Kendo 100-150

Front 1

Q100. Dx: tender, enlarged thyroid, fever and signs of hyperthyroidism; jaw or tooth pain; hypothyroidism may develop; what other Dx is similar to this without tenderness?

Back 1

A100. Subacute Thyroiditis; other: Silent thyroiditis

Front 2

Q101. Dx: fever with severe neck pain, focal tenderness of involved portion of thyroid

Back 2

A101. Suppurative Thyroiditis

Front 3

Q102. Dx: slowly enlarging rock hard mass in anterior neck, tight and stiff neck, fibrosis of mediastinum

Back 3

A102. Riedel's Thyroiditis

Front 4

Q103. what labs allow you to distinguish b/t Subacute, Silent and suppurative thyroiditis?

Back 4

A103. Silent: high serum Thyroglobulin levels only (and possible Antimicrosomal Ab); Subacute: high serum Thyroglobulin levels and WBC left shift; Suppurative: WBC with left shift only

Front 5

Q104. What is Tx for: 1. Pain from Subacute thyroiditis; 2. Suppurative thyroiditis; what should never be given to any thyroiditis patient?

Back 5

A104. 1. NSAIDs (or steroids); 2. IV Abx and drainage of abscess; Never give PTU to thyroiditis

Front 6

Q105. *Best test to evaluate a thyroid nodule

Back 6

A105. Fine-needle aspiration

Front 7

Q106. If thyroglobulin levels return to normal after a thyroidectomy, what does that suggest?

Back 7

A106. Absence of metastatic thyroid tissue

Front 8

Q107. what test distinguishes b/t Hot and Cold thyroid nodules?; what is the difference b/t them?; which is more likely malignant?

Back 8

A107. Thyroid Scan with t-99; Hot: Hyperfunctioning thyroid; less likely malignancy; Cold: Hypofunctioning thyroid; more likely malignant

Front 9

Q108. (4) Types of thyroid Cancer; which is most common?; has best prognosis?; worst prognosis (0% survival in 5 yrs)?; Seen in MEN II and III?

Back 9

A108. 1. Papillary - MC; best prognosis; 2. Follicular; 3. Anaplastic - worst prognosis; 4. Parafollicular (Medullary) - in MEN II and III

Front 10

Q109. Thyroid CA: ground-glass "Orphan Annie" nuclei and psammoma bodies

Back 10

A109. Papillary

Front 11

Q110. Thyroid CA: good prognosis but commonly bloodborne mets to bone and lungs

Back 11

A110. Follicular

Front 12

Q111. Thyroid CA: cancer of the "C" cells, derived from branchial pouch 5 and secretes Calcitonin; (2 names)

Back 12

A111. Parafollicular; (Medullary thyroid CA)

Front 13

Q112. Tx for any thyroid CA; (2)

Back 13

A112. Thyroidectomy; Oral thyroxine supplements after surgery

Front 14

Q113. Definition: hypersecretion of PTH by the parathyroid gland

Back 14

A113. Primary Hyperparathyroidism

Front 15

Q114. Definition: Glandular hyperplasia and elevated PTH in an inappropriate response to hypocalcemia

Back 15

A114. Secondary Hyperparathyroidism

Front 16

Q115. Definition: continued elevation of PTH after the disturbance causing secondary hyperparathyroidism has been corrected

Back 16

A115. Tertiary Hyperparathyroidism

Front 17

Q116. Etiology of Hyperparathyroidism; (3)

Back 17

A116. Hyperplasia of all 4 glands;; Adenoma/carcinoma;; MEN II and III

Front 18

Q117. Pathophysiology of the parathyroid gland; (4 ways to increase Calcium)

Back 18

A117. PTH increases serum Ca levels: 1. stimulates renal hydroxylation of Vit-D (needed for GI to absorb Ca); 2. Increases renal resorption of Ca; 3. Decreases renal resorption of phosphorus;; 4. Increases Osteoclastic resorption of bone (via osteoblast receptors)

Front 19

Q118. what do lab tests show to Dx Hyperparathyroidism?; (3)

Back 19

A118. high serum calcium (low phos);; high serum PTH;; hypercalciuria

Front 20

Q119. what are the indications for surgery with Dx of hyperparathyroidism?; (2)

Back 20

A119. Adenomas should be removed;; Hyperplasia of all four glands: remove and reinsert a small portion of one on the SCM so that it is accessable if problems arise

Front 21

Q120. Emergent measures taken (PRN) with hyperparathyroidism; (3)

Back 21

A120. 1. Hydration with Lasix; 2. Bisphosphonates to block bone resorption; 3. Calcitonin

Front 22

Q121. When is Mg deficiency seen?; (3)

Back 22

A121. SAP: SIADH;; Alcoholism;; Pancreatitis

Front 23

Q122. Etiology of Hypoparathyroidism; (3)*

Back 23

A122. HID Parathyroids: Hypomagnesium;; Infiltrative CA / Irradiation;; DiGeorge Syndrome;; Post-surgical

Front 24

Q123. Dx: 30-yo woman presents with perioral paresthesia and long QT interval. She recently had surgery on her goiter.

