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ENDOCRINOLOGY step 2 C/S > E2 > Flashcards

E2 Flashcards

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1
Q

Benefits of pharmacologic intervention for adequate blood glucose control?

A

Reduce microvascular(retinophaty,nephrophaty and nurophaty) complication

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2
Q

What about macrovascular complications and mortality?

A

show no benefit

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3
Q

What factors reduce Macrovascular complications?

A

smocking sensation
Lipid level control
Exercise
BP. control

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4
Q

Indication for treatment in prolactinoma?

A

Macroprolactinoma(>10 mm )
Symptomatic macroprolactinoma
Treat with a dopamine agonist(Capergolin,bromocriptine)

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5
Q

surgery indication?

A

Sise > 3 cm

Enlargement during treatment

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6
Q

Antithyroid drug S/E?

A

Allergic rxn(MC)
Agranulocytosis(rare,do CBC if patient have infection symptom)
MTZ:1st TM teratogenic(aplasia cuitis),cholestasis
PTU:Hepatic failure,ANCA associated vasculitis

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7
Q

Osteomalacia symptoms?

A 
maybe asymptomatic
bone pain
muscle weakness
muscle cramp
difficulty of walking
waddling gait
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8
Q

Diagnosis?

A 
Inc.ALP and PTH
Dec.Ca, P,
Low urinary ca
low VIT D
thining of bone cortex and decrease density
bilateral symmetric psudo#
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9
Q

pathophysiology?

A

Vitamin D deficiency

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10
Q

Cause of diabetic foot ulcer?

A

Neuropathic (MCC)
Previous DFU
Vascular insuficiency
Foot deformity

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11
Q

Neuropathic ulcer?

A

Mainly affect plantar bony prominence area

Punched out ulcer with undermined border

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12
Q

diagnosis?

A

test with monofilament

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13
Q

PAD and diabetic foot ulcer?

A

AKI assess macrovascular obstruction

But diabetic foot ulcer is related to microvascular lesion

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14
Q

Arterial ulcer cmon location?

A

Tip of toe

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15
Q

Confirmatory Diagnosis of PAD?

A

Adrenal suppression test after normal saline
But adrenal venous sampling is important to assess which adrenal is hypersecretory(The mass is not always an indicator of the hypersecreting adrenal)

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16
Q

Managment?

A

For unilateral
Surgery
Aldosterone antagonist for refusing or non-candidates for surgery
For bilateral
Aldosterone antagonist(eplerenone–selective)

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17
Q

What form of estrogen can not affect TBG level?

A

Transdermal estrogen pach(bypass liver)

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18
Q

In Hashimoto thyroiditis which complication can happen even in a subclinical state with high TPO titer?

A 
Recurrent miscarriage
This patient(HTPO) is also at high risk for progression to clinical hypothyroidism. So Levetyroxin Tx is recomended
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19
Q

Initial test to assess the cause of PAI?

A

8-AM cortisol and ACTH

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20
Q

If low cortizole<5ug/dl and high TSH?

A

Confirmatory for PAI

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21
Q

If High cortizole>15ug/dl ?

A

Rule out PAI

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22
Q

If Cortisol 5-15?

A 
Non-confirmatory
Do cosyntropin(HM ACTH) test
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23
Q

If low cortisone and High ACTH after CT?

A

PAI

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24
Q

Low Cortisol and Low ACTH after the test?

A

Therithery/secondary AI(will have blunted response due to adrenal athrophy)

