RAIU ↑ / US = vascularity ↑
  • PTU / MMI
  • Thyroid gland destruction
  • TSH ↓ / T4 ↑ / T3 ↑ / RAIU ∅ / US = vascularity ↓
  • Steroids
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22
Q

Thyroid binding globulin

What can cause high TBG? 2
What can cause low TBG? 3

Associated labs & management?

A
  • Estrogen (OCP, Pregnancy, HRT) / Hepatitis
  • T4 ↓ / T3 ↓ / TSH ↑
  • ↑ Thyroid med
  • Androgen, Steroids, Protein ↓ (Nephrotic, Starvation), Liver disease
  • T4 ↑ / T3 ↑ / TSH ↓
  • ↓ Thyroid med
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23
Q

Estrogen induced thyrotoxicosis

Mechanism?
Study finding? Labs?

A

T4 ↑ / T3 ↑ –> TSH ↓

RAIU ⊝ / T-Ig↓

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24
Q

Definition of
Vitamin D insufficiency
Vitamin D deficiency

Treatment?

A
  • Insufficiency = Vit D 20-30
  • Deficiency = Vit D < 20
  • Calciferol 50ku/w x8w –> Vit D > 30
  • Calcitriol 2ku/d (3-6ku/d @ malabsorption)
25
Q

Incidental adrenal mass

Evaluation? 3
Surgery indication? 3

A
  • Electrolyte
  • DexaMethason Suppression
  • 24h urine (Catecholamine, Metanephrine, VMA, 17-keto steroid)
  • Functional tumor
  • Malignancy / Heterogenous
  • Size > 4cm
26
Q

TSH ↓ / T3 n / T4 n

Diagnosis?
Initial management?
Treatment indication?

A

SubClinical HyperThyroid

Repeat test @ 6-8w

TSH < 0.1
TSH > 0.5 + (Age > 65, Heart disease, OsteoPorosis, Nodular Thyroid)

27
Q

1° Ovarian Insufficiency

Labs? 3
Treatment?

A

Estrogen ↓
FSH ↑ / LH ↑

Estrogen + Progestin

28
Q

Statin

High medication? 2
Moderate medication? 5

A

AtorvaStatin 40-80mg
RousuvaStatin 20-40mg

AtorvaStatin 10-20mg
RousuvaStatin 5-10mg
Simvastatin 20-40mg
Prvastatin 40-80mg
Lovastatin 40mg
29
Q

Statin therapy indication

High statin indication?

Moderate statin indication?

A
  • Age < 75 + (ACS / Angina / CABG / TIA / CVA)
  • LDL > 190
  • Age > 40 + DM + ASCVD risk > 20%
  • Age > 75 + (ACS / Angina / CABG / TIA / CVA)
  • Age > 40 + DM + ASCVD risk < 20%
  • ASVCD risk 7.5-20%
30
Q

Patient has mood swings, hypertension, osteoporosis
Diagnosed with cushing syndrome

Associated lab results? 3

A
  • Gluc ↑
  • K ↓
  • Aklalosis / HCO3 ↑
31
Q

Male in puberty
Breast mass < 4cm

Diagnosis?
Management?
Course?

A
  • GynecoMastia
  • Reassess / Observe
  • Resolve < 1y
32
Q

GDM cause?

When to screen?

A
  • Human placental lactogen increase

* Screen @ GA 24-28w

33
Q

CAH types

1) Hypertension?
2) Hypotension?
3) Low potassium?
4) High potassium?
5) Ambiguous genitalia @ F
6) Ambiguous genitalia @ M
7) Low sodium & low glucose?

A

1) 11b-OH, 17a-OH
2) 21-OH
3) 11b-OH, 17a-OH
4) 21-OH
5) 11b-OH, 21-OH
6) 17a-OH
7) 21-OH

34
Q

Exercised induced amenorrhea

Labs? 3
PE?
Complications? 2

A
  • LH ↓ –> Estrogen ↓ / Cholesterol ↑
  • Atrophy @ breast / vagina
  • Osteopenia / Osteoporosis / Infertility
35
Q

Vitamin B12 deficiency

Treatment effects?
Follow up?

