Endocrinology Consensus And Review Articles Board Study 2015

Front 1

1. What is the primary indication for pursuing a diagnosis of hyperadrenocorticism

Back 1

a. Presence of one or more clinical signs; pituitary macrotumor, diabetic dog with persistently poor response to high dosages of insulin, an adrenal mass, persistent hypertension
2.

Front 2

What are considered common clinical signs of HAC

Back 2

a. PU/PD, polyphagia, panting, abdominal distention, endocrine alopecia, hepatomegaly, muscle weakness, systemic hypertension
3.

Front 3

What are considered less common clinical signs of HAC

Back 3

a. Lethargy, hyperpigmentation, comedones, thin skin, poor hair growth, urine leakage, insulin resistant DM
4.

Front 4

What are considered uncommon clinical signs of HAC

Back 4

a. Thromboembolism, ligament rupture, facial nerve palsy, psuedomyotonia, testicular atrophy, persistent anestrus
5.

Front 5

When adrenocortical tumors are invasive (invading phrenicoabdominal vein or caudal vena cava) they can cause what

Back 5

a. Retroperitoneal hemorrhage, blood loss anemia, abdominal pain, thrombi causing ascites or rear limb paresis
6.

Front 6

What labwork parameters should increase suspicion of hyperadrenocorticism

Back 6

a. Neutrophilic leukocytosis, lymphopenia, eosinopenia, thrombocytosis, mild erythryocytosis; increased alk phos, increased ALT, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, hyposthenuria, proteinuria
7.

Front 7

If a patient is negative on multiple screening tests for HAC, but there is an increased suspicion for the patient having HAC, what should one do

Back 7

a. Repeat test in 3-6 months if signs persist
8.

Front 8

Which drugs in veterinary medicine have been shown to affect the HPAA

Back 8

a. Metoclopramide, buprenorphine, codeine, clomipramine, desmopressin
9.

Front 9

Dogs treated with phenobarbital can occasionally show what

Back 9

a. No suppression when they are really not HAC
10.

Front 10

What is considered the test of choice for HAC (unless iatrogenic)

Back 10

a. LDDS
11.

Front 11

What form of ACTH is recommended for ACTH stimulation tests

Back 11

a. Synthetic ACTH and recommend to avoid compounded formulations
12.

Front 12

What drugs can affect results of ACTH stimulation

Back 12

a. Progestagens, glucocorticoids, ketoconazone; NOT phenobarbital
13.

Front 13

What is the sensitivity and specificity for UCCR in hospital (1 sample) and at home (2 samples)

Back 13

a. In hospital sensitivity was 75-100% and specificity was 20%; at home sensitivity increased to 99% and a specificity of 77%
14.

Front 14

What is the most accurate stand-alone biochemical test for differentiating PDH from AT

Back 14

a. Serum ACTH concentrations
15.

Front 15

Why is sample handling important when measuring ACTH

Back 15

a. Plasma proteases degrade ACTH so must be centrifuged and frozen quickly. Can also add aprotinin to prevent proteases
16.

Front 16

In the 25% of dogs with PDH that do not suppress with higher dosages of dexamethasone, what is likely

Back 16

a. A large pituitary tumor
17.

Front 17

What characteristics of an adrenal tumor suggest malignancy

Back 17

a. Over 4 cm adrenal width, metastases, and venal caval invasion
18.

Front 18

What are the proposed rationale for reclassifying atypical cushings

Back 18

a. Dogs that are “normal on LDDS” may not be normal as reference intervals should likely be lowered; cortisol is highly variable; some dogs may be more sensitive to the effects of “normal” cortisol levels; dogs may be affected by food dependent HAC
19.

Front 19

What is recombinant Thyrotropin used for in veterinary medicine

Back 19

a. Diagnosis of hypothyroidism in dogs and cats, aid in diagnosis of hyperthyroidism in cats
20.

Front 20

What foods can inhibit iodide trapping

Back 20

a. Thiocyanate is sweet potatoes or lima beans; perchlorate
21.

Front 21

When starved of iodine, the thyroid gland preferentially makes what hormone

Back 21

a. T3 because more biologically active
22.

Front 22

How does thyroid hormone negatively feedback to the pituitary

Back 22

a. T4 is taken in by the pituitary and deionated to T3 which subsequently inhibits TSH synthesis
23.

Front 23

What enzymes in the peripheral tissues covert T4 into T3

Back 23

a. 5-deiodinase
24.

Front 24

How do glucocorticoids affect thyroid levels

Back 24

a. Inhibit pituitary secretion of TSH, impair 5-deiodinase, and decrease thyroxine binding globulin in humans; markedly decrease TT4, TT3 and to some degree FT4
25.

Front 25

How do long term effects of phenobarbital affect thyroid levels

Back 25

a. Long term phenobarbital can decrease TT4 and FT4; TSH is variable; phenobarbital is theorized to increase hepatic clearance of thyroid; conversely thyroid can increase phenobarbital metabolism and could be a reason why some dogs have seizures
26.

Front 26

Does potassium bromide affect thyroid levels

Back 26

a. No
27.

Front 27

How do sulfonamides affect thyroid function

Back 27

a. They inhibit thyroid peroxidase and prevent iodination and are considered goitrogens but only at prolonged high dosages in the dog. Cause decreased TT4, TT3, FT4 and cause clinical hypothyroidism
28.

Front 28

What are the effects of NSAIDS on thyroid

Back 28

a. Competition with binding sites on thyroid hormone binding protein, increased hepatic metabolism, and competition on plasma membrane
29.

Front 29

What drugs are known to diminish T4 binding to canine serum

Back 29

a. Furosemide, flunixin, and probenecid
30.

Front 30

When are radiographs considered useful diagnostic tools for canine thyroid disease

Back 30

a. When congenital hypothyroidism is suspected to evaluate bones or when there is concern for thyroid carcinoma and pulmonary metastases
31.

Front 31

Is scintigraphy a first tier diagnostic for canine thyroid disease

Back 31

a. Not really as uptake pattern does not correlate with tumor presence nor can it’s pattern be predictive of histologic tumor. It is a specific tool for mets but not sensitive and it has a low sensitivity and specificity for hypothyroidism in dogs (acquired)
32.

Front 32

What is one of the most prevalent diagnostic tools for evaluating the thyroid in the dog due to its cost and convenience

Back 32

a. Ultrasound as changes to echogenicity can occur with hypothyroidism or malignancy; evaluate retropharyngeal lymph nodes, ultrasound abdomen for staging. It cannot differentiate between benign and malignant masses however
33.

Front 33

What advantages does CT have over ultrasound

Back 33

a. Most sensitive tool for detecting pulmonary mets and can potentially differentiate benign from malignant diseases using IV contrast
34.

Front 34

What advantages does MRI have over CT

Back 34

a. Superior soft tissue contrast and the ability to demonstrate vascular structures without use of contrast; recommended for mediastinal extension of large goiters