Block 70,71: Endocrine

Question 1

chronic weakness, weight loss, hyponatremia, hyperkalemia with low-normal cortisol level

Answer 1

primary adrenal insufficiency (addison disease)

Question 2

initial evaluation for Addison disease

Answer 2

8 AM serum cortisol
plasma ACTH

ACTH stimulation test is faster (cosyntropin test)

Question 3

Lab values for Eurthroid sick syndrome

Answer 3

Low in total and free T3 levels

normal T4 and TSH

Question 4

Riedel’s (fibrous) thyroiditits

Answer 4

inflammatory disorder

- fibrosclerosis of thyroid and non thyroid structures

Question 5

patient has UTI that is treated. comes back days later and has dark urine. with urine sample stains positive with Prussian blue

Answer 5

glucose-6-phosphate dehydrogenase deficiency

Question 6

a positive Prussian blue stain indicates what in urine

Answer 6

hemosiderin

Question 7

Heinz bodies

Answer 7

G6PD

Question 8

Most common cause of primary adrenal insufficiency in developed countires

Answer 8

autoimmune adrenalitis

Question 9

what is the difference between primary adrenal insufficiency and central adrenal insufficiency

Answer 9

PAI: hyperpigmentation and hyperkalemia

Question 10

Difference between follicular thyroid cancer and benign follicular adenomas

Answer 10

FTCL invasion of tumor capsule and/or blood vessels. Hematogenous spread to distant tissues

Question 11

hyperosmolar hyperglycemic state in type 2 diabetes mellitus

Answer 11

severe hyperglycemia and hyperosmolality

altered sensorium

Question 12

characterize corticosteroid-induced psychosis

Answer 12

delusions, hallucinations

Question 13

weight loss, tachycardia with proptosis and impaired extraocular motion

Answer 13

graves ophthalmopathy

Question 14

Graves disease

Answer 14

TSH receptor antibody

Question 15

what causes Graves ophthalmopathy

Answer 15

T cell activation and stimulation of orbital fibroblasts by TSH receptor autoantibdoies

Question 16

Type 1 multiple endocrine neoplasia

Answer 16

• primary hyperparathyroidsim
• pituitary tumors
• GI/pancreatic endocrime tumors

Question 17

glucagonoma

Answer 17

hyperglycemia
necrolyic migratory erythema
weight loss
anemia

Question 18

cause of hypocalcemia in alcoholics ? explain phosphorus levels

Answer 18

hypomagnesemia

- decreases PTH release, but Phosphorus levels are not elevated

Question 19

what causes graves Ophthalmopathy

Answer 19

activated t cells and thyrotropin receptor antibodies on TSH receptors

Question 20

what treatment can worsen graves ophthalmopathy

Answer 20

radioactive treatment

- raise thyrotropin receptor antibodies

Question 21

treatment for macroprolactinoma ( 1cm greater) or symptomatic prolactinoma

Answer 21

Dopaminergic agonists

Cabergoline, bromocriptine

Question 22

presenting signs of glucagonoma

Answer 22

• mild diabetes or hyperglycemia

- necrotic migratory erythema

Question 23

most beneficial therapy to reduce progression of diabetic nephropathy is

Answer 23

blood pressure control

130/80 goal

Question 24

what percent is normal saline

Answer 24

.9%

Question 25

oral estrogen preparations increase levels of what? what happens when you are on thyroid replacement

Answer 25

thyroxine-binding globulin | - higher dose of thyroid

Question 26

acute thyrotoxicosis with mild thyroid gland enlargement and suppressed TSH

Answer 26

painless thyroiditis

Question 27

thyroid scintigraphy for painless thyroiditis shows

Answer 27

decreased radioiodine uptake

Question 28

Is thyroid enlarged in struma ovarii

Answer 28

no

Question 29

is thyroid enlarged in painless thyroiditis

Answer 29

yes

Question 30

pseudodemantia

Answer 30

major depression in elderly

Question 31

hoarsness if throat is a sign of

Answer 31

hypothyroidism

Question 32

hypothyroidism can cause reversible changes in

Answer 32

memory and mentation

Question 33

high volume blood transfusion can cause what

Answer 33

symptomatic hypocalcemia due to chelation of ionized calcium by citrate in transfused blood - increase risk with hepatic function impaired due to decrease clearance of citrate by liver

Question 34

what is and when does carpal spasm ( trousseau sign)

Answer 34

hypocalcemia | - flexed wrist with abduction of thumb

Question 35

next step in determining hypocalcemia

Answer 35

check PTH then vitamin D

Question 36

easy bruisability, hyperpigmentation, hyperandrogenism

Answer 36

cushing

Question 37

Potassium level for mild primary hyperaldosteronism, especially if on diuretic

Answer 37

hypoK

Question 38

when do you not give metformin for type 2 initially

Answer 38

renal insufficiency

Question 39

side effect of GLP-1

Answer 39

weight loss and lower hypoglycemia risk

Question 40

hypocalcemia, hyperphosphatemia, and increased PTH characteristic of

Answer 40

secondary hyperPTH in chronic renal failure

Question 41

somes symptoms of hyperosmolar hyperglycemic state

Answer 41

neurologic symptoms ( blurry vision, lethargy)

Question 42

what trigger thyroid storm

Answer 42

``` non-thyroid surgery trauma infection iodine contrast childbrith ```

Question 43

tachycardia, hypertension, cardiac arrhthmias, high fever, tremor , altered mentation, lid lag

Answer 43

thyroid storm

Question 44

estrogen increases the levels of what for thyroid

Answer 44

T4- binding globulin | Euthroid state for normal people, b/c thyroid increases production to keep up with globulin

Question 45

when do you screen for diabetes

Answer 45

- blood pressure 135/ 80 and greater | - 45 and over

Question 46

what tests do you use to screen for diabets

Answer 46

- fasting plasma glucose - 2-hour oral glucose tolerane test - Hemoglobin A1c

Question 47

Name aldosterone antagonists

Answer 47

Spironolactone | Elperenone

Question 48

What is typical for patients with central-type obesity and is the key to devleopment of type 2, hypertension, dyslipidiemia

Answer 48

insulin resistance

Question 49

initial step in hyperosmolar hyperglycemic state

Answer 49

normal saline

Question 50

how does hypoalbuminemia change electorlytes

Answer 50

decrease total serum calcium | ionized calcium remains stable

Question 51

who makes vasoactive intestinal peptide (VIP)

Answer 51

pancreatic cells

Question 52

Biggest symtpoms for VIPoma

Answer 52

watery diarrhea | hypokalemia

Question 53

fever and sore throat is any patient taking antithyroid drug suggests

Answer 53

agranulocytosis

Question 54

Methimazole

Answer 54

anti- thyroid drug