Endo Geriatrics

Question 1

what antibodies are found in hypothyroidism

Answer 1

antithyroid peroxidase
anti-thyroglobulin

Question 2

what crisis can occur as a result of hypothyroidism

Answer 2

myxedema coma

Question 3

what antibodies are found in hyperthyroidism

Answer 3

thyroid-stimulating antibodies

Question 4

PE hyperthyroidism

Answer 4

proptosis
exophthalmos
lid lag
pretrial myxedema - swollen red or brown patches on legs with non-pitting edema

Question 5

MC type of thyroid CA

Answer 5

papillary

Question 6

paget disease of the bone is also called

Answer 6

osteitis deformans

Question 7

what is paget disease of the bone

Answer 7

abnormal bone remodeling in aging bone
leads to focal areas of larger, weaker bone formation

Question 8

sx paget disease of the bone

Answer 8

most asx - may have incidentally high alk phos
bone pain
skull enlargement – deafness

Question 9

dx paget disease of the bone

Answer 9

isolated elevated alk phos

plain radiographs - cotton wool appearance

Question 10

tx paget disease of the bone

Answer 10

bisphosphonates first line

calcitonin if patients unable to take bisphosphonates

Question 11

MCC hyperparathyroidism

Answer 11

parathyroid adenoma

lithium is another cause

Question 12

sx hyperparathyroidism

Answer 12

stones
bones
abdominal groans
psychic moans

DECREASED DTR

Question 13

dx hyperparathyroidism

Answer 13

hypercalcemia
increased PTH
decreased phosphate

Question 14

tx hyperparathyroidism

Answer 14

parathyroidectomy

can also do bisphosphonates

Question 15

2 MCC hypoparathyroidism

Answer 15

post neck surgery
autoimmune

Question 16

sx hypoparathyroidism

Answer 16

increased muscle contraction
increased DTR
perioral numbness

Question 17

dx hypoparathyroidism

Answer 17

hypocalcemia
decreased PTH
increased phosphate

Question 18

tx hypoparathyroidism

Answer 18

calcium + vitamin D (calcitriol)

if sx - IV calcium gluconate

Question 19

acute adrenal insufficiency is also called

Answer 19

addisonian crisis

Question 20

what is addisonian crisis typically precipitated by

Answer 20

stressful event

Question 21

MCC addisonian crisis

Answer 21

abrupt withdrawal of steroids

Question 22

sx addisonian crisis

Answer 22

shock - hypovolemia, orthostatic hypoTN, hypotension

Question 23

dx addisonian crisis

Answer 23

hyponatremia
hypoglycemia
hyperkalemia

elevated ACTH + low cortisol in primary

decreased ACTH + low cortisol in secondary

Question 24

tx addisonian crisis

Answer 24

IV normal saline
IV steroids - don’t wait for lab results

Question 25

what is SIADH

Answer 25

excess ADH –> free water retention and hyponatremia

Question 26

causes SIADH

Answer 26

Hemorrhage (subarachnoid) - MC
pulmonary - SCLC

Question 27

sx SIADH

Answer 27

cerebral edema
nausea and malaise
seizure (< 120)

euvolemia - no edema or ascites

Question 28

dx SIADH

Answer 28

hyponatremia
decreased serum osmolality

increased urine osmolarity
increased urine sodium

Question 29

tx SIADH

Answer 29

fluid and water restriction

ADH receptor antagonists - Conivaptan, Tolvaptan

severe - IV hypertonic saline

Question 30

metabolic syndrome is also called

Answer 30

syndrome X

Question 31

key component of metabolic syndrome

Answer 31

insulin resistance

Question 32

what criteria is used to dx metabolic syndrome

Answer 32

ATP III criteria (at least 3 of the following)

Question 33

dx metabolic syndrome

Answer 33

HDL < 40 in men; < 50 in women
SBP >/= 135 or DBP >/= 85 (or meds)
TG >/= 150 (or meds)
FBG >/= 100 (or meds)
Waist circumference > 40 inches in men and > 35 inches in women

Question 34

MCC HHS

Answer 34

infection

Question 35

dx HHS

Answer 35

increased osmolarity (>320)
increased serum glucose (> 600)
absence of acidosis (arterial pH > 7.3 and serum bicarb > 15)

Question 36

dx DM

Answer 36

A1C ≥6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*

OR

FPG ≥126 mg/dL (7 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.*

OR

2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.*

OR

In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).