A
  • ↑ K cellular use
  • ↓ K @ serum

• Monitor K within 48h

36
Q

Patient with fatigue, weight loss, myalgia, hyperpigmentation
Diagnosed with Addisons (adrenal insufficiency)

Lab results? 4

A
  • Na ↓
  • K ↑
  • Cl ↑
  • Metabolic Acidosis
37
Q

HypoCalcemia
Lab findings

1) Normal PTH
2) Normal Vit D
3) Vitamin D deficiency
4) Hypo-parathyroidism
5) Pseudo-Hypot-parathyroidim
6) Hyper-phosphatemia

A

HypoCalcemia
Differential

1) PO4 ↓ + Ca ↑
2) Ca ↑ + PO4 ↑
3) Ca ↓ + PO4 ↓ –> PTH ↑
4) PTH ↓ –> Ca ↓ + PO4 ↑
5) Ca ↓ + PO4 ↑–> PTH ↑
6) PO4 ↑ + PTH ↑

38
Q

Precocious Puberty (evaluation)

1) Normal bone age + pubic hair
2) Normal bone age + breast
3) Older bone age + LH ↑
4) Older bone age + LH ↓

A

• Precocious Puberty (evaluation)

  • Premature adrenarche
  • Premature thelarche
  • Central precocious puberty
  • Peripheral precocious puberty
39
Q

Fever, Neck pain, Tender thyroid, suspicious for subacute thyroiditis

Lab test? 4
Study resuts?

A
  • TSH ↓ / T4 ↑
  • ESR ↑
  • TPO Ab ⊕
  • RAIU ↓
40
Q

Diseases of

MEN 1
MEN 2a
MEN 2b

A
  • Pituitary
  • HyperParaThyroid
  • Pancreatic
  • Medullary Thyroid Cancer
  • PheoChromoCytoma
  • HyperParaThryoid
  • Medullary Thyroid Cancer
  • PheoChromoCytoma
  • Neuroma / Marfanoid
41
Q

Congenital Hypothyroidism

Management? 3

A
  • LevoThyroxine
  • US thyroid
  • Endocrine referra
42
Q

Glucagonoma (pancreatic tumor)

Endocrine manifest?
Skin manifest?
At risk for what cancer?

A
  • Diabetes
  • Necrotic Migratory Erythema
  • Liver malignancy
43
Q
  • Erythematous / Scaly
  • Itchy / Painful
  • Central clearing
  • Borders elevated & crusty
A

Necrotic migratory erythema

44
Q

Prolactinoma

Pre-menopausal symptoms? 5
Post-menopausal symptoms? 2
Symptoms at male?

Diagnostic? 5
Treatment? 2

A
  • Amenorrhea
  • Infertility
  • Galactorrhea
  • Hot flashes
  • Osteoporosis
  • Headache
  • Vision changes
  • Impotence
  • Gynecomastia
  • Infertility
  • Libido ↓
  • Prolactin > 200
  • Check: Cr / TSH / T4
  • MRI brain
  • Dopamine Agonist (cabergoline)
  • TransSphenoid surgery
45
Q

Thyroiditis

Diffuse goiter
Hypo symptoms
3 types, 2 labs

Small / Non-tender goiter
Mild & short – Hyper symptoms
Spontaneous recovery
2 labs

Post viral / Fever
Painful & tender goiter
3 labs, 3 treatment?

A
  • Chronic / AutoImmune / Hashimoto
  • TPO Ab ⊕, RAIU ⊕ / ⊝
  • Painless / Silent
  • TPO Ab ⊕, RAIU ⊝
  • SubAcute / deQuervain
  • ESR ↑ / CRP ↑ / RAIU ⊝
  • Propranolol / Atenolol, NSAID, Steroid
46
Q

Diabetic neuropathy

SSRI (2 med, 2 use, 3 avoid)
TCA (3 med, 3 use, 5 avoid)
Gaba (2 med, 3 use, 3 avoid)

