Usmle Step 2: Endocrinology Qbank 2

Front 1

how to lower bp in pheo

Back 1

give alpha blockers IN CONJUNCTION WITH beta blockers

if you give a beta blocker first, you can precipitate a dangerous increase in BP

Front 2

hypercalcemia with low/high PTH

Back 2

low PTH: malignancy, vitD toxicity or granulomatous diseases (sarcoid)

inappropriately nl or elevated PTH: most commonly due to primary hyperparathyroidism

Front 3

panhypopituitarism

Back 3

highly suggestive of pituitary tumor

look for glucocorticoid deficiency (weakness, fatigue, loss of appetite, EOSINOPHILIA), and hypothyroidism (cold intolerance, constipation, brady).

Testing will show low TSH, low free T4 and low cortisol

hyperpigmentation is absent in central adrenal insufficiency as ACTH and melanocyte stimulating hormones levels are low.

Aldosterone secretion from the zona glomerulosa is ACTH-independent. As a result, secondary central adrenal insufficiency does not cause hyperK or salt wasting

Front 4

most common cause of thyroid nodules

Back 4

colloid nodule, followed by follicular adenoma

Front 5

hyperthyroidism: distinguishing between the different types

Back 5

radioactive iodine uptake!

low: thyroiditis
high: graves dz

heterogenous uptake: toxic multinodular goiter, more common in older pts. cause "hot nodules" (increased uptake of iodine in the nodule with no uptake in the rest of the thyroid gland)

Front 6

testosterone deficiency with inappropriately nl gonadotropin levels. next step?

Back 6

indicative of secondary (central) hypogonadism)

best next step is serum prolactin level.
MRI of pituitary indicated in pts with high serum prlactin, serum testosterone < 150 ng/dL, visual field defects, or features of other pituitary hormonal dysfunction.

elevated prolactin suppresses GnRH release to cause hypogonadotropic hypogonadism.

Front 7

potassium in DKA

Back 7

despite nl or elevated serum K levels, pts with DKA have a total body K deficit due to excessive urinary loss caused by glucosuria-induced osmotic diuresis.

aggressive insulin therapy for DKA can lower serum K levels further and cause severe hyperK

Front 8

DKA

Back 8

characterized by triad of hyperglycemia, ketonemia, and anion gap metabolic acidosis

Front 9

Choriocarcinoma, teratoma, seminoma, yolk sac tumor, leydig cell tumor

Back 9

chorio: increased serum beta HCG

teratoma: elevation sin serum APF or beta-hCG

seminoma: serum tumor markers usually nl, although beta-hCG may be somewhat elevated with seminomas

yolk sac tumor: increase in AFP

leydig cell tumor: estrogen production increased with secondary inhibition of LH and FSH

Front 10

MEN2A

Back 10

look at 3520

Front 11

classic presentation of thyrotoxicosis

Back 11

weight loss, irritability, tachy, TREMORS, and LID RETRACTION

pts usually have systolic HTN and an increase in pulse pressure.

Imp to know that the hyperdynamic state!!! of hyperthyroidism causes the secondary hypertension.

Front 12

diagnostic approach to hypocalcemia

Back 12

check PTH hormone level to distinguish between low PTH associated conditions (parathyroid surgery, polyglandular autoimmune) and elevated PTH associated conditions (eg vitD deficiency, CKD)

Front 13

vitD deficiency

Back 13

can lead to osteomalacia with findings that include bone pain or tenderness, muscle weakness or cramps, gait abnl, and increased fx risk.

look for low Ca, low Phos, and high PTH

Front 14

diagnosis of SIADH

Back 14

low plasma osmolality and high urine osmolality

Front 15

hypothyroidism can cause what kind of metabolic abnormalities

Back 15

hyperlipidemia, hyponatremia and asymptomatic elevations in CK and serum transaminases

most pts have hypercholesterolemia alone or with hypertriG

Front 16

mgmt of diabetic foot ulcers

Back 16

in those that do not involve the bone or abscess formation or cellulitis, debridement and antibiotics good

for greater ones, typically need short period of hospitalization, surgical debridement, cx of material obtained deep in the ulcer, bone bx, and IV antibiotics. Infxn typically due to multiple organisms; therefore, antibiotics with anaerobic and gram neg coverage is usually used in pts with deep foot ulcerations.

