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Flashcards in Endo Uworld Deck (130):
1

pins and needles sensation and mucle cramps. no PMH or FMH
has low Ca and high phosphorus and BUN 10 Cr 0.8

hypoparathyroid- primary

2

post hysteretomy patient develops nausea vomiting and acute abdomenal pain
has Hx SLE and takes prednisone
BP 70/40 pulse 110 and BP increases slightly after 4 L fluid

adrenal insufficiency having acute adrenal crisis

3

what drug can bring out adrenal crisis during surgery

etomidate

4

16 year old with facial hair, irregular menstrual cycles, and normal external genitalia
LH and FSH inc
17 hydroxyprogesterone inc
serum testosterone inc and DHEA inc

CAH from 21 a hydroxylase deficiency

5

what to check for primary amenorrhea

prolactin TSH and FSH after checking pregnancy

6

primary amenorrhea with increased FSH

premature ovarian failure

7

primary amenorrhea with increased TSH

hypothyroid

8

Euthyroid sick syndrome

fall in T3 levels. normal T4 and TSH
during acute sick illness

9

why do heavy women have milder post menopasual Sx

conversion of adrenal androgens to estrogens by adipose tissue

10

2 months fatigue and nausea vomiting, polyuria and polydipsia with constipation
smoking and drinking Hx
normal vitals
mucous membranes dry
Ca elevated, albumin norm. PTH low. Cr 1.9 BUN 54 glucose 180 and mildly low activated Vit D

hypercalcemia of malignancy
- osteolytic mets
-PTHrp
-inc tumor production activated Vit D (lymphoma)
- inc IL6 levels in MM

11

what releases PTHrp usually

squamous cell lung!
renal
bladder
breast
ovarian

12

signs of precocious puberty next step

check bone age
if advanced then check basal LH
if normal then isolated development- no further testing

13

what does basal LH tell you in precocious puberty

if low then do GnRH stimulation and if still low it is peripheral precocious (gonadotropin independent)
if high- central (gonadotropin-dependent)

14

dosing levothyroxine with pregnancy

increase dose when pregnant

15

6 mo history fatigue, HA, decreased libitdo
decreased testicular volume
low LH, low Testosterone, low TSH and T4 and mildly elevated prolactin

hypopituitarism
pituitary adenoma

16

DKA presentation

15 year old in ED with confusion, rapid breathing, abdominal pain. cold 3 days ago. has urinary frequency and progressive fatigue and somnolence
mucous membranes dry
K is high in serum Na normal bicarb very low

17

generalized bone pain. just had bowel resection for crohns. has pseudofractures and proximal muscle weakness

osteomalacia

18

labs of osteomalacia

decreased Ca, decreased phosphorus.
increased PTH

19

C peptide reflects what

natural insulin by product

20

how to Dx primary polydipsia

if urinary omsolality increases after water deprivation test

21

how to Dx central vs nephrogenic DI

central will get better with vasopressin
nephrogenic barely has a response to vasopressin in increasing urine osmolality

22

untreated hyperthyroidism is greatest risk for

bone loss

23

signs hyperthyroid with painless nodule and decreased uptake

painless thyroiditis

24

what DM med is helpgul to reduce weight and control BP

GLP-1 agonist
exenatide or lireglutide

25

side effect of GLP-1 agonists for dM

pancreatitis

26

DM with decreased appetite nausea and abdominal bloating. gets early satiety and low glucose right after meals

delayed gastric emptying (gastroparesis)
Tx with metoclompramide or small frequent meals

27

signs hyperthyrdoi and thyroid exam show 2 nodules on scan only uptake in one of them and no uptake anywhere else

toxi adenoma

28

what dugs can precipitate hyperosmolar hyperglycemic states in DM

thiazides because volume deplete and dec GFR more which activates hormones to counter regulate

29

comorbidities with PCOS

overweight/obesity
glucose intolerance/DM
dyslipidemia
OSA
endometrial hyperplasia/cancer

30

best step in manageing diabetic nephropathy

BP control

31

fatigue myalgias and muscle weakness in both elgs for a month. difficult standing up out of a chair. weakness and cramping in legs
decreased strength in proximal mm in LE and sluggish ankle jerks
normal ESR and elevated CPK
electrolytes normal
enxt step

measure thyroid hormones because hypothyroid can cause myopathy

32

signs hyperthyroid. on diet, has diffuse decrease uptake on scan

low TBG level due to exogenous thyroid supplements

33

what CA is associated with hashimoto

lymphoma of thyroid

34

decreaseing HbA1c to less than 6.5% helps prevent what

retinopathy

35

progressive watery diarrhea. cramps and feels dehydrated. stools are tea colored and has episodic flushing of face
no traveling
normal vitals
normal abdominal exam
mass on pancreatic tail on imaging

