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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
Vomiting: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
low<10, up, up, down, up, low/normal
26
Bartter/Gitelmann: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, up, up, down, up, normal
27
Primary hyperALDO: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, down, up, down, up, up
28
Renin-secreting tumor: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, up, up, down, up, up
29
factitious diarrhea: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
low<10, up, up, down, up, low/normal
30
HypoNa Ddx if normal serum osmolarity?
hyperproteinemia, hyperlipidemia
31
HypoNa Ddx if serum osm>295?
hyperglycemia, radiocontrast, mannitol
32
HypoNa Ddx if hypovolemic, with Urine Na <10?
Nonrenal salt loss (vomiting, diarrhea, dehydration)
33
HypoNa Ddx if hypovolemic with urine Na >20?
Renal salt loss (diuretics, ACE-Is, Mineralocorticoid deficiency)
34
HypoNa Ddx if euvolemic with osm<280 Urine Na 20+ and Uosm less than 300
psychogenic polydipsia, beer potomania
35
HypoNa Ddx if euvolemic with urine Na >20 and Uosm >300
SIADH
36
HypoNa Ddx if osm<280, and hypervolemic?
CHF, cirrhosis, nephrotic syndrome
37
Non-tumor differentiation between MEN2a and 2b?
elevated PTH (from parathyroid adenoma) vs Marfanoid habitus
38
Causes of myopathy?
1. Connective tissue disease (polymyositis and dermatomyositis) 2. Endocrine (thyroid and cushings) 3. Neuromuscular (LE, MG) 4. Drugs (steroids)
39
VIt D toxicity?
constipation, abdominal pain, polyuria, polydipsia
40
Pt with ED - question to ask? If organic, possible hormonal causes?
nocturnal erections (to differentiate between psych vs neurological problem) thyoid, prolactin, testosterone, cushings,
41
Hashimotos - antibodies?
anti-thyroid peroxidase (anti-TPO) | anti-thyroglobubin
42
Management of hypercalcemia?
If symptomatic or calcium >14: 1. Short-term: saline and calcitonin (diuretic only if volume overloaded) 2. Long-term: bisphosphonate (zoledronic acid)
43
Metabolic syndrome?
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
Serious side effect of PTU and methinazole? Appropriate management?
Agranulocytosis. Stop drug at any sign of infection and measure white count.
45
Effect of alkalosis on calcium levels? Mechanisms?
Decreased serum calcium due to increased binding affinity to albumin.
46
Patient with renal insufficiency. CT shows adrenal calcification – cause?
TB
47
Treatment for diabetic neuropathy?
TCAs (amitriptyline, desipramine, nortriptyline) > gabapentin > NSAIDs
48
Endocrine problem that causes eosinophilia?
Glucocorticoid deficiency
49
Signs of panhypopituitary?
ACTH deficiency (hypotension, weight-loss, hypoglycemia, eosinophilia) Hypothyroid (cold intolerance, dry skin, weak deep tendon reflexes, anemia) HypoGonadotropin (decreased libido, amenorrhea)
50
Give diabetics metoclopramide if?
Diabetic neuropathy of the gastrointestinal tract (gastroparesis)
51
Most sensitive test for nephropathy in diabetes?
microalbumin/creatinine ratio
52
Normal TSH, Normal T3, low T4?
Central hypothyroidism
53
High TSH, low T3, low T4?
Primary clinical hypothyroidism
54
High TSH, Normal T3, normal T4?
Subclinical primary hypothyroid
55
Low TSH, low T3, low/normal T4?
Euthyroid sick syndrome
56
Normal TSH, low T3, normal T4?
Low T3 syndrome (version of sick euthyroid syndrome)
57
MEN 1 MEN 2A MEN 2B
Parathyroid, pituitary, pancreatic Medullary thyroid, parathyroid, pheochromocytoma Mucosal ulcers, Medullary thyroid, pheochromocytoma
58
Sx and EKG: HyperK vs HypoK?
Both: Muscle weakness and flaccid paralysis Asystole vs EKG U waves
59
Treatment of hyperkalemia - ways to drive K into cells?
Insulin and glucose, Sodium bicarb, B-2 agonist
60
Effect of magnesium on calcium level?
HypoMg inhibits PTH (decreased secretion and increased resistance), leading to low Ca
61
Signs of fibromuscular dysplasia?
``` #Vision loss (Amarosis fugax) #Stroke (family history) #Bruits #High renin/Aldo ```
62
Do not treat a pheochromocytoma with? (Why?)
B-blocker; will increase BP
63
Treatment of pageants disease? If fails?
Bisphosphonates to suppress bone turnover (Pagents is a disease of Osteoclasts) If fails, calcitonin

Medicine (106 decks)

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