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UWorld Endo And Electrolytes Flashcards

0
Q

Most common neuropathy in diabetics?

A

Symmetrical distal polyneuropathy

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1
Q

Other causes of Addison disease?

A
  1. Chronic granulomatous infections (histoplasmosis, Coccidioides mycosis)
  2. DIC
  3. Adrenal metastasis
  4. Adrenoleukodystrophy
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3
Q

Sx of acromegaly? Test?

A

Arthalgias, HTN, finger swelling, skin tags, carpal tunnel, jaw enlargement

IGF-1

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4
Q

Pt with suspected acromegaly and elevated IGF-1: next step?

A

Oral glucose tolerance test. (Glucose should decrease GH in normal patients) If inadequate, MRI brain.

If mass - operate
If no mass - look for GHRH secreting tumor

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5
Q

Causes of alkalosis with hypoK and normotension? HypoCl seen in?

A
  1. Vomiting - hypoCl
  2. Diuretic use
  3. Bartter syndrome
  4. Gitelman syndrome
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6
Q

Indications for thyroid functioning tests?

A
  1. Hyperlipidemia
  2. hypoNa
  3. Elevated serum muscle enzymes
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7
Q

Use of beta blockers in thyroid disease?

A

Sx relief in thyrotoxicosis

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8
Q

Sestamibi scan - follow up?

A

Purpose: to localize PTH adenoma

Neg with many abnormal glands: bilateral neck exploration

Equivocal scan: bilateral neck exploration

Positive scan with 1 adenoma: parathyroidectomy with radio guidance

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9
Q

Elevated testosterone hormone with normal DHEAS versus elevated DHEAS with normal testosterone?

A

Ovarian versus adrenal source of excess androgen production

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10
Q

Screening test for congenital adrenal hyperplasia?

A

17-hydroxyprogesterone

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11
Q

Suspected pagent’s disease: two tests to order?

A
  1. Serum alk phos

2. Urinary analysis for telopeptides, hydroxyproline, and deoxypyridinoline (Marker of bone resorption)

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12
Q

Most likely cause of death in acromegaly?

A

Congestive heart failure

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13
Q

Teaticular tumors with increased bata-hCG? Increase in only AFP? increase in AFP and beta-hCG?

A

ChorioCA, yolk-sac tumor, teratomas/non-seminatous germ cell tumor

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14
Q

Adverse effect of PTU and methimazole?

Adverse effect of radioiodine ablation?

Adverse effect of thyroidectomy?

A

Agranulocytosis

Worsening of Ophthalmopathy

Recurrent laryngeal nerve damage

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15
Q

Contraindications of radioactive iodine tx?

A

Pregnancy and severe ophthalmopathy

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16
Q

Type of lung cancer associated with hypercalcemia?

A

Squamous (sCa++mous) cell carcinoma

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17
Q

Differential diagnosis for anterior mediastinal mass?

A 
4 T's
Thymoma
Teratoma
Thyroid neoplasm 
"Terrible" Lymphoma
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18
Q

Pt with hashimoto’s thyroiditis is at a higher risk for developing?

A

thyroid lymphoma

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19
Q

Bartter’s syndrome - labs?

A
  1. hypoK
  2. metabolic alkylosis
  3. Elevated urine Cl
  4. Normal BP
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20
Q

Pt with suspected adrenal insufficiency. Must do this test?

A

Cosyntropin stimulation test.

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21
Q

Purpose: Cosyntropin test vs 24 urine cortisol

A

adrenal insufficiency vs cushings

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22
Q

Distingush between cushing’s disease vs ectopic ACTH production?

A

Dex suppression test.

If cortisol drops, then cushing’s disease (pit adenoma)

If cortisol doesn’t drop, then ectopic ACTH

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23
Q

Causes of primary hypoPTH?

A
  1. post-surgical
  2. congenital absence of parathyroids
  3. autoimmune
  4. defect in Ca sensing receptor
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24
Q

Diuretic abuse: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

high>20, up, up, down, up, low/normal

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25
Q

Vomiting: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

low<10, up, up, down, up, low/normal

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26
Q

Bartter/Gitelmann: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

very high>40, up, up, down, up, normal

27
Q

Primary hyperALDO: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

very high>40, down, up, down, up, up

28
Q

Renin-secreting tumor: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

very high>40, up, up, down, up, up

29
Q

factitious diarrhea: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

A

low<10, up, up, down, up, low/normal

30
Q

HypoNa Ddx if normal serum osmolarity?

A

hyperproteinemia, hyperlipidemia

31
Q

HypoNa Ddx if serum osm>295?

A

hyperglycemia, radiocontrast, mannitol

32
Q

HypoNa Ddx if hypovolemic, with Urine Na <10?

