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72 Cards in this Set
- Front
- Back
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For the entire Endocrine section. What is the order from patient presentation to Diagnosis that a doctor must follow? |
History and physical Laboratory Testing
Both of these BEFORE imaging |
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How does estrogen effect thyroid levels |
TSH = normal T4 “Total” = elevated Free T4 = normal
Total T4 is elevated because estrogen increases TBG levels |
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What is always the treatment in hypothyroidism |
levothyroxine |
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what are the labs going to look like in hypothyroidism |
TSH high FT4 low |
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What do the labs look like in hyperthyroidism |
TSH low FT4 high Typically there will be high antibodies as well |
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What would imaging of thyroiditis look like |
lower uptake |
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What would you suspect if thyroid imaging shows low uptake but testing showed high thyroid |
A med student is taking exogenous thyroid hormone and isn't telling you about it. |
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What is the DOC for hyperthyroid conditions |
Methimazole |
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What drug is used in first trimester of pregnancy in hyperthyroid |
PTU (propylthiouracil) |
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If you are taking exogenous thyroid hormone (like our med student friend from earlier) what would you expect the thyroglobulin to be (not the TBG)? what if the elevated thyroid hormone is from the thyroid |
thyroglobulin is low if taking exogenous thyroid hormone.
Thyroglobulin is high in if thyroid is the cause of high thyroid hormone |
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What do you use to pre-treat prior to thyroid surgery? |
You need to prep with anti-thyroid medication and beta-blockers to avoid thyroid storm |
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What are the ranges for thyroid nodules when considering biopsy? What kind of nodule do you not biopsy? |
<1 cm = observe 1 - 1.5 cm = observe or consider biopsy ≥1.5 cm = biopsy
Do not biopsy hot nodules |
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Which thyroid cancer is the most aggressive and has the poorest prognosis |
Anaplastic |
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Which thyroid cancer is the least aggressive? What is the treatment? |
Papillary Total thyroidectomy |
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Radioactive iodine is not useful in what type of thyroid cancer |
Medullary |
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When a patient has had thyroid surgery what do we do next? How must the patient be prepared and what treatments can they continue while prepping for it? |
Do a whole body radioactive iodine scan.
Patient needs to be on low iodine diet Patient can continue to take thyrotropin (TSH) and can keep taking thyroid hormone.
This is because we want any remaining thyroid tissue to be starving for iodine so that it will image very clearly |
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What physical features make a nodule more suspicious for biopsy on ultrasound |
Hypoechoic Microcalcification Increased blood flow Irregular border |
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What is the MCC of hyperparathyroidism? |
solitary parathyroid neoplasm |
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What are the classic labs in Primary hyperparathyroidism |
PTH high Calcium High Phosphorus Low |
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What is the significance of urinary calcium based on |
How well calcium is being absorbed in the gut |
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What are the labs for secondary hyperparathyroidism and what is the classic cause |
PTH high Calcium normal
classically caused by Vitamin D deficiency |
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If a patient presents with high calcium and low PTH with high urinary calcium in an emergent situation what is the most likely cause |
probably malignancy |
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What are the risk factors for osteoporosis |
Parent fractured a hip, currently smoking (age, gender, weight, previous fracture) |
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What does low urine calcium indicate? |
poor GI absorption.
This is related to osteomalacia (softening of bones) and Vit D deficiency |
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What is the treatment for osteoporosis |
bisphosphonates |
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What hormone is missing in primary adrenal insufficiency? What do the electrolytes look like? what is the treatment of choice? |
Missing cortisol Sodium Low Potassium High Treatment of choice is hydrocortisone (synthetic cortisol) |
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What hormone is low in secondary adrenal insufficiency? What is not affected so which electrolyte is normal? |
ACTH is low so therefore cortisol is low
Aldosterone is not affected so potassium is normal |
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What is a neurosurgical emergency related to the pituitary |
Pituitary apoplexy (bleeding into a pituitary tumor) |
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What is the acute hormonal risk in from pituitary apoplexy and why it is a neurosurgical emergency? |
The acute hormonal risk is from adrenal insufficiency because you can't go without cortisol at all |
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What is the presentation of Cushing |
Cortisol high weight gain with striae |
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Describe the difference between ACTH dependent and ACTH independent. What is ACTH dependent called and what is the MCC? |
ACTH dependent is when the cortisol is high due to excess ACTH from the pituitary. This is called Cushing's DISEASE and MCC is a pituitary tumor.
