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UWorld Step 3 > UWS3 Endocrine > Flashcards

UWS3 Endocrine Flashcards

1
Q

What are the trimester-specific ranges for TSH?

A

1st TM: from 0.1 to …
2nd TM: from 0.2 to …
3rd TM: from 0.3 to …

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2
Q

Total T3 and total T4 during pregnancy are how many folds of normal values?

A

1.5-fold

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3
Q

Screening for hyperthyroidism during pregnancy

A

TSH

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4
Q

Definition of delayed puberty in boys

A

testes volume <4 mL by age 14

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5
Q

How does OCP affect thyroid hormone level?

A

OCP contains estrogen –> estrogen stimulates TBG production –> increased TBG causes decreased free T3/T4 –> functional hypothyroidism

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6
Q

Another name for the following thyroiditis:

  • de Quervain thyroiditis
  • Hashimoto’s thyroiditis
A
  • de Quervain thyroiditis = subacute granulomatous thyroiditis
  • Hashimoto’s thyroiditis = chronic lymphocytic thyroiditis
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7
Q

DDx btw de Quervain thyroiditis vs Hashimoto’s thyroiditis

A
  • de Quervain thyroiditis: tender goiter

- Hashimoto’s thyroiditis: nontender goiter

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8
Q

Other than Hashimoto’s thyroiditis, anti-thyroid peroxidase is elevated in

A

Hashimoto’s thyroiditis and its variants:

  • postpartum thyroiditis
  • silent thyroiditis
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9
Q

Definition of postpartum thyroiditis =

A

<1 yr after pregnancy

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10
Q

DDx btw Hashimoto’s thyroiditis vs postpartum/silent thyroiditis

A
  • Hashimoto’s thyroiditis: permanent hypothyroidism

- postpartum/silent thyroiditis: transient hypothyroidism

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11
Q

Do strict glycemic control decrease the risk of macrovascular and microvascular complications of diabetes?

A

Macrovascular: No
Microvascular: risk of neuropathy decreased in DMT1 but not in DMT2; retinopathy and nephropathy - yes, decrease

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12
Q

Do toxic thyroid nodules need FNA?

A

No, hyperfunctioning nodules are rarely cancer

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13
Q

2-step management of toxic thyroid nodules

A

1) pretreatment with antithyroid medications to achieve euthyroid state
2) definitive treatment with radioactive iodine ablation or surgery

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14
Q

Which 2 antithyroid drugs are commonly used? Which drug is preferred for most patients? Which drug is preferred for first TM of pregnancy?

A

1) methimazole - most pts

2) propylthiouracil (PTU) - first TM; risk of hepatotoxicity

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15
Q

Complications of subclinical hypothyroidism

A

pregnancy complications (eg, recurrent miscarriages)

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16
Q

Nonpitting tibial edema is the complication of (hypothyroidism/hyperthyroidism).

A

hyperthyroidism (Graves disease)

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17
Q

Definition of subclinical hypothyroidism and its workup

A

Subclinical hypothyroidism = elevated TSH with normal FT4 - check anti-TPO - treat pts if elevated

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18
Q

diabetes + erythematous skin rash with central clearing

A

glucagonoma - characteristic “necrolytic migratory erythema (NME)”

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19
Q

Definition of precocious puberty

A

presence of secondary sexual characteristics in boys <9 yr and girls <8 yr

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20
Q

Central vs peripheral precocity in boys

A

Central: start with testicular enlargement
Peripheral: no testicular enlargement

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21
Q

Classic vs nonclassic congenital adrenal hyperplasia (CAH)

A

Classic CAH: complete absence of 21-OH; present with salt-wasting at birth
Nonclassic CAH: reduced activity of 21-OH; no salt-wasting hence not identified at birth - presented with precocious puberty instead

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22
Q

Definition of primary amenorrhea

A

absence of menarche by age 15 if breast development present by age 13

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23
Q

primary amenorrhea + normal breast development + absence of axillary/pubic hair

A

Androgen insensitivity syndrome

  • primary amenorrhea - absence of uterus/ovaries (46, XY)
  • normal breast development - testosterone aromatized into estrogen
  • absence of axillary/pubic hair - androgen insensitivity
24
Q

What is iodine-induced hyperthyroidism (Jod-Basedow phenomenon)?

A

Iodine (eg, in radiocontrast or amiodarone) serves as a substrate for autonomous thyroid nodule (formed by chronic iodine deficiency)

25
Q

What is Nelson’s syndrome?

A

Bilateral adrenalectomy - low cortisol - high CRH - development of pituitary adenoma

26
Q

Before sending pts with medullary thyroid cancer for thyroidectomy, what should be ruled out?

A

pheochromocytoma (part of MEN type 2) - undiagnosed pheochromocytoma might cause hemodynamic instability during durgery

27
Q

Treatment of Graves disease during pregnancy is aimed at maintaining a (mild hypothyroid/euthyroid/mild hyperthyroid) state.

