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53 Cards in this Set

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  • Back
What are:
Antimicrosomal Antibodies
Antithyroid Peroxidase (anti-TPO) Antibodies
Antithyroglobulin Antibodies
These antibodies are associated with Hashimoto's thyroiditis and Graves' disease. If hypothyroid, if they are positive, you will move straight to treatment with synthroid because the etiology of the hypothyroidism has been confirmed.
When are Antimicrosomal Antibodies
Antithyroid Peroxidase (anti-TPO) Antibodies
Antithyroglobulin Antibodies the answer?
They are the answer once you have proven hypo- or hyperthyroidism. They are not to diagnose the thyroid function state. They are to confirm the autoimmune etiology of thyroid state.
Do you expect high or low values with autoimmune thyroiditis?
You expect teh levels to be high wiht autoimmune thyroiditis. This is whether the person is hypo- or yperfunctioning. Nutritional problems and synthroid abuse will give low levels of the antibodies.
For which diagnosis(es) is 24-Hour Urine Cortisol Level most sensitive?
When collected for 24 hours, urinary cortisol excretion is the most sensitive indicator of endogenous hypercortisolism and is the most sensitive test for Cushing's syndrome?
What is cortisol?
Cortisol is a glucocorticoid hormone produced in the adrenal cortex.
When do you answer urinary free cortisol?
Look for a question with a case with truncal obesity, "buffalo hump," striae, and easy bruising. Answer either 24-hour urine cortisol or overnight dexamethasone suppression test as the best initial test.
What is ACTH (Cosyntropin) Stimulation Test?
The ACTH stimulation (cosyntropin) test evaluates adrenal function and is the best test for adrenal insufficiency. Baseline cortisol levels are taken, then ACTH is administered and follow-up cortisol levels monitored. If cortisol is low, think primary adrenal insufficiency. If cortisol levels rise, the adrenal gland is functioning.
When do you ansewr an ACTH stimulation test?
Look for a fatigued patient wiht skin hyperpigmentation, hyperkalemia, slight metabolic acidosis, and a taste for pickle juice (high salt content). Also look for an ICU patient with unexplained hypotension.
What is C-Peptide?
Serum measurement of C-peptide is the best test to distinguish endogenous from exogenous hyperinsulin in patients with hypoglycemia.
What do low values represent in a patient wiht hypoglycemia?
Low values of C-peptide in patients wiht hypoglycemia represent factitious insulin injection. The patient is abusing insulin.
What do high C-peptide levels represent in a person with hypoglycemia?
High C-peptide values represent endogenous insulin production, such as that induced by sulfonylureas or form an insulinoma.
When do I answer C-peptide level?
Look for a patient with unexplained hypoglycemia, high insulin level, and multiple hospital visits. Answer C-peptide as teh next best step to determine the etiology.
What is fine-Needle Aspiraton of the Thyroid?
A sample of thyroid cells colleted by a needle inserted into the thyroid is the initial test for all solitary nodules unless teh patient is thyrotoxic.
When is fine-needle aspiration of the thyroid the most accurate test?
Look for a case with a palpable nodule and normal thyroid function tests and the question asks for the next step in diagnosis.
When is fine-needle aspiration of the thyroid the wrong answer?
This is the wrong answer in patients wiht a solitary nodule who are thyrotoxic. In such patients a SCINTISCAN (I121 scan) should be done first to see if the nodule is hyperfunctioning (hot) or hypofunctioning (cold). Hyperfunctioning modules are almost never malignant.
What is oral glucose tolerance testing?
An oral glucose tolerance test is the measurement of serum glucose levels at baseline and 2 hours after teh ingestion of an oral load of 75 grams of glucose.
What constitutes a positive glucose tolerance test?
A positive test means that the glucose level 2 hours after teh ingestion of teh oral glucose load is >200mg%. This is one of the methods of diagnosing diabetes. Teh ordinary method is to find two fasting glucose levels to be >126 mg/dl.