ACTH independent is when cortisol is high on its own |
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Young, in shape patient presents with HTN, normal sodium and low potassium. What is the Dx? What is the gold standard to Dx? |
Primary hyperaldosteronism
Adrenal venous sampling |
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What size is a micro adenoma What size is a macro adenoma of the pituitary |
Micro <1cm Macro ≥1cm |
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What is the MCC of pituitary tumor? What is the treatment? |
Prolactinoma Treat with bromocriptine or cabergoline (non-surgical) |
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What is the MCC of Cushing SYNDROME? |
Cushing DISEASE |
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How do you screen for Cushing's |
24 hour urine free cortisol or dexamethasone suppression test. |
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What are the results of high dose dexamethasone suppression test for Cushing's when trying to differentiate Syndrome vs disease |
Cushing syndrome caused by a pituitary tumor (Cushing disease) = normal suppression
Cushing Syndrome from Adrenal tumor or Ectopic source = no suppression |
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Pretend for a second you're an idiot and you do imaging first and find an incidentaloma of the pituitary. What do you need to do next? |
you need to make sure you evaluate the hormonal status of the patient BEFORE you initiate any treatment |
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If a patient has a microadenima (not compromising the optic chiasm) what testing does not need to be performed |
you do not need formal visual field testing |
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What are the physiological and pathological reasons for pituitary hyperplasia? |
Physiologic: lactotroph hyperplasia in pregnancy
Pathologic: GHRH or CRH secreting neuroendocrine tumors |
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A patient presents with high urine volume (~10 L/day) and increased thirst. What Dx are you starting to think about |
Diabetes insipidus |
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What is the MCC of diabetes insipidus |
Central DI from loss of vasopressin |
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How do you test for Diabetes insipidus. What will their labs be? What if a DI patient can access water? |
Fluid restriction
Hypernatremia Dehydration High serum osmolality Low urine osmolality
If they can get water they will not usually be dehydrated and their serum sodium will be normal |
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How will a patient present in SIADH (syndrome of innapropriate anti-diuretic hormone). What is the treatment of choice? |
Hyponatremia due to excess fluid Serum osmolality is low Urine sodium is high Treatment is fluid restriction |
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What is the classic presentation of hyperprolactinemia? What must you correct first? |
hypothyroidism
Need to correct hypothyroidism first to see if the hyperprolactinemia will correct itself (Primary hypothyroidism can cause hyperprolactinemia and galactorrhea, because increased levels of thyroid-releasing hormone increase secretion of prolactin as well as thyroid-stimulating hormone (TSH)) |
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What are the medications that can cause hyperprolactinemia?
So what do you do if a patient has hyperprolactinemia and is on one of these medications? |
metoclopramide and anti-psychotics (haldol and risperidone).
Start by removing the drug |
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What is the classic genetic syndrome in HYPERgonadotropic HYPOgonadism (Turner's) |
Klinefelters (low male hormones but high gonadotropins) |
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A male comes in with symptoms that seem related to hypogonadism (low testosterone). You are seeing them in the afternoon. What do you do? |
You order testosterone testing |
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A male comes in with symptoms that seem related to hypogonadism (low testosterone). You are seeing them in the afternoon. You test their testosterone level.