A
  • Duloxetine / Venltafaxine
  • Depression / Anxiety
  • Restless leg / Sexual dysfunction / Glaucoma
  • AmiTryptyline / Nortryptyline / Desipramine
  • Depression / Anxiety / Insomnia
  • QT ↑ / Ortho BP ↓ / Sexual dysfunction / Urinary retention / Glaucoma
  • Gabapentin / Pregabalin
  • Restless leg / Tremor / Insomnia
  • Substance abuse / Peripheral edema / COPD
47
Q

Lithium induced Hypothyroidism

Mechanism?
Treatment? 2

A

• ↓ T3 & T4 synthesis & release

  • Continue Lithium
  • Add Levothyroxine
48
Q

Breast development = n
No pubic or axillary hair
1° Amenorrhea > 15y

Diagnosis?
Additional PE findings? 2
Imaging study finding?
Lab finding?

A

• Androgen Insensitivity

  • Blind vaginal pouch
  • CyrptoOrchitism
  • US vagina = No uterus
  • Testosterone = n @ male
49
Q

Diagnosis?

Cortisol low
ACTH ↑
ACTH test = minimal response

Cortisol low
ACTH ↓
ACTH test = minimal response

A
  • 1° = Adrenal gland

* Central = Pituitary

50
Q

Central adrenal insufficiency

Lab & diagnostic?

Associated condition & lab?

A
  • Na ↓ / ACTH ↓
  • ACTH test = minimal response
  • MRI brain
  • Hypothyroidism
  • TSH ↓ / T4 ↓ / T3 ↓
51
Q

HyperThyroidism (complications)

Cardiac? 2
Endocrine? 1

A
  • Arrhythmia
  • CardioMyopathy

• Osteoporosis

52
Q

Bisphosphonate

4 indications ?

A
  • History of fracture
  • Osteoporosis (T < -2.5)
  • Osteopenia (T -1 to -2.5)
    • Fracture risk > 20%
    • Hip fracture risk > 3%
53
Q

HypoAldosterone / Conn (lab check)

A
  • HTN + K ↓

* Aldosterone : Renin > 30

54
Q

Delayed Puberty @ boys

PE? 2
Diagnostics tests? 6

A
  • No testicle size ↑ by 14y
  • Delayed growth spurt
  • Bone age
  • FSH / LH
  • TSH
  • Testosterone
  • Prolactin
55
Q

How do these affect thyroid medication?

  • Cholestramine
  • Iron / Calcium / Aluminum
  • PPI / Sucralfate
  • Estrogen
  • Tamoxifen
  • Androgen
  • Steroids
  • Rifampin
  • Phenytoin
  • Carbamazepine
A
  • ↓ Levothyroxine absorption - increase thyroid med
  • ↑ TBG - increase thyroid med
  • ↓ TBG - decrease thyroid med
  • ↑ Thyroid hormone metabolism - increase thyroid med
56
Q

Menopausal HRT

Benefits? 5
Risks? 5

A
  • Symptoms ↓
  • Bone ↑ / Fracture ↓
  • Colon cancer ↓
  • DM2 ↓
  • Mortality ↓ < 60y
  • VTE
  • Breast cancer
  • CAD > 60y
  • CVA
  • Gall bladder disease
57
Q
  • Pubic & Axillary hair ⊕
  • Acne
  • Girls = hirsutism / Oligomenorrhea
  • Boys = normal testis

Diagnosis?

A

Precocious puberty / Non classical CAH

58
Q

Grave’s Disease (management)

  • 3 Medication indication? What medication?
  • What to do radiation treatment?
  • Thyroidectomy indication? 6
  • Follow up?
A
  • Propranolol
  • Mild symptoms
  • Old age
  • Pregnancy

• Moderate / Severe

  • Large goiter
  • Thyroid cancer suspicion
  • Opthmalopathy
  • Obstructive symptoms
  • Medication intolerance @ pregnancy
  • 1° HyperParathyroidism

• T3 / T4 check @ 4-6w –> q3m

59
Q

Metformin

Contraindications? 3

A
  • Alcohol abuse
  • Sepsis
  • CHF

UW3 (2020) (19 decks)

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