Front 17

hypercalcemia 2/2 elevated or inappropriately nl parathyroid hormone level

Back 17

due to primary hyperparathyroidism or familial hypocalciuric hypercalcemia

urinary calcium creatine clearance ratio is usually < 0.01 in FHH compared to > 0.02 in PHP!!!!

Front 18

hyperandrogenism in female. What is most specific measurement for this condition

Back 18

DHEA-S, which is predominantly produced in the adrenal glands only.

Front 19

hypercalcemia of malignancy pathogenesis

Back 19

most commonly due to parathyroid hormone-related peptide (PTHrP) production.

produced locally! when the tumor metastasizes into the bone to induce bone resorption. systemic PTHrP levels are not elevated in these pts.

Other mechanisms include excess vitD production, bone metastasis with local cytokine release to induce bone resorption, and ectopic PTH production.

IN SOME MALIGNANCIES, (multiple myeloma, lymphomas, leukemia), osteoclastic bone resoprtion is increased by cytokine production.

Front 20

causes of paradoxical increase in K following DKA

Back 20

1) extracellulr shift of potassium in exchange to hydrogen ion, with resultant intracellular potassium deficit (metabolic acidosis)
2) impaired insulin-dependent cell entry of hte K ion

Front 21

most common thyroid malignancy

Back 21

papillary, followed distantly by follicular

anaplastic has worst prognosis
medullary -> ME!
thyroid lymphomas -> think hashimoto's thyroiditis (rare)

Front 22

primary hyperaldo: tx for pts with bilateral adrenal hyperplasia or with unilateral adenoma who either refuse surgery or are poor surgical candidates?

Back 22

spironolactone -> aldo antagonist -> look for decreased libido, gynecomastia, breast tenderness, menstrual irregularities

Front 23

preferred therapy for graves' disease

Back 23

radioactive iodine therapy

contraindications include pregnancy and very severe ophthalmopathy (use subtotal thyroidectomy instead, though most expensive and can be complicated by recurrent laryngeal nerve paralysis, hypoparathyroidism, and hypothyroidism)

Front 24

proptosis in grave's ophthalmopathy

Back 24

results from increased volume of retro-orbital tissues! (connective, muscular, and adipose tissue expansion, lymphocytic infiltration) and is a direct result of anti-thyrotropin receptor autoantibodies!

Front 25

differential dx with hypokalemia, alkalosis, and normotension

Back 25

1) surreptitious vomiting (look for low chloride)
2) diuretic abuse and bartter/gitelman's syndrome -> look for elevated urine chloride!

Front 26

most serious side effect of anti-thyroid drugs

Back 26

propylthiouracil -> severe liver injury and acute liver failure (but preferred in first trimester pregnancy d/t fetal teratogenicity with methimazole)

most common side effect is allergic reaction. most serious is agranulocytosis (0.3% of pts)!!!

Front 27

how does respiratory alkalosis affect serum Ca levels

Back 27

can increase affinity of serum albumin to calcium , consequently DECREASING levels of ionized calcium -> only physiologically active form which means you may see manifestations of hypocalcemia

Front 28

mechanism of bisphosphonates

Back 28

inhibit osteoclasts to suppress bone turnover

Front 29

sick euthyroid syndome

Back 29

aka low T3 syndrome

any pt with an acute, severe illness may have abnl TFTs -> called sick euthyroid syndrome, and most common thyroid hormone pattern in such patients is a fall in total and free T3 levels with nl T4 and TSH levels.

Front 30

parathyroidectomy for asymptomatic hypercalcemia

Back 30

at least one of the following features:
1) serum ca > 1 above upper limit of nl
2) young age < 50
3) bone mineral density < T-2.5 at any site
4) reduced renal function (estimated GFR < 60)

older pts can use medical surveillance

Front 31

physical exam findings of hyperthyroidism

Back 31

goiter, hypertension, tremors involving fingers/hands, hyperreflexia, proximal muscle weakness, lid lag, atrial fibrillation

Front 32

pathophysiologic mechanism of paget dz

Back 32

abnl bone remodeling

Front 33

adrenal insufficiency with calcifications of adrenal glands

Back 33

adrenal tuberculosis

continues to be prominent cause of primary adrenal insufficiency in developing countries.

in contrast, autoimmune adrenalitis is currently the most common cause of primary adrenal insufficiency in developed countries

Front 34

most appropriate next step in mgmt of DKA

Back 34

normal saline and regular insulin

correct hyperK