A

Nonrenal salt loss (vomiting, diarrhea, dehydration)

33
Q

HypoNa Ddx if hypovolemic with urine Na >20?

A

Renal salt loss (diuretics, ACE-Is, Mineralocorticoid deficiency)

34
Q

HypoNa Ddx if euvolemic with osm<280 Urine Na 20+ and Uosm less than 300

A

psychogenic polydipsia, beer potomania

35
Q

HypoNa Ddx if euvolemic with urine Na >20 and Uosm >300

36
Q

HypoNa Ddx if osm<280, and hypervolemic?

A

CHF, cirrhosis, nephrotic syndrome

37
Q

Non-tumor differentiation between MEN2a and 2b?

A

elevated PTH (from parathyroid adenoma) vs Marfanoid habitus

38
Q

Causes of myopathy?

A
  1. Connective tissue disease (polymyositis and dermatomyositis)
  2. Endocrine (thyroid and cushings)
  3. Neuromuscular (LE, MG)
  4. Drugs (steroids)
39
Q

VIt D toxicity?

A

constipation, abdominal pain, polyuria, polydipsia

40
Q

Pt with ED - question to ask?

If organic, possible hormonal causes?

A

nocturnal erections (to differentiate between psych vs neurological problem)

thyoid, prolactin, testosterone, cushings,

41
Q

Hashimotos - antibodies?

A

anti-thyroid peroxidase (anti-TPO)

anti-thyroglobubin

42
Q

Management of hypercalcemia?

A

If symptomatic or calcium >14:

  1. Short-term: saline and calcitonin (diuretic only if volume overloaded)
  2. Long-term: bisphosphonate (zoledronic acid)
43
Q

Metabolic syndrome?

A

Three of the five:

  1. Waist circumference >40 in men >35 in women
  2. Fasting glucose >100
  3. Blood-pressure >130/80
  4. Triglycerides >150
  5. HDL <50 in women
44
Q

Serious side effect of PTU and methinazole? Appropriate management?

A

Agranulocytosis. Stop drug at any sign of infection and measure white count.

45
Q

Effect of alkalosis on calcium levels? Mechanisms?

A

Decreased serum calcium due to increased binding affinity to albumin.

46
Q

Patient with renal insufficiency. CT shows adrenal calcification – cause?

47
Q

Treatment for diabetic neuropathy?

A

TCAs (amitriptyline, desipramine, nortriptyline) > gabapentin > NSAIDs

48
Q

Endocrine problem that causes eosinophilia?

A

Glucocorticoid deficiency

49
Q

Signs of panhypopituitary?

A

ACTH deficiency (hypotension, weight-loss, hypoglycemia, eosinophilia)

Hypothyroid (cold intolerance, dry skin, weak deep tendon reflexes, anemia)

HypoGonadotropin (decreased libido, amenorrhea)

50
Q

Give diabetics metoclopramide if?

A

Diabetic neuropathy of the gastrointestinal tract (gastroparesis)

51
Q

Most sensitive test for nephropathy in diabetes?

A

microalbumin/creatinine ratio

52
Q

Normal TSH, Normal T3, low T4?

A

Central hypothyroidism

53
Q

High TSH, low T3, low T4?

A

Primary clinical hypothyroidism

54
Q

High TSH, Normal T3, normal T4?

A

Subclinical primary hypothyroid

55
Q

Low TSH, low T3, low/normal T4?

A

Euthyroid sick syndrome

56
Q

Normal TSH, low T3, normal T4?

A

Low T3 syndrome (version of sick euthyroid syndrome)

57
Q

MEN 1

MEN 2A

MEN 2B

A

Parathyroid, pituitary, pancreatic

Medullary thyroid, parathyroid, pheochromocytoma

Mucosal ulcers, Medullary thyroid, pheochromocytoma

58
Q

Sx and EKG: HyperK vs HypoK?

A

Both: Muscle weakness and flaccid paralysis

Asystole vs EKG U waves

59
Q

Treatment of hyperkalemia - ways to drive K into cells?

A

Insulin and glucose, Sodium bicarb, B-2 agonist

60
Q

Effect of magnesium on calcium level?

A

HypoMg inhibits PTH (decreased secretion and increased resistance), leading to low Ca

61
Q

Signs of fibromuscular dysplasia?

A 
#Vision loss (Amarosis fugax)
#Stroke (family history)
#Bruits
#High renin/Aldo
62
Q

Do not treat a pheochromocytoma with? (Why?)

A

B-blocker; will increase BP

63
Q

Treatment of pageants disease? If fails?

A

Bisphosphonates to suppress bone turnover (Pagents is a disease of Osteoclasts)

If fails, calcitonin

Medicine (106 decks)

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