Endocrine Ab Pa Final Exam

Front 1

patient is a 70 year old woman post CVA presenting with altered mentation, hypothermia not due to January temperatures, and elevated TSH/low free T4. What is most likely ddx?

Back 1

Myxedema coma

Front 2

What is the tx of myxedema coma?

Back 2

maintain adequate airway
- if hyponatremic <120, add hypertonic saline.
- glucocorticoids
thyroid replacement IV bolus 500 mg
- tx underlying cause

Front 3

Cushing's disease results from?

Back 3

pituitary adenoma

Front 4

What is in excess in Cushing's?

Back 4

ACTH

Front 5

a patient with Cushing's has an elevated or decreased risk of infection?

Back 5

elevated

Front 6

To dx Cushings, what should be done?

Back 6

24 H urine cortisol (x2) - levels of 2-3 times normal helps establish dx.
Other tests include low dose dexamthasone suppression test. Failure to suppress cortisol supports diagnosis
MRI to confirm tumor

Front 7

what is the normal value in a low dose dexamethasone test?

Back 7

< 2mg

Front 8

How many abnormal diagnostic tests are necessary for dx of Cushing's?

Back 8

2

Front 9

How is Cushing's tx?

Back 9

transphenoidal surgery - 80-90% success with microadenoma

Front 10

T/F signs and symptoms of Cushings may disappear after 2-12 months

Back 10

true

Front 11

T/F Untreated Cushings can be fatal due to cardio, infectious, HTn or thromboembolic complications

Back 11

True

Front 12

When measuring ACTH in a patient with suspected Cushing's what else should be measured?

Back 12

cortisol

Front 13

When and under what conditions is ACTH highest

Back 13

morning or when under stress

Front 14

what is the MC solid malignancy in males ages 15-35?

Back 14

testicular CA

Front 15

95% of testicular cancers are what type of tumor?

Back 15

germ cell

Front 16

What is a major risk factor for testicular cancer?

Back 16

cryptorchidism

Front 17

What are s/s of testicular cancer?

Back 17

painless nodule, dull ache in lower abdomen/perianal area/scrotum, gynecomastia

Front 18

How is testicular cancer diagnosed?

Back 18

scrotal US, serum tumor markers (AAFP, BHCG, LDH), CT

Front 19

?what organisms are involved most commonly in prostatitis>

Back 19

gram - (e coli, proteus)

Front 20

what would be found on a rectal exam in prostatitis?

Back 20

tender, swollen, warm prostate

Front 21

How is acute out-patient prostatitis treated?

Back 21

quinolones, bactrim for 4w + NSAIDs for pain

Front 22

For how long is chronic prostatitis treated?

Back 22

4-8 weeks

Front 23

if there is primary adrenal insufficiency, what will ACTH be?

Back 23

Normal to high (prob in adrenal)

Front 24

If there is secondary adrenal insufficiency, what will ACTH be?

Back 24

Low to absent (prob in pituitary)

Front 25

what is the MC cause of adrenal insufficiency worldwide>

Back 25

TB

Front 26

In US what is primary cause of adrenal insufficiency?

Back 26

AI (70%)

Front 27

T/F hyperpigmentation is found in secondary ACTH insufficiency

Back 27

False - only in primary

Front 28

what are the signs and symptoms of adrenal gland insufficiency?

Back 28

chronic malaise, weakness, anorexia, NVD, syncope

Front 29

T/F in secondary or tertiary adrenal gland insufficiency, there is no volume depletion due to Aldosterone being intact

Back 29

True

Front 30

What is found on labs in adrenal insufficiency?

Back 30

hyponatremia (85-95%)
hyperkalemia (60-65%)

Front 31

to dx adrenal insufficiency, basal cortisol must be < _____.

Back 31

3 mcg/dL

Front 32

Primary adrenal insufficiency has ___ Renin and ____ Aldosterone

Back 32

Increased renin, decreased aldosterone

Front 33

Secondary adrenal insufficiency has ___ Renin and ____ Aldosterone

Back 33

Normal, normal

Front 34

how is adrenal insufficiency treated?

Back 34

glucocorticoids

Front 35

T/F LH is always suppressed in secondary hypogonadism

Back 35

True

Front 36

What is Kalmann's syndrome?

Back 36

ansomnia (can't smell), neurosensorial hearing loss, midline facial deformities, hypogonadotrophic hypogonadism

Front 37

what % of couples cannot get pregnant?

Back 37

15%

Front 38

In couples with infertility, how often is man to blame? both?

