Endocrinology

Front 1

headache, palpitations, abdominal pain, nausea & vomiting w/increased urinary vanillylmandelic acid

Tx?

Back 1

Pheochromocytoma

alpha-blocker first then beta-blockers

- blocking just beta-receptors causes unopposed stimulation of a alpha-receptors and increased BP

Front 2

Polyuria + polydipia in normal individual

1. causes (2)

2. How to distinguish

Back 2

1. Primary polydipsia vs diabetes insipidus

2. Water deprivation test - increased urine osmolality after water deprivation suggest primary polydipsia

Front 3

ammenorrhea w/galactorrhea

Treatment?

Back 3

Prolactinoma

dopamine agonists (bromocriptine, cabergoline)

Front 4

Metabolic syndrome

Define

Cause?

Back 4

At least 3 of 5 criteria:

1. Increase BP (hypertension)

2. Hypertriglycerides

3. Decreased HdL

4. fasting glucose > 100

5. Abdominal obesity

Insulin resistance

Front 5

How does hyperventilation affect calcium?

Back 5

Hyperventilation -> Decreased PaCO2 -> Repiratory alkalosis -> Increased H+ dissociation from albumin -> increased Ca2+ bound to albumin -> decreased ionized Ca2+ and hypocalcemia

Front 6

best long-term therapy for graves disease?

contraindictions?

Back 6

Radioactive iodine ablation

pregnancy and severe ophthalmopathy

Front 7

Causes of thyrotoxicosis with low radioactive iodine uptake (4)

Back 7

- thyroiditis (inflammation causes leakage of hormones)

iodine-induced thyroid toxicosis

levothyroxine overdose

struma ovarii

Front 8

Tight glycemic control in diabetes decreases risk of what?

Back 8

microvascular complications (retinopathy, nephropathy)

Front 9

Hyperpigmentation

Hyponatremia

Hyperkalemia

Hypotension

Back 9

Adrenal insufficiency (autoimmune)

Front 10

Estrogen replacement or pregnancy in a pt w/hypothyroidism do what?

Why?

Back 10

Increased L-thyroxine dose

Estrogen increases levels of thyroxine-binding globulin so more hormone is required to saturate these sites

Front 11

Steatorrhea causes what vitamin deficiency

Back 11

Vit. D deficiency

Front 12

How to distinguish between follicular cancer and follicular adenoma?

Back 12

follicular cancer invades tumor capsule and surrounding blood vessels

Front 13

Constipation, abdominal pain polyuria, polydipsia

Back 13

Vitamin D toxicity

Front 14

Fatigue, proximal muscle weakness, increased CK, sluggish ankle reflex

First step?

Back 14

Get TSH and Free T4

Front 15

Diabetes Insipidus

1. Kinds - define

2. How to distinguish

Back 15

1. Central - Decreased ADH secretion

Nephrogenic - ADH resistance

2. Desmopressin test - Increased urine osmolality s/p desmopressin means central DI

Front 16

Pt w/AMS, wt loss, polydipsia and polyuria

next step?

Back 16

DKA

Fingerstick glucose

Front 17

Most common type of neuropathy in diabetics?

Back 17

Symmetrical distal polyneuropathy

Front 18

Gynecomastia w/testicular nodule negative beta-HCG and AFP

Back 18

Leydig tumor (increased testosterone and estrogen)

Front 19

Impotence and absent morning erections

Cause?

Back 19

Neurogenic

Front 20

Swollen hands/feet and coarse facial features.

1. Common cause of death

2. Next step in dx

Back 20

Acromegly

1. Cardiovascular disease

2. Measure IGF-1 level

Front 21

fever/sore throat in a pt on propylthiouracil or methimazole

next step

Back 21

Stop antithyroid drugs and check WBC count for agranulocytosis

Front 22

Hypoalbuminemia

Effect of calcium?

Back 22

40-55% of calcium is bound to albumin so decreased albumin can cause decreased total calcium but normal ionized calcium

Front 23

headache, deafness, back pain in an elderly

1. Mechanism

2. Labs show what?

3. Tx

Back 23

Paget's Disease

1. Increased bone remodeling (disorganized)

2. Increased Alk phos but normal calcium, phosphorus, etc.

3. Bisphosphonates

Front 24

Screening recommendations for diabetes

Back 24

Screen if BP > 135/80 and consider if >4.5 y.o. w/risk factors: ethnicity, hyperlipidemia, increased BMI, FH, cardiovascular ds, etc

Front 25

Vipoma

1. Symptoms

2. Common location

Back 25

1. Watery diarrhea, muscle weakness/cramps (from hypokalemia)

2. Pancreatic tail

Front 26

Non-hormonal cause of hypercalcemia

Treatment

Back 26

Immobilization

Hydration & bisphosphonates

Front 27

Treatment of choice for diabetic neuropathy

Alternative?

Back 27

TCAs

gabapentin

Front 28

What vitamin deficiency w/carcinoid syndrome?

