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USMLE Step 2 > endocrine > Flashcards

endocrine Flashcards

1
Q

“thyroiditis”. What does RAIU look like?

A

preformed T4 –> infx insult –> thryoid splits and dumps T4!!!

  • option a) thyroid reforms
  • option b) thyroid shrivels up and dies –> hashimotos

RAIU is cold because no new T4 being formed during dump

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2
Q

how do you treat Grave’s?

A

methimazole or PTU

-if they have exopthalmous or pretibial myxedema they need steroids

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3
Q

when do you tx subclinical hypothyroidism?

A

when >10, or any hypothyroid sx

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4
Q

myxedema coma

A

hypotn
hypothermia

give them IV T4/T3

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5
Q

papillary thyroid CA on bx

A

orphan annie nuclei

  • psammoma bodies
  • microcalcifications
  • often presents earlier with palpable non tender cervical lymphnodes

Most common!

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6
Q

follicular thyroid

A

looks like nl thyroid tissue so FNA can be inconclusive and it spreads HEMATOGENOUSLY and therefore usually does not show lymph node involvement

RAI ablation will kill all mets, but you should resect the thyroid first

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7
Q

medullary thryoid CA

A

c cells –> calcitonin –> dec calcium

-assoc with pheo and RET oncogene

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8
Q

anaplastic yhroid ca

A

very invasive ca that older people get

-spindle cells

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9
Q

toxic adenoma

A

gain of function mutation at TSH receptor

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10
Q

andrgen insensitiviy genotype

A

(testicular feminization)
46xy –> genotypically male, phenotypically female on the outside but uterus end in blind pouch

**they get breast development because test can perpiherally be converted to estrogen

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11
Q

confirmation of neuroblastoma?

A

young kiddo
mass crosses midline
homovanillc/vanyllamendlic acids in urine
n-myc overexpresion

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12
Q

describe mech of ED in male with pituitary tumor

A

prolactinoma –> inhibits GnRH –> dec LH –> dec testosterone from leydig cells

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13
Q

the basics of basics of apprach to thyroid nodule

A

1) TSH!!!!!!!!
2) then probably scintigraphy
3) then whatver is next

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14
Q

galactorrhea associated with hypothryoidism?

A

TRH stimulates prolactin

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15
Q

SIADH after neurosurgery

A

euvolemic*** hyponatremia with inappropriately high urine osm (>100)

***normal vitals, no edema or tacky membranes

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16
Q

conn’s syndrome dx

A

increase aldo:renin > 30

-will see metabolic alkalosis

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17
Q

most common cause of hypothyroidism in children

A

hashimotos –> lymphocyctic infiltrate around germinal centers

18
Q

perinaud syndrome

A

from pinealoma –> most common= germinoma

  • vertical gaze palsy
  • pupils do not react to light be react to accomodation

**boys are at risk for precocious puberty –> germinoma –> bhCG –> leydig cells –> test

19
Q

insulinoma findings

A

high insulin, low glucose, elevated c peptide

*often assciated with weight gain

20
Q

what do you need to w/u when working up hyperparathyroid/ medullary thyroid canc?

A

majority of patients with MEN2 will develop medullary thyroid which is prevented with thyroidectomy, but you need to check for pheo which can cause intraop catechol surg

21
Q

21b-oh deficiency

A

ambiguous genitalia with precocious puberty

  • hypotension with high K and low Na
  • high levels of 17 hydroxyprog

tx= hydrocortisone for cortisol replacement (decrease ACTH) and fludrocortisone which replaces aldosterone and correct BP/ lytes

22
Q

next step in working up cushings after ACTH comes back high?

A

hi dose dexamethasone suppression test to determine if its central or ectopic

23
Q

presentation of thyroglossal duct cyst. How does this different from branchial cleft cyst?

A

painless, firm, midline neck mass that moves with swallowing and tongue protrusion in a child

branchial cleft cysts are lateral, ant to SCM and do NOT move with swallowing

24
Q

why do you do adrenal sampling before resection of adrenal tumor?

A

to ensure that sx are result of mass and that its not incidental finding

25
Q

subacute thyroiditis

A

deQuervains= painful

  • elevated ESR
  • usually postviral process
26
Q

phsysiologic thyroid changes of pregnancy

A

bhcg (shares a common a subunit with TSH) and so directly inc T4 and suppresses TSH

27
Q

irritability, tachy, poor feeding/ weight gain in baby born to mom with Graves

A

thyrotoxicosis of the newborn:

  • anti TSH ab cross the placenta
  • treat with BB and methimoazole
28
Q

secondary hyperthyroidism

A

high TSH, high T3/T4 –> scan for TSH secreting pituitary tumor

29
Q

early secondary sexual developemtn with NRMAL bone age:

A
  • isolated breast –> premature thelarche

- isolated pubic hair –> premature adrenarche

30
Q

early secondary sexual development with ADVANCED bone age

A

central precocious puberty –> early activation of GNRH axis high FSH, LH from pulsatile GnRH

Peripheral precocious puberty will have low FSH/LH due to gonadal/adrenal release

31
Q

antiemetic prokinetic drug used in diabetic gastroparesis

A

metacloprimide

32
Q

differentiate small fiber from large fiber in diabetic polyneuropathy

A

small fiber= pstivie sx= pain, parasthesias, allodynia

large fiber=negative sx= numbness, loss of proprioception, loss of DTR

33
Q

dx of metabolic syndrome

A

3/5:

  1. abdominal circ
  2. fasting gluc >110
  3. BP >130/80
  4. triglycerides >150
  5. HDL <40 (men), 50 (women)
34
Q

best measures for resolution of DKA?

A

anion gap (bicarb) and betahydroxybutarate (produced by ketones)

35
Q

how do you minimize effects of thyroid receptor antibodies on eyes in Graves when using radioactive ablation

A

glucocorticoids

36
Q

good DM2 drug in addition to metformin for weight loss?

A

GLP1 agonist, also has lower risk f hypoglycemia

37
Q

milk alkali syndrome

A

inc intake of ca with absorbable alkali in preps for patients with osteoporosis

38
Q

explain neonatal hypoglycemia at birth from MGD pregnancy

A

fetus develops high insulin levels to deal with moms glucose, but glucose doesn’t cross placental barrier so as soon as the placenta is gone the fetus becomes hypoglycemic

39
Q

effect of low mag in alcoholics

A

dec Ca 2/2 resistance to PTH and dec PTH

40
Q

age of presentation and sx of G6pD

A

Von gerke (type 1 glycogen storage do)

  • presents about 3 months with signs of hypoglycemia, lactic acidosis, uricemia
  • hepatomegaly
41
Q

lab values you’d expect in primary polydipsia

A

dilute urine –> Uosm < 1/2 plasma osm

hyponatremia –> <145

42
Q

Na levels in: central DI, nephrogenic DI, primary polydipsia

A

nephrogenic DI–> usu normal

Central DI –> hypernatremia

primary polydipsia –> hyponatremia

USMLE Step 2 (18 decks)

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