Back 38

20%; 27%

Front 39

T/F testicle size < 5.6 cm is abnormal

Back 39

F - 3.6

Front 40

Somatostatin _____ growth hormone

Back 40

inhibits

Front 41

to dx adrenal insufficiency, basal cortisol must be < _____.

Back 41

3 mcg/dL

Front 42

Primary adrenal insufficiency has ___ Renin and ____ Aldosterone

Back 42

Increased renin, decreased aldosterone

Front 43

Secondary adrenal insufficiency has ___ Renin and ____ Aldosterone

Back 43

Normal, normal

Front 44

how is adrenal insufficiency treated?

Back 44

glucocorticoids

Front 45

T/F LH is always suppressed in secondary hypogonadism

Back 45

True

Front 46

What is Kalmann's syndrome?

Back 46

ansomnia (can't smell), neurosensorial hearing loss, midline facial deformities, hypogonadotrophic hypogonadism

Front 47

what % of couples cannot get pregnant?

Back 47

15%

Front 48

In couples with infertility, how often is man to blame? both?

Back 48

20%; 27%

Front 49

T/F testicle size < 5.6 cm is abnormal

Back 49

F - 3.6

Front 50

Somatostatin _____ growth hormone

Back 50

inhibits

Front 51

what is the most common presenting feature/sxm in acromegaly?

Back 51

joint sxms

Front 52

what is the MC cause of acromegaly?

Back 52

somatotroph adenoma of anterior pituitary

Front 53

T/F at time of dx, most patients with acromegaly have micoradenomas

Back 53

False - macro

Front 54

T/F patients with acromegaly will increase in height

Back 54

false

Front 55

What increased cancer risk is someone with acromegaly at?

Back 55

increased risk of colon cancer

Front 56

To dx a pt with acromegaly, do you measure growth hormone?

Back 56

No - measure IGF-1 hormone

Front 57

What is the most common diagnosed cancer?

Back 57

prostate CA

Front 58

what is the second MC cause of CA deaths in men?

Back 58

prostate CA

Front 59

T/F PSA is specific for prostate CA

Back 59

false

Front 60

when is a biopsy recommended based on PSA levels?

Back 60

> 10

Front 61

T/F a patient with a PSA rising at a rate of 1.1 ng/ml/year for the last 4 years should have a biopsy. total PSA is 5.6.

Back 61

Yes, biopsy b/c raising faster than 0.75 ng/mL/year

Front 62

T/F well differentiated prostate cancer is a poor prognosis

Back 62

false

Front 63

Where is LH and gNRH produced?

Back 63

LH = anterior pituitary
gNRH = hypothalamus

Front 64

sperm production is regulated by ____ that acts on sertoli cells under the influence of _____/

Back 64

FSH, gNRH

Front 65

testosterone deficiency in the 3rd trimester results in:

Back 65

micropenis

Front 66

in primary hypogonadism, where are FSH & LH levels?

Back 66

elevated

Front 67

What is the MC cause of hypogonadism?

Back 67

Kleinfelters (XXY)

Front 68

ADH is released from posterior pituitary in response to:

Back 68

- plasma volume
- plasma osmolality
- cholecystokinin from SI

Front 69

in nephrogenic DI,urine SG is < ____ and serum is _______.

Back 69

SG < 1.010

serum > 290 mOsm

Front 70

In central DI, urine Osm <______

Back 70

290

Front 71

How is nephrogenic DI treated?

Back 71

tx underlying cause, Na+ restrict, thiazide

Front 72

what percent of thyrotoxicosis occurs in adults > age 60

Back 72

15-25%

Front 73

what is MC form of hyperthyroidism>

Back 73

graves

Front 74

what is a common presenting sign of hyperthyroidism?

Back 74

proximal muscle weakness

Front 75

what is the TOC in elderly patients with hyperthyroidism?

Back 75

radioactive ablation

Front 76

What is a dangerous side effect of tapazole in the tx of hyperthyroidism?

Back 76

agranulocytosis

Front 77

depression, A fib and weight loss in an elderly patient with Graves disease may be a sign of:

Back 77

apathetic hyperthyroidism

Front 78

an elderly patient wth signs and symptoms of thyrotoxicosis, suppressed TSH and very elevated T3, mildly elevated T4 may have:

Back 78

toxic adenoma

Front 79

will acute thyroiditis have elevates in thyroid hormones?

Back 79

no

Front 80

what is the MC form of thyroid cancer?

Back 80

papilalry

Front 81

How is nephrogenic DI treated?

