Endo

Question 1

Thyroglobulin

Answer 1

Precursor of T4 T3, can only be produced by thyroid (or ectopic), test for ca recurrence

Question 2

Neonatal thyrotoxicosis

Answer 2

MOC w Graves, 3rd tri antiTSH receptor Ab crosses the placenta, resolves ~3mo, tx methimazole and Bb

Question 3

Thyroid storm

Answer 3

Pt w subclinical hyperthyroid, surgery/trauma/infx, order thyroid studies, tx Bb, iodine, glucocorticoid, PTU

Question 4

Thyroid nodules (malig)

Answer 4

U/S + TSH (unless >2cm FNA) –> if TSH low ONLY radionucleotide uptake, MC papillary (psammoma, LN), follicular (capsule/vascular invasion, hard, cold, hem spread), medullary (MEN2B, calcitonin)

Question 5

Congenital hypothyroidism

Answer 5

OK for a few months, then apathy, hypotonia, macroglossia, umbilical hernia

Question 6

Primary adrenal insufficiency

Answer 6

dark skin, GI, fatigue/wt loss/weakness, hypoNa, hyperK, hypotension, w/u 8AM cortisol + ACTH + ACTH stim=low cortisol (<5) high ACTH (central has nl aldo/skin/lytes maybe hypoNa)

Question 7

MEN syndromes

Answer 7

MEN1 PTH, pituitary, pancreas
MEN2A PTH, pheo, medullary thyroid
MEN2B (RET) medullary thyroid, mucosal neuromas, pheo MARFANOID HABITUS

Question 8

Cushing syndrome

Answer 8

Proximal muscle weakness 2/2 atrophy, easy bruising (nl plt)*** w/u late night salivary cortisol or 24h urine or low-dose dex supp –> ACTH (high=ectopic ACTH or pituitary –> high dose dex supp, low=exogenous or primary adrenal less common)

Question 9

Primary hyperaldosteronism

Answer 9

U/l (aldosteronoma), b/l (hyperplasia), hypoK muscle pain/weakness, worse w/ diuretics, screen ald/ren>20, dx CT, tx spironolactone

Question 10

Acute hypoCa

Answer 10

Trousseau (BP)/Chvostek (cheek), chelation (citrate tfusion +liver probs, lactate sepsis)

Question 11

PKU

Answer 11

musty urine, phenylalanine

Question 12

Anti-thyroid Rx

Answer 12

methimazole (agranulocytosis BOTH, terat 1st tri), propylthiouracil (hep FAILURE), radioiodine (exophthalmos)

Question 13

Cirrhosis

Answer 13

Hyperestrogenism=hypothalamic hypogonadism, euthyroid

Question 14

Exophthalmos

Answer 14

GRAVES ONLY, anti-TSHr Ab=prolif of orbital tissue

Question 15

Carcinoid

Answer 15

Flushing, diarrhea, tricuspid regurg, GI sometimes liver, inc tryptophan–>SE (5-HIAA) leads to niacin def

Question 16

Endo causes of myopathy

Answer 16

Cushing, hypothyroid, lytes

Question 17

Glycemic control in DM

Answer 17

Microvascular (retinopathy, nephropathy)

Question 18

Hyperthyroid bone disease

Answer 18

inc osteoclast act (bone resorption, dec density, hyperCa)

Question 19

Secondary amenorrhea w/u

Answer 19

UPT –> TSH, FSH, prolactin

Question 20

Gaucher disease

Answer 20

Bone pain, HSM, anemia/thrombocytopenia, delayed puberty

Question 21

Milk alkali syndrome

Answer 21

HyperCa, met alk, AKI, usually pt taking some kind of OTC supplement (Ca carbonate)

Question 22

HyperCa workup

Answer 22

Albumin, ionized Ca –> PTH (primary, familial, Li) –> PTHrp (cancer), vit D

Question 23

Osteomalacia

Answer 23

D deficiency (Ricketts kids), PTH high phos low Ca nl-low, cortical thinning dec density

Question 24

DM nephropathy

Answer 24

Control HTN, A1C<7

Question 25

Hyperprolactinemia

Answer 25

Non-functioning pit adenoma (prolactin slightly high, TSH, LH low), prolactinoma (>200), Rx TSH nl

Question 26

Glucagonoma

Answer 26

Mild DM, necrolytic migratory erythema, GI, wt loss, anemia glucagon >500

Question 27

DM peripheral neuropathy

Answer 27

Large fibers proprioception/numbness/hyporeflexia, small fibers pain/paresthesias

Question 28

Hyperandrogenism

Answer 28

Rapid virilization c/f androgen-secreting tumor, measure testosterone (ovarian), DHEAS (adrenal)

Question 29

Subacute thyroiditis

Answer 29

Viral illness, Bb + NSAID

Question 30

Hypothyroidism metabolic abnormalities

Answer 30

Hyperlipidemia, CK, LFTs, hypoNa

Question 31

Acromegaly

Answer 31

Concentric LV hypertrophy, LV dilation, hypokinesis

Question 32

Graves tx

Answer 32

Anti-thyroid + Bb first, then radio-iodine or surg

Question 33

Thyrotoxicosis

Answer 33

inc myocardial contractility + HR --> hyperdynamic circulation, HTN

Question 34

Pheochromocytoma

Answer 34

Makes you NRVous (NF1 RET/MEN2 VHL) NOT CARCINOID is only flushing and diarrhea

Question 35

Panhypopit

Answer 35

Aldosterone is nl

Question 36

Ca + pH

Answer 36

High pH —> more Ca-alb = less ionized Ca nl labs but sx hypoCa

Question 37

Medullary thyroid cancer

Answer 37

Parafollicular cells make calcitonin, measure for prog + f/u for recurrence (MEN2)

Question 38

Painless thyroiditis

Answer 38

Have Abs, transient/self-limiting 3w, small or no nodule no uptake release of pre-formed

Question 39

Hyperglycemia

Answer 39

A1C 8-10 post-prandial, >10 hyperglyc all the time | Dawn phenomenon=HYPER in the AM cortisol