A

mild hyperthyroid - overtreatment with antithyroid during pregnancy might cause fetal hypothyroidism

28
Q

Why serum calcium may be normal in secondary hyperparathyrodism?

A

high PTH level may normalize previously low calcium

29
Q

Which tests are used to monitor antithyroid drugs response?

A

Serum free T4 and total T3

30
Q

Screening of gestational diabetes and its normal results

A

1-hr 50 g OGTT at 24-28 wk (normal <140)

31
Q

Confirm diagnosis of gestational diabetes

A

3-hr 100 g OGTT

32
Q

Target blood glucose for gestational diabetes

A

fasting <95
1-hr postprandial <140
2-hr postprandial <120 (compre to general population: postprandial <140)

33
Q

What is the treatment for abnormal TFT with elevated T4 and low T3 after taking amiodarone?

A

No treatment needed - pts are clinically euthyroid in “low T3 syndrome” and the condition normally resolves spontaneously in a few months

34
Q

Screening tests for pheochromocytoma

A

1- plasma free metanephrine

2- 24-hr urinary metanephrine and catecholamine

35
Q

Intraoperative complications of pheochromocytoma removal and their prophylaxis or management

A

1- hypertensive crisis - prevented by preop alpha blocker (phentolamine)
2- hypotensive crisis - managed by aggressive fluid

36
Q

Algorithm for pheochromocytoma diagnosis

A

1- plasma free metanephrine or urinary metanephrine and catecholamine
2- abdominal MRI
3- if abdominal MRI negative, MIBG scan

37
Q

Management for incidentally found small pituitary mass which does not affect any hormonal function

A

followup by repeated pituitary MRI (in 6-12 mo)

38
Q

Most common cause of congenital adrenal hyperplasia (CAH)

A

21-hydroxylase deficiency

39
Q

Medication used for large sulfonylurea overdose

A

octreotide - inhibits insulin secretion from pancreas

40
Q

Long-term metabolic effect of prolactinoma

A

osteoporosis (d/t low gonadotropin levels)

41
Q

Management of asymptomatic subclinical thyrotoxicosis

A

followup with repeated TFT as normalization occurs frequently

42
Q

Under which circumstances gastrin could be falsely elevated?

A

1- hypercalcemia

2- PPIs

43
Q

Indications for parathyroidectomy

A

1- symptomatic hypercalcemia or serum Ca >1 above normal (i.e. >11.5)
2- end-organ complications: osteoporosis, CKD, nephrolithiasis, or increased risk of complications (i.e. UCa >400)
3- age <50 (very likely to develop complications later in life)

44
Q

Hypothyroidism was found incidentally during preop workups before emergency CABG. Best next step?

A

Proceed with surgery - Hypothyroidism only slightly increases intraoperative risk.

45
Q

OHA that could cause hypoglycemia

A

1- sulfonylurea

2- meglitinides

46
Q

How to adjust mealtime insulin before exercise - decrease dosage vs complete hold?

A

decrease dosage - complete skip might precipitate DKA

47
Q

When should we add IV dextrose during management of DKA?

A

when BG <200

48
Q

4 criteria to stop insulin infusion in DKA management

A

1- AG <12
2- HCO3 >15
3- BG <200
4- able to tolerate oral fluid

49
Q

Indications for treatment of subclinical thyrotoxicosis

A

1- TSH <0.1
2- age >65
3- high risk for complications: heart disease, osteoporosis

50
Q

Most common presentations of nonfunctioning pituitary adenoma

A

commonly arise from gonadotrophs which are dysfunction

  • hypogonadism and low gonadotropin levels
  • increased alpha subunits levels
  • prolactin only mildly increased (d/t compression of pituitary stalk)
51
Q

Management of pituitary adenoma which compresses on adjacent structures

A

trans-sphenoidal surgery - to provide rapid relief of neurological symptoms

52
Q

Indications for bisphosphonates therapy

A

1- T score <2.5
2- FRAX-calculated 10-yr risk for major fracture >20% or hip fracture >3%
3- personal history of fragility fractures

53
Q

What is Pemberton’s sign?

A

facial plethora and neck veins engorgement after raising arms d/t substernal thyroid extension that causes obstructions

54
Q

Medications for severe diabetic neuropathy

A

1- TCA
2- duloxetine (SNRI)
3- certain anticonvulsants (gabapentin, pregabalin)

55
Q

Clinical presentatiosn of hereditary hemochromatosis

A
  • presents at age 40-60
  • bronze diabetes
  • central hypogonadism (iron deposition in pituitary)
  • hepatomegaly with elevated LFT
56
Q

Before proceeding to definitive surgery, what workup should be done for newly diagnosed papillary thyroid cancer?

A

neck US for staging - if mass <1 cm, thyroid lobectomy (only one side) may be attempted

UWorld Step 3 (1 decks)

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