Back 81

tx underlying cause, Na+ restrict, thiazide

Front 82

what percent of thyrotoxicosis occurs in adults > age 60

Back 82

15-25%

Front 83

what is MC form of hyperthyroidism>

Back 83

graves

Front 84

what is a common presenting sign of hyperthyroidism?

Back 84

proximal muscle weakness

Front 85

what is the TOC in elderly patients with hyperthyroidism?

Back 85

radioactive ablation

Front 86

What is a dangerous side effect of tapazole in the tx of hyperthyroidism?

Back 86

agranulocytosis

Front 87

depression, A fib and weight loss in an elderly patient with Graves disease may be a sign of:

Back 87

apathetic hyperthyroidism

Front 88

an elderly patient wth signs and symptoms of thyrotoxicosis, suppressed TSH and very elevated T3, mildly elevated T4 may have:

Back 88

toxic adenoma

Front 89

will acute thyroiditis have elevates in thyroid hormones?

Back 89

no

Front 90

what is the MC form of thyroid cancer?

Back 90

papilalry

Front 91

what is the most aggressive thyroid cancer?

Back 91

anaplastic

Front 92

follicular thyroid carcinoma has hematogenous spread to:

Back 92

lung, bone, liver, CNS

Front 93

An adrenal crisis is a medical emergency manifesting with signs of shock and best treated:

Back 93

with immediate fluids & glucocorticoid replacement

Front 94

What is the MC cause of mineralocorticoid excess?

Back 94

aldosterone producing adenoma

Front 95

What are 2 major clinical findings in mineralocorticoid excess?

Back 95

HTN & hypokalemia

Front 96

if plasma aldosterone is elevated but renin is suppressed, what is dx?

Back 96

primary aldosteronism

Front 97

what is a mineralocorticoid antagonist?

Back 97

spironolactone

Front 98

how long do you have to untorse a testicular torsion?

Back 98

4-6 H preferably

Front 99

what is the MC side for a varicocele?

Back 99

L side

Front 100

PVR should be less than ____ mL of urine or BPH might be suspected

Back 100

12 mL

Front 101

what are tx options for BPH?

Back 101

alpha adrenergic blockers

Front 102

epididymitis is usually due to:

Back 102

chlamydia

Front 103

DeQuervain's thryoiditis is most commonly following:

Back 103

viral infection

Front 104

DeQuervian's thryroiditis has ____ TSH and ____ T4

Back 104

low TSH, elevated T4

Front 105

how is deQuervain's thyroiditis tx?

Back 105

NSAIDs & prednisone tape

Front 106

In secondary hypothyroidism, what will labs show?

Back 106

low TSH, low Free T4

Front 107

what are two drugs that cause hypothyroidism?

Back 107

lithium, amiodarone

Front 108

after starting L-thyroxine, how soon should TSH be repeated?

Back 108

6 weeks

Front 109

If TSH is decreased after starting L-thyroxine, what should be done?

Back 109

decrease dose until TSH is normal

Front 110

If TSH is normal after starting L-thyroxine, what should be done?

Back 110

nothing

Front 111

If TSH is elevated after starting L-thyroxine, what should be done?

Back 111

increase dose

Front 112

What is the MC secretory tumor?

Back 112

prolactinoma (benign!)

Front 113

Prolactin levels that are high suppress ovulation by inhibiting:

Back 113

FSH & GNRH

Front 114

Prolactinomas in men are usually ____ (size) while in women, they are _____ (size)

Back 114

large
small

Front 115

nonfunctional thyroid nodules are usually _____ and associated with ______.

Back 115

cold, malignancy

Front 116

Probenicid MOA =

Back 116

promotes inhibition of urate thus promoting renal excretion

Front 117

allopurinol is what type of drug

Back 117

xanthine oxidase inhibitor

Front 118

T/F allopurinol is good for underexcretors or overproducers

Back 118

T

Front 119

pseudogout under microscope =

Back 119

+ bifringent calclium pyrophosphate

Front 120

laterally epicondylitis effects what muscles?

Back 120

extensor carpi radialis brevis & longus tendons

Front 121

medially epicondylitis effects what muscles?

Back 121

flexor carpi radialis tendon

Front 122

in lateral epicondylitis, pain is aggravated when:

Back 122

resisted wrist extension and forearm supination

Front 123

In medial epicondylitis, pain is aggravated when:

Back 123

wrist flexion & forearm pronation

Front 124

what is involved in DeQuervain Tenosynovitis?

Back 124

abductor pollicus longus & extensor pollicus longus & brevis

Front 125

what is diagnostic in DeQuervain tenosynovitis?

Back 125

Finklestein test