VIPoma
achlorhydria from dec gastric acid secretion

36

lab findings in VIPoma

hypokalemia
hypercalcemia
hyperglycemia

37

first line for DM neuropathy

TCA

38

high TSH T3 T4

TSH secreting pituitary adenoma

39

causes of proximal muscle myopathy

polymyosistis dermatomyositis
hypo or hyper thyroid
cushings
lambert eaton
myasthenia gravis
steroids

40

HTn and hypokalemia

check plasma aldosterone/renin ratio

41

what do you check if suspect acromegaly

IGF-1 if high then do glucose suppression test. if does not suppress GH = acromegaly

42

low and high dose DXM does not suppress cortisol

ectopic ACTH production

43

calcification of both adrenal glands
from mexico

TB causing adrenocortical insufficiency

44

what is the main difference between primary adrenal insufficiency and secondary from chronic glucocorticoid

secondary does not affect aldosterone. only decrease in cortisol and ACTH because aldosterone is primarly regulated by RAAS
secondary do not get hyperg\pigementation or hyperkalemia

45

why does TSH decrease in pregnancy

bhcg causes inc T4 in first trimester then suppressing TSH

46

change in thyroid hormones in pregnancy

increase total T4
increase free T4
decrease TSH

47

best markers fr resolution of ketoacidosis

serum anion gap and beta hydroxybutyrate

48

best immediate therapy for Sx hyperthyroid

propranolol

49

low Ca with high PTH

vit D deficiency
chronic kidney disease
pancreatitis or sepsis
tumor lysis

50

prussian blue stain

presence hemosiderin

51

underlying path in G6PD def

oxidative stress

52

heinz bodies

G6PD def

53

in glucagon world what gets converted to pyruvate

lactate, alanine and otehr aa

54

unique property of collicular carcinoma of thyroid

encapsulated. so invasion of tumor capsule and blood vessels

55

when is oral glucose testing done in pregnancy

24-28 weeks

56

what organ is responsible for precocious sexual development

adrenal androgen release

57

isolated premature adrenarche

PCOS, MD 2 or metabolic syndrome

58

management of prolactinoma in premenopausal with no mass effects

cabergoline or bromocriptine

59

How does steatorrhea affect Calcium
aka celiacs

disrupts absorption vit D. so get vit d deficiency with low Ca, phosphorus and high PTH

60

signs of thyroid storm

high fever!
tachy cardia and hypternsion
arrhythmias
agitation, delirium
goiter, lid lag, tremor
warm and moist skin
n/v/d and jaundice

61

how does prolactinoma cause hypogonadism

suppress gnRH hormone

62

what cancer most commonly produces PTHrp

metastatic breast cancer

63

clinical manifestations carcinoid

skin flushing, telangiectasias
GI diarrhea and cramping
valvular lesions in heart
bronchospams
niacin deficiency

64

Dx carcinoid

increased 5HIAA
CT MRI abdomen and pelvis
octreoscan to see mets
echo

65

deficiency in carcinoid

niacin and tryptophan

66

niacin def

dermatitis, diarrhea dementia (pellagra)

67

sheehan

pituitary infarction- ischemic necrosis

68

signs primary adrenal insufficiency (addison)

fatigue, hyperpigmentation, low BP, eosinophilia, low sodium and hyperkalemia

69

what are the tests for adrenal insufficiency

basal early morning cortisol, ACTH and cosyntropin test

70

what is cosyntropin test

ACTH synthetic analogue
serum cortisol usually increases after administration cosyntropin unless have adrenal insufficiency

71

low basal cortisol in morning with low ACTH

central adrenal insufficiency (pituitary or hypothalamus)

72

central adrenal insufficiency is synonymous with

secondary or tertiary

73

signs of refeeding syndrome

arrhythmia
CHF
seizures
wernicke encephalopathy

74

what causes refeeding syndrome

the release of insulin causing uptake phosphorus, K and Mg
fast refeeding can cause cardiopulmonary failure

75

what is hyperCa of immobilization

increased osteoclastic bone reabsorption
need hydration and bisphosphonates

76

what causes neonatal thyrotoxicosis

transplacental passage materna anti TSH R Ab
causing warm moist skin
tachy cardia
poor feeding, poor weight gain
low birth weight

77

what is T for neonatal thyrotoxicosis

self resolves once Ab disappears
give methimazole and beta blocker for Sx

78

what will happen if give betablocker to pheo exacerbation

BP will increase rapidly from unnopposed alpha

79

why can large tranfusion cause hypocalcemia

patient has to have liver impairment usually
citrate in tranfused blood binds the active ionized Ca

80

side effects of antithyroid drugs

agranulocytosis
methimazole is 1st trimester teratogen
propylthiouracil cause hepatic failure and ANCA assoc vasculitis

81

most common cause death in acromegaly

CHF

82

signs of glucocorticoid deficiency

fatigue, loss of appetite, hypoglycemia, hyponatremia and eosinophilia

83

what is not affected in pan hypopituitarism

aldosterone
remember it is central adrenal insufficiency or secondary.