Back 28

Niacin (Pellagra)

Front 29

Hirsutism + menstrual irregularities in an overweight female

Tx?

Do what screening test?

Back 29

Polycystic ovarian syndrome

Weight loss, oral estrogen/progestin contraceptive

Oral glucose tolerance test b/c of increased likelihood of having T2 diabetes

Front 30

How to reduce progression of diabetic nephropathy?

1. Goal?

2. Drugs

Back 30

Hypertension control

1. < 130/80

2. ACE inhibitors

Front 31

Increased blood glucose, hypertension, and weight gain

1. Other signs/symptoms

2. Most common cause

Back 31

Cushings

1. Obesity, striae, proximal muscle weaknesses, and psychiatric disturbances

2. Excess glucocorticoid intake

Front 32

Graves Disease

1. Mechanism

2. Mechanism of exophtalmos

Back 32

1. autoantibodies to TSH receptors stimulate thyroid hormone production

2. Retro-orbital tissue expansion

Front 33

What lab is specific for androgen-producing adrenal tumors?

Back 33

DHEA-S

Dehydroepiandrosterone - sulfate

Front 34

Primary hyperaldosteronism

1. another name

2. common causes

3. Labs - renin, Na, K, bicarb

4. Tx

Back 34

1. Conn's syndrome

2. Adrenal adenoma or bilateral adrenal hyperplasia

3. Decreased renin, increased Na, decreased K, increased bicarb

4. Surgery if unilateral adrenal adenoma spironalactone/eplerenone for all else

Front 35

Medullary thyroid cancer secretes what?

Back 35

Calcitonin

Front 36

pts w/Hashimoto's thyroiditis are at increased risk of developing what cancer?

Back 36

Thyroid Lymphoma

Front 37

Explain paradoxical hyperkalemia

Back 37

Increased K+ 2/2 extracellular shift in DKA

Front 38

Calcification of both adrenal glands

Most common cause of AI in the US

Back 38

Tuberculosis causing adrenal insufficiency -> most common in developing countries

Autoimmune adrenalitis

Front 39

Evaluation of thyroid nodule

1. First step

2. Fine needle biopsy if?

3. Radionucleotide scan if?

Back 39

1. TSH and thyroid ultrasound

2. Increased TSH or abnormal US findings

3. Decreased TSH - hot nodule = hyperthyroidism

cold nodule = FNA

Front 40

Psammoma bodies

What disease?

Back 40

Papillary thyroid cancer

Front 41

Hypothyroidism causes what lab changes? (3)

Back 41

hyperlipidemia (increased cholesterol, increased triglycerides)

hypertransaminases (increased ALT, increased AST)

elevated creatine kinase

Front 42

Diabetic med that causes weight loss

What side-effects?

Back 42

GLP-1 agonist (glucagon-like peptide 1) -> exenatide, liraglutide

acute pancreatitus

Front 43

Fatigue, hypotension, hyperpigmentation

1. Lab findings

2. Dx tests

Back 43

Primary adrenal insufficiency (Addison's)

1. Decreased Na, Increased K, eosinophillia

2. Morning ACTH (high is diagnostic) and low cortisol cosyntropin stimulation (CTH analog) -> should not increase cortisol

Front 44

Anorexia, early satiety and vomiting in a diabetic

Treatment?

Back 44

Gastroparesis

frequent small meals, metoclopramide/erythromycin

Front 45

Hyperosmolar Hyperglycemia

1. Complication of what disease

2. Signs/symptoms

3. Labs: glucose? anion gap? Ketones?

Back 45

1. Diabetes, type 2

2. AMS, weakness

3. Very high glucose, normal anion gap (unlike DKA), and normal or slightly elevated ketones

Front 46

alcholic w/hypocalcemia cause?

mechanism?

Back 46

Hypomagnesemia

Decreased PTH release and increased PTH resistance

Front 47

Thyroid function test in a sick patient

disease name

Back 47

Decreased T3, normal T4 and TSH

Euthyroid sick syndrome

Front 48

Continuous urinary dribbling in a diabetic with high post void bladder volume

Back 48

Neurogenic bladder dysfunction

Front 49

Best marks of DKA resolution

Back 49

Serum anion gap

Beta-hydroxybutyrate

Front 50

What treatment for Graves disease is associated with development or worsening opthalmopathy?

Back 50

Radioactive iodine

Front 51

What drug slows down diabetic nephropathy?

Back 51

ACE inhibitors

Front 52

Headache, loss of libido, erectile dysfunction and visual disturbances

Back 52

Prolactinoma

Front 53

Hyperthyroidism + warm nodule

Potential complications if untreated? (2)

Back 53

Thyroid adenoma

Bone loss, a-fib

Front 54

Young pt w/hypertension that doesn't resolve with low-dose hydrochlorothiazide and hypokalemia

next step

Back 54

Primary hyperaldosteronism

morning aldosterone: renin ratio

Front 55

diabetes, wt loss, erythematous plaques, diarrhea, anemia

Back 55

glucagonoma