You get their values back and they are low. What do you do next |
You need them to come back for an AM draw and test their testosterone again. |
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A male comes in with symptoms that seem related to hypogonadism (low testosterone). You are seeing them in the afternoon. You test their testosterone level
You get their values back and their testosterone is ~400. What is the cause of their symptoms |
Don't know but it isn't the testosterone. (Testosterone testing is valid on an afternoon draw only if the value is normal, which is ~400) |
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Male patient presents with known pituitary disorder that was treated with surgical removal of the pituitary. What will their hormone levels look like? What is this called? |
Gonadotropin is low Testosterone is low Prolactin is low
Called hypogonadotropic hypogonadism |
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Patient presents with Hirsutism, irregular menses, involution, hyperglycemia (or glucose intolerance) with a predisposition for DM. You do some testing and find that the LH:FSH ratio is elevated (maybe around 3:1?). What is your Dx? |
PCOS |
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What values would cause you to make the diagnosis of diabetes for: random plasma glucose FPG 2-h PPG with 75 g OGTT A1C Is one value enough to make the diagnosis? |
random plasma glucose: ≥200 with symptoms FPG: ≥126 2-h PPG with 75 g OGTT: ≥200 A1C: ≥6.5%
You need two or more values of the same test type to diagnose |
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What values for screening of gestational diabetes would cause you to diagnose gestational diabetes. |
Gestational diabetes is diagnosed with ONE draw and ONE of the following values being exceeded
Fasting ≥92 1 hour ≥ 180 2 hour ≥ 153 |
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The A1C shows diabetes control over how long? Why? |
2-3 months period based on 120 day lifespan of RBCs |
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What study was done for type 1 diabetes? What was the biggest risk in being very aggressive with treatment? |
DCCT
Biggest risk was hypoglycemia |
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What study was done for type 2 diabetes |
UKPDS |
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Fasting and preprandial glucose are reduced by what drug classes best with less effect on postprandial increments? |
sulfonylureas, repaglinide, metformin, and glitazones (TZDs) |
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Postprandial glucose increments are reduced best by |
alpha glucosidase inhibitors |
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A1C reductions are best done by |
sulfonylureas, metformin, and glitazones |
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What is the presentation of ketoacidosis and what is the treatment? |
Dehydration, acidotic, hyperglycemic
Tx: Give them insulin and fluid (HYDRATION) |
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What values are most important in making adjustments to a treatment plan in diabetes |
home glucose values |
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What is the DOC for diabetes (question may involve a classic type II diabetic and ask what treatment they should be started on) |
Metformin |
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Which drug is last resort in diabetes and why? |
Sulfonylureas
Because of risk of hypoglycemia |
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A patient presents with pancreatitis or symptoms that may indicate pancreatitis (such as abdominal pain) What drug class should not be used? |
GLP-1 agonists |
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Know the difference between the exogenous and endogenous pathways of lipid metabolism |
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What are the four statin benefit groups |
1. People with clinical ASCVD 2. People with primary elevations of LDL-C ≥190 3. People 40-75 yrs with diabetes and LDL-C 70-189 4. People without clinical ASCVD or diabetes 40-75 yrs with LDL-C 70-189 and estimated 10 year ASCVD risk of ≥7.5% |
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A child presents with Triglycerides >1000 and pancreatitis. What hyperlipoproteinemia do you suspect? |
Type I (Familial Chilomicronemia Syndrome) |
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A 10 year patient presents with tendon xanthomas and coronary artery disease. What lipid disorder do you suspect |
Type II (familial hypercholesterolemia) |
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An adult patient presents with elevated LDL and normal triglycerides. You find a genetic defect in APO E. What hyperlipoproteinemia do they have? |
Type III (Familial dysbetalipoproteinemia) |
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How do you calculate lipid profile? |
Total = LDL + Triglycerides/5 + HDL |
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A patient presents with abdominal pain and pancreatitis. What lipid do you suspect is elevated |
hypertriglyceridemia (elevated triglycerides) |