84

what sex hormone is primarily made in adrenals

DHEA-S

85

overproduction DHEA-S

gets converted to testosterone, hirsutism!

86

most common cause primary adrenal insufficiency

autoimmune

87

most common malignant thyroid carcinoma

papillary from epithelial-thyroid follicular cells)

88

definition constitutional growth delay

delayed growth spurt
delayed puberty
delayed BONE AGE!!!!

89

chronic kidney disease cause what imbalance in electrolytes

secondary hyperPTH from low Ca from low Vit D conversion
also holds onto phosphorus which also stimualtes PTH

90

TSH and LH values in prolactinoma

low LH
normal TSH

91

target blood glucose for gestational DM

fasting

92

what is next step if diet modification is not good enough for Gestational DM

insulin

93

what are complications of late maternal hyperglycemia for neonate

polycythemia from inc metabolic demand
organomegaly
macrosomia shoulder dystocia
neonatal hypoglycemia

94

MEN 1

pituitary adenoma
primary hyper PTH
pncrease/GI gastrinoma

95

best initial therapy for primary hyperaldosteronism

eplerenone

96

side effects spironolactone

decreased libido and gynecomastia in men
breast tenderness and menstural irregularities in women

97

best management in young girl with PCOS no intention of getting pregnant

combined OCP

98

which treatment for graves will worsen eyes temporarily

radioactive iodine pre treat with glucocorticoids to decrease effects

99

nephrotic syndrome. what is causing low serum Ca

low albumin

100

what metabolic abnormalities occur with hypothyroid

hyperlipidemia and hyponatremia
sometimes aSx elevations CPK and increased AST ALT

101

hypercortisolism

glucose HTN and weight gain. cushings.
can cause proximal wekaness, central adiposity and abdominal striae
HA
usually exogenic. can be small cell lung cancer making ACTH
or ACTH porducing pituitary adenomas (cushing diseasE)

102

hyperCa, metabolic alkalosis and renal failure

milk alkali syndrome
PTH will be suppressed.

103

HTn with undetectable renin activity

primary hyperaldosteronism

104

how do kidneys escape excess Na with hyperaldosteronism

increase renal blood flow and GFR and atrial natriuretic peptide is relased all to promote Na excretion

105

thyroid nodule. next step

TSH and U/S

106

46 XX with vomiting, poor feeding, dry mucous membranes, skin turgor decreased, enlargement clitoris and fusion labioscrotal folds with no palpable gonads
Na is low and K is high
what is increased

17-hydroxyprogesterone from a deficiency in 21 hydroxylase
salt wasting!!!

107

best IV fluid for hyperosmolar hyperglycemic state

normal saline

108

patient with hypothyroid taking levothyroxine. now going on estrogen. what is going to happen

need more leveothyroxine because TBG increases

109

osteomalacia

impaired osteoid matrix mineralization from vit D def

110

if this electrolyte is low can cause hypoCa

Mg because induces resistance to PTH and decrease PTH secretion

111

how does PE affect Ca

increase Ca bound to albumin so decrease serum Ca
because respiratory alkalosis causes H to dissociate from albumin freeing up space for Ca

112

respiratory alkalosis effect on Ca

causes H to dissociate albumin freeing space to bind Ca
so decrease serum Ca

113

preferred Tx for graves

radioactive iodine therapy unless severe opthamology or pregnant

114

advanced bone age, precocious puberty but LH and after gnRH still is low

peripheral cause-- CAH

115

15 weight gain with muscle weakness proximally and HTN
glucose is elevated and CXR show right hilar mass and lymphadenopathy

cushings from small cell cancer creating ACTH

116

hyperandrogenism in adult female occuring rapidly

check DHEA-S and testosterone

117

elevated testosterone and normal DHEA-S in female

ovarian source

118

elevated DHEA-S and normal testosterone

adrenal source

119

most common testicular sex cord stromal tumor

leydig cell tumor

120

what do leydig cell tumors produce

testosterone and estrogen from increased aromatase activity
secondary inhibition LH and FSH

121

skin hyperpigmentation

primary adrenal insufficiency!!!!! not secondary!!!!!!!!!!

122

what causes HTN in thyrotoxicosis

increased myocardial contractility

123

MEN2B

marfinoid!!!
Pheo
medullary thyroid carcinoma
mucosal neuromas

124

Men2A

PTH
Pheo
medullary thyroid

125

fever and sore throat after starting anti thyroid

stop meds! agranulocytosis

126

glucagonoma Sx signs

necrolytic migratory erythema- erythematous plaques on face, perineum enalarge and coalesce
DM - mild hyperlycemis
diarrhea, anorexia, abdominal pain
weight loss
ataxia, dementia, proximal mm wekaness

127

DM patient with rash and has lost a lot of weight

glucagonoma

128

when do ulcers require amputation

gangrene

129

when to hospitalize for foot ulcer

cellulitis and abscess formation or osteomyelitis
gangrene

130

risk factors for graves opthamology

SMOKING
female se
advancing age