Back 24

A123. Hypoparathyroidism

Front 25

Q124. Dx: seizures, perioral paresthesia, tetany, fasciculations, muscle weakness, CNS depression, faint heart sounds, bronchospasm

Back 25

A124. Hypoparathyroidism

Front 26

Q125. What is seen in hypoparathyroidism on the EKG?

Back 26

A125. QT prolongation

Front 27

Q126. Tx for hypoparathyroidism; (life-threatening versus maintenance)

Back 27

A126. Life-threatening: IV Calcium; Maintenance: Calcitriol and oral calcium

Front 28

Q127. Dx: Similar characteristics to Hypoparathyroidism, but tissue is resistant to PTH, causing an INCREASE in serum PTH

Back 28

A127. Pseudohypoparathyroidism

Front 29

Q128. What is pseudohypoparathyroidism assoc with?

Back 29

A128. Albright's hereditary osteodystrophy

Front 30

Q129. If you suspect over-the-counter thyroid hormone abuse, TSH is low and T4 is high, what other lab test can you check?

Back 30

A129. Thyroglobulin levels will be low.

Front 31

Q130. Radioactive iodine uptake scan is increased in (3)

Back 31

A130. Graves' disease; toxic adenoma/toxic nodules; multinodular goiter

Front 32

Q131. Radioactive iodine uptake scan is decreased in (4)

Back 32

A131. subacute thyroiditis (hyperthyroid stage),; hashimotos thyroiditis (hypothyroid stage),; exogenous T3/T4/levo,; postpartum thyroiditis

Front 33

Q132. In which conditions are thyroglobulin levels high?

Back 33

A132. Thyroiditis,; iodine-induced thyrotoxicosis,; amiodarone-induced thyrotoxicosis

Front 34

Q133. Medications that increase the need for thyroid hormone are (4)

Back 34

A133. estrogen,; rifampin,; carbamazepine,; phenytoin

Front 35

Q134. TSH and Free T4 are both decreased in these two conditions:

Back 35

A134. pituitary hypothyroidism,; hypothalamic hypothyroidism

Front 36

Q135. Most cases of hyperthyroidism can be treated with (2)

Back 36

A135. propylthiouracil or methimazole. Severe cases require radioactive ablation.

Front 37

Q136. Why can't you give methimazole during pregnancy to treat hyperthyroidism?

Back 37

A136. It can cause aplasia cutis in the fetus

Front 38

Q137. Another name for Primary Adrenal insufficiency

Back 38

A137. Addison's Dz

Front 39

Q138. Dx: shock, dehydration, confusion, vomiting, hyperK and Hypoglycemia; What are the (3) causes?

Back 39

A138. Addisonian (or adrenal) crisis causes: Hemorrhage;; Sepsis;; Trauma

Front 40

Q139. (2) main causes of Addison's Dz

Back 40

A139. Autoimmune (80%);; TB (15%)

Front 41

Q140. MCC of Secondary adrenal insufficiency; (2) other causes

Back 41

A140. MCC: Exogenous steroid drugs others: Sheehan's syndrome;; Pituitary infarct

Front 42

Q141. How is Aldosterone made?; (2) functions

Back 42

A141. Angiotensin II acts on the zoNa glomerulosa to convert cortisone to aldosterone Functions: Increase sodium reabsorption;; secretion of K+ and H+

Front 43

Q142. What does a deficiency in aldosterone cause with electrolytes?; (2)

Back 43

A142. HyperK; HypoN

Front 44

Q143. Dx: 18-yo man with hemophilia A who was recently mugged (receiving multiple blows to head and abdomen) is now complaining of dizziness, abdominal pain, dark patches on his elbows and knees, and uncontrollable cravings for pizza and french fries

Back 44

A143. Primary Adrenal Insufficiency; (Addison's Dz)

Front 45

Q144. How is secondary insufficiency distinguished from Addison's Dz?; (3)

Back 45

A144. No hyperpigmentation;; Normal aldosterone secretion;; Signs of hypopituitarism (hypothyroidism or hypogonadism)

Front 46

Q145. What is Cortisol's relation to glucose?; (2)

Back 46

A145. Stimulates gluconeogenesis by increasing protein and fat catabolism;; Decreases utilization of glucose and sensitivity to insulin

Front 47

Q146. How does cortisol promote an anti-inflammatory state?; (3)

Back 47

A146. Inhibits Arachidonic Acid;; Inhibits IL-2 production;; Inhibits release of histamine from Mast cells

Front 48

Q147. Definition: Hemorrhagic necrosis of the adrenal medulla during the course of meningococcemia

Back 48

A147. Waterhouse-Friderichsen Syndrome

Front 49

Q148. Dx: hyperpigmentation, salt cravings, orthostatic hypotension, amenorrhea

Back 49

A148. Addison's Dz; (primary adrenal insufficiency)

Front 50

Q149. Describe the ACTH (Cortrosyn) test to Dx Adrenal insufficiency etiology; How does it distinguish b/t primary and secondary?

Back 50

A149. Give ACTH and measure at zero and 30 minutes. A level of < 18 at 30 = adrenal insufficiency; Measure plasma ACTH after test: Primary = high ACTH; Secondary = low ACTH

Front 51

Q150. Tx for adrenal insufficiency; what additional Tx for Addison's only?

Back 51

A150. Tx: Glucocorticoid replacement (especially at times of stress); additional for Addisons: Mineralcorticoid replacement