When is an oral glucose tolerance the most accurate diagnostic test?
The strongest indication for an oral glucose tolerance test is in screening for diabetes during pregnancy. Because of the short duration of pregnancy, the potential for marked worsening over a short period of time, and the harmful effects of diabetes on the fetus, this is the single most urgent time to make a prompt diagnosis of diabetes. Oral glucose tolerance testing is like putting your pancreas on a treadmill to evoke subtle amounts of diasease not detected by the ordinary test.
What is Beta-Human Chorionic Gonadotropin(B-hCG)?
B-hCG is a pregnancy test.
When is B-hCG the answer?
Urine and /or serum measurement of B-hCG is the best initial test for any woman of reproductive age complaining of a missed period (amenorrhea), delayed period, vaginal bleeding, or abdominal pain. Any unexplained abdominal pain in a woman is an ectopic pregnancy until you have the B-hCG.
What is 5-HIAA?
A 24-hour urine level of 5-HIAA is the best initial diagnostic test for carcinoid syndrome. 5-HIAA is the end-product of serotonin metabolism.
When do you answer 5-HIAA level?
Look for a patient with episodic diarrhea and / or hypotension associated with unexplained flushing and wheezing.
What is the most accurate diagnostic test?
The most accurate test for carcinoid syndrome is a biopsy. Although CT adn MRI scanning can localize the disease, they are not as accurate as teh tissue diagnosis you obtain form a biopsy.
What is 17-Hydroxyprogesterone Level?
17-hydroxyprogesterone level is the best initial test to diagnose 21-hydroxylase deficiency or congenital adrenal hyperplasia.
When do you answer 17-Hydroxyprogesterone Level?
Answer 170hydroxyprogesterone in a patient presenting with one of the following syndromes:

1) Female infant with ambiguous genitalia (simple virilizing)
2) Infant wiht hyponatremia, hyperkalemia, and hypotension (sald-wasting syndrome)
3) young women wiht hirsutism, acne, and irregular menses
4) Child with precocious puberty.
For which disease(s) is IGF-1 the single best test for diagnosis?
Serum measurement of IGF-1 is the best initial test for acromegaly.
What is IGF-1?
IGF-1 is a somatomedin secreted from the liver. Growth hormone when combined with thyroid hormone stimulates linear skeletal growth in children through IGF-1. It stimulates protein synthesis in muscle (anabolic effect) in children and the release of fatty acids form adipose tissue (catabolic effect) in adults. Growth hormone secretion is pulsatile, has a short half-life, and reaches maximal life in the middle of the night. A single test of the GH level is not accurate. IGF-1 levels are more stable and reliable.
What is the best test to confirm the diagnosis?
Teh best confirmatory test for acromegaly is the oral glucose tolerance test. Glucose normally suppresses GH. In acromegaly glucose does NOT suppress GH.
What is the most common wrong answer for the best confirmatory test?
The most common wrong answer is GH levels.
What disease is Metaiodobenzylguanidine (MIBG) scan?
Metaiodobenzylguanidine (MIBG) scanning is used to detect occult pheochromocytoma if the blood and urine testing (VMA, catecholamines, metanephrines) are positive and the scans are nondiagnostic.
How is MIBG scan done?
MIBG is injected into the body. MIBG is an agent similar to norepinephrine and should be taken up by adrenergic tissue. The MIBG scan allows visualization of potential adrenal masses.
When do you answer MIBG scan?
Answer MIBG scan when you see a patient with palpitations, intermittent tachycardia, and biochemical evidence of pheochromocytoma (e.g., catecholamines, metanephrines) when the CT and MRI can't visualize the lesion. You can't remove a pheochromocytoma adn cure it if you can't find where it is.
For which clinical scenario(s) is progesterone challenge the best test?
Oral dosing of progesterone of 10mg daily for 5 days is used in amenorrheic women after pregnancy is excluded to determine if the cause of amenorrhea is due to outflow tract obstruction or secondary to the hypothalamus and pituitary. Look for a woman who has no eperiods and a negative hCG.