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25
The normal response after CT >20?
rule out PAI
26
Indeterminate?
Asses pituitary
27
the first test to do in hypercalcemia?
PTH level
28
If have low PTH?
PTHrP | Vit D level
29
The first test to do in thyroid nodule in patients with low risk and non-suggestive PE for ca?
TSH and U/S
30
Indication for FNAC?
Noncystic >2 cm | malignancy feacher in U/S with size > 1cm
31
malignancy feature?
microcalcification internal vascularity irregular margin
32
other feature for malignancy?
Low TSH with low RIU relative to surrounding tissue
33
First-line Tx for DN?
TCA(amitriptyline)--Inhibit pain signaling SNRI(Duloxetine)---Inhibit pain signaling AC(Pregabaline, Gabapentine)--Central NS inhibition
34
TCA C/I?
Age > 65 | Underling cardiac disease
35
What to rule out in hyperprolactinemia?
Hypothyroidism | RF(Cr)
36
AT drug indication In graves?
``` Mild symptoms Low Anti TSHR Ab In old age pregnants small goiter ```
37
surgery and Radiation?
Moderate and severe symptoms | w/o above mentiond list
38
Diabetic Gastropathy pathogenesis?
Long-standing DM(T1) Enteric nerve damage Failure of fundal relaxation Uncoordinated peristelisis
39
Diagnosis?
nuclear gastric emptying study
40
Managment?
Metoclopramide | Erythromycin
41
CM?
Postprandial bloating and vomiting Early satiety Impaired nutrition Wight loss
42
GI S/E of DM?
Gastroparesis esophageal dysmotility Intestinal disorder(diharoa,constipation and incontinence)
43
VIPoma Syndrome CM?
``` W.Diarrhea--secretory(low stool OG<50) Hypokalemia Sx--Due to GI loss Metabolic Alkalosis---GI BC loss Hypo/ achlorhydria---Decrease GA production Nausea, Vomiting, and flushing Hyperglycemia---Glycogenolysis Maybe Ass. with MEN1 ```
44
Diagnosis?
VIP>75 pg/ml | CT: Mass at Tail
45
Management?
Rehydration Octreotide SUrgery if have hepatic metastasis
46
Hyperthyroid bone disease?
High thyroid--Activate osteoclast---B.Reasorbition-D.Bone density/I.# risk---Hypercalcemia--I.PTH--Dec R.Ca and L.Vit D--Renal loss of ca despite hypercalcemia
47
euthyroid sick syndrome?
Thyroid hormonal abnormality due to pheripherial T4 to T3 conversion in acute illnes.
48
Cxs?
Low T3 Normal T4 and TSH High rT3 a patient will have no CM
49
Causes ESS?
Inc. endogenous glucocorticoid Inflammatory cytokine(TNF) Starvation Drug(amiodarone,CS,BB )
50
How to d/t primary (testicular) male hypogonadism from Secondary(P/H) disorder?
PH: High LH/FSH SH: Normal/Low LH/FSH
51
Is a test next to do?
SH: Prolactine and Transferrin saturation +-MRI PH: karyotype and based on risk
52
Ovarian androgen?
Testosterone Androstenedione DHEA
53
Adrenal Androgen?
All three ovarian A. | DHEA sulfate
54
The first test to do in an old patient with hirsutism with no other disease manifestation like Cushing?
Testosterone and DHEAS level
55
Cause of Hypoglycemia in non-diabetics?
B cell tumor(high C-P,>20% of insulin C) surreptitious insulin usage(low C-p) ILGFII producing mesenchymal tumor (Low I and C.P) D/T using C-Peptide level
56
CM of Cushing?
``` Central obesity Skin atrophy wide purplish stria proximal muscle weakness HTN Glucose intolerance Skin Hyperpigmentasion Depression and anxiety Hirsutism ```
57
Diagnosis?
2 of these 3 criteria positive 1-24-hour urinary cortisol level 2-Late-night salivary cortisol assay 3-Low dose DEXA supresion test
58
Next to do?
TSH level
59
MEN 1 genetic?
Autosomal dominant | Due to
60
CXS?
3 P tumor 1) pituitary(mainly prolactinoma) 2) P.Hyperparathyroidism 3) Pancras/Gi tumor - --Gastrinoma(recurrent, resistant PUD) - --Insulinoma - --VIP oma - --Glucagonoma
61
Comorbidity can occur in PCOS?
Metabolic syndrome(DM,HTN) OSA Non-alcoholic liver disease Endometrial hyperplasia
62
The best test to diagnose DM in PCOS?
Oral glucose tolerance test
63
the precipitating factor for HHS?
Acute illness(MI) and trauma Infection Insulin therapy interruption Medication impacts CH metabolism(GC, thiazide, and atypical antipsycotic)
64
things should do before measuring PAC/Renin ratio?
Stop drugs that alter aldosterone mechanisms like spironolactone, el, tr, and amiloride.
65
Hypercalcemia of malignancy cause?
``` Squamous Ca(high PTHrP, Low PTH, and Low P) Bone metastasi(Low PTH and PTHrP) ```
66
Treatment for hyperthyroidism due to thyroid distruction?
Propranolol
67
What about prednisolone?
In dequrivian thyroiditis not respond to NSAID | Amidadron induced destructive thyrotioxicosis
68
Hormonal abnormality in primary hypothyroidism?
Hign TSH HIGH TRH(lead to high prolactin ) Low FSH/LH(due to high prolactin)
69
Large fiber neuropathy in DM manifestation?
pressure, proprioception, and balance loss numbness and poor balance diminished /absent AR Reduced/absent VIB,LT, and proprioception
70
small fiber neuropathy in DM manifestation?
pain and temprature loss numbness and poor balance reduced pinprick Ankle reflex preserved
71
The first test to do in hypocalcemia?
Serum Mg level(low mg cause PTH resistance and low production)
72
the major cause of milk-alkali syndrome?
excessive intake of CaCo3
73
Cause of hypercalcemia with low PTH?
``` Hypercalcemia of malignancy Vit D toxicity Granulomatous disease Drug-induced(thiazide) Milk alkali syndrome Thyrotoxicosis Vitamin A toxicity Immobility ```
74
MEN2A?
Medullary thyroid ca(calcitonin) Pheochromocytoma parathyroid adenoma
75
why we should screen for pheochromocytoma before resectioning of MTca?
prevent catecholamine surge(pheochromocytoma should be first resected)
76
how to screen?
Plasma fractionated metanephrine assay
77
NA level in three types of DI?
Central--High Nephrogenic--Normal Psychogenic--Low
78
Is hypocalcemia secondary to RF feature?
High PTH High P Low Ca Low Vit D

ENDOCRINOLOGY step 2 C/S (4 decks)

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