If bleeding occurs after a progesterone challenge, it indicates what?
If bleeding occurs following the challenge, it indicates that htere is adequate estrogen adn that the outflow tract exists.
What is the next best test if the bleeding occurs?
The next best test is to check FSH, LH, prolactin, and TSH to rule out a hypothalamic or pituitary etiology.
If there is no bleeding, what is the next best test?
If there is no bleeding, the next best test to evaluate for an outflow tract obstruction with ultrasound, and with MRI if ultrasound is not definitive.
What is pro-insulin test for?
Pro-insulin assay is used to distinguish autoimmune causes of hypoglycemia from insulinoma.
What do high levels of pro-insulin represent?
High levels of pro-insulin represent insulinomas.
When do I answer pro-insulin levels?
Answer a pro-insulin level when you see a case of recurrent fasting, hypoglycemia, symptoms of weakness, and high C-peptide levels.
For which disease(s) is RAIU (radioiodine uptake) test the right answer?
The measurement of orally ingested radioactive iodine (I121) that accumulates in the thyroid gland is used to differentiate Graves'/toxic multinodular goiter from Thyroiditis/Factitious.
When do you expect uptake to be high in RAIU (radioiodine uptake) test?
RAIU is increased in Graves' disease and with hot nodules (toxic multinodular goiter, toxic solitary nodule).
When do you expect uptake to be low in RAIU (radioiodine uptake) test?
RAIU is decreased when thyroiditis induces a thyrotoxic state or when a person is abusing thyroid hormone (thyroiditis factitia).
When do you answer RAIU (radioiodine uptake) scan?
Answer RAIU scan when the question shows a case of hyperthyroidism. The qquestion will include a high T4 level, for instance, and will ask you the next best step to determine the etiology.
For which clinical scenario(s) are TSH, Thyroxine (T4), and Thyroglobulin tests used?
Serum levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) are measured to assess thyroid function (both hypofunction and hyperfunction). Thyroglobulin is used to monitor recurrence in patients who have been treated for papillary or follicular cancer of the thyroid.
What are TSH, Thyroxine (T4), and Thyroglobulin?
TSH is produced by the pituitary to stimulate the thyroid. T4 is one of the priincipal metabolism-inducing hormones produced by the thyroid gland, and thyroglobulin is an iodine-containing glycoprotein synthesized by the thyroid gland from which thyroxine (T4) is derived. Thyroglobulin is the storage form of thyroid hormone. Thyroid-binding globulin is the transport protein.
When do you answer TSH and thyroxine (T4)?
TSH and T4 are always the best initial test for thyroid diseases.
When do you answer thyroglobulin?
Thyroglobulin is to follow the response to the treatment of thyroid cancer.
When do you answer VGB?
Use the venous blood gas (VBG) for the follow-up of diabetic ketoacidosis (DKA). A VBG could replace teh arterial sample for assessing the degree of acidosis and hypocarbia when all you need is pH and not the pO2 while avoiding an additional painful procedure.
For which condition is 24-hour Urine for metanephrine, Vanillylmandelic Acid (VMA), and Catecholamines the best initial test?
Twenty-four-hour urine collection for metanephrine, vanillylmandelic acid (VMA), and catecholamines is the best initial test for pheochromocytoma.
If VMA and Catecholamines are positive, what is the next best imaging test?
if the question says the VMA or catecholamines are elevated, then answer CT or MRI of the adrenal glands as the next best test to find the pheochromocytoma.
If all imaging done is negative, what would you do next?
If CT/MRI find nothing, a metaiodobenzylguanidine (MIBG) sintigraphy would be teh next best option. This is a norepinephrine analogue that concentrates in the adrenals and pheochromocytomas
This disease is associated with which syndrome?
Pheochromocytoma is associated with MEN II and MEN III.
When do you answer VMA, metanephrines, or catecholamines?
Look for a case of episodic hypertension, particularly with flushing and diarrhea.