Endocrine 1 practice

Question 1

What allows you to differentiate between thyroid etiologies like Graves vs Toxic multinodular goiter?
a) CT with PO and IV contrast
b) MRI
c) Ultrasound
d) RAIU scan

Answer 1

d) RAIU scan

Question 2

In central (secondary) hypOthyroid disease, TSH will be ______ and T3/T4 will be _____
a) Low; low
b) High; high
c) High; low
d) Low; high

Answer 2

a) Low; low

Question 3

Which of the following is NOT a symptom of Grave’s disease?
a) Pretibial Myxedema
b) Heat intolerance
c) Cold intolerance
d) AFIB

Answer 3

c) Cold intolerance

Question 4

What can make exophthalmos with Grave’s disease worse?
a) Prednisone
b) Radioactive iodine
c) Propylthiouracil (PTU)
d) Beta blockers

Answer 4

b) Radioactive iodine

Question 5

In which of the following situations would all of the thyroid be cold on a RAIU scan?
a) Toxic Multinodular Goiter / Toxic Adenoma
b) TSH Secreting Pituitary Adenoma
c) Factitious/Struma Ovarii

Answer 5

c) Factitious/Struma Ovarii

Question 6

Which of the following is NOT a preferred treatment for thyroid storm?
a) Propranolol IV
b) Propylthiouracil (PTU)
c) Dexamethasone
d) Tylenol
e) Advil

Answer 6

e) Advil

Question 7

A patient has lost ⅓ of her eyebrows, myxedema, goiter, & galactorrhea. Based on these Sx alone, what is a likely diagnosis?
a) Grave’s disease
b) Toxic adenoma
c) Hashimoto’s
d) Cretinism

Answer 7

c) Hashimoto’s

Question 8

What is the typical dose of levothyroxine for an average adult?
a) 50 mcg
b) 25 mcg
c) 4 mcg/ kg/ day
d) 1 mcg/ kg/ day

Answer 8

a) 50 mcg (can also use 1.6 mcg/kg/day)

Question 9

Coarse facial features, macroglossia, umbilical hernia, hypotonia, jaundice, feeding problems are all Sx of what?
a) Grave’s disease
b) Toxic adenoma
c) Hashimoto’s
d) Cretinism

Answer 9

d) Cretinism

Question 10

Which of the following was NOT listed as a cause of cretinism?
a) Lack of iodine in third world
b) Dysgenesis of the thyroid gland
c) Maternal thyroid antigens cross the placenta
d) Maternal antithyroid antibodies cross the placenta

Answer 10

c) Maternal thyroid antigens cross the placenta

Question 11

T/F: Thyroiditis typically starts with hyperthyroid Sx and then turns into hypothyroid Sx

Answer 11

True

Question 12

Which of the following is NOT a medication that can potentially cause hypothyroidism?
a) Levothyroxine
b) Amiodarone
c) Lithium
d) Iodine

Answer 12

a) Levothyroxine

Question 13

With thyroiditis, RAIU scan is cold because no new ____ is being made during this period.
a) T3
b) T4
c) TSH
d) LH

Answer 13

b) T4

Question 14

Which of the following are painful or tender forms of thyroiditis? Select all that apply
a) Silent (lymphocytic) / Postpartum thyroiditis
b) Subacute / Dequervain (granulomatous) Thyroiditis
c) Riedel’s Thyroiditis
d) Suppurative Thyroiditis
e) Hashimoto’s thyroiditis

Answer 14

b) Subacute / Dequervain (granulomatous) Thyroiditis
d) Suppurative Thyroiditis
(subacute is very painful, suppurative is tender)

Question 15

Normal thyroid antibodies are seen in what? Select two
a) Silent (lymphocytic) / Postpartum thyroiditis
b) Subacute / Dequervain (granulomatous) Thyroiditis
c) Riedel’s Thyroiditis
d) Suppurative Thyroiditis

Answer 15

b) Subacute / Dequervain (granulomatous) Thyroiditis
d) Suppurative Thyroiditis

Question 16

Which of the following is a bacterial infection of the thyroid?
a) Silent (lymphocytic) / Postpartum thyroiditis
b) Subacute / Dequervain (granulomatous) Thyroiditis
c) Riedel’s Thyroiditis
d) Suppurative Thyroiditis

Answer 16

d) Suppurative Thyroiditis

Question 17

T/F: The primary purpose of getting your patient to swallow is to appreciate the consistency of the thyroid

Answer 17

True

Question 18

You do a PE on a patient and notice a smooth, firm, sharply outlined, and painless lump on their thyroid. Should you be super concerned about malignancy?
a) No, these are characteristics of a benign thyroid nodule
b) Yes, these are characteristics of a malignant thyroid nodule

Answer 18

a) No, these are characteristics of a benign thyroid nodule

Question 19

You find a thyroid nodule on PE. You do TSH and thyroid ultrasound, and the TSH is subnormal. What should you do next to evaluate if the nodule is functioning or nonfunctioning?
a) FNA alone
b) Radionuclide thyroid scan + FNA
c) Radionuclide thyroid scan & measure T4 + T3
d) Radionuclide thyroid scan alone

Answer 19

c) Radionuclide thyroid scan & measure T4 + T3

Question 20

List the types of thyroid cancer from most to least common

Answer 20

Follicular, Papillary, Anaplastic, Medullary

Question 21

T/F: Hashimoto’s is a cause of permanent hypothyroidism

Answer 21

True

Question 22

Which of the following is NOT a target organ of PTH?
a) Bone
b) GI tract
c) Liver
d) Kidney

Answer 22

b) GI tract

Question 23

Which of the following is NOT a symptom of hyperparathyroid?
a) Osteopenia
b) Kidney stones
c) Constipation
d) Encephalopathy
e) Hyperactive nerves

Answer 23

c) Constipation

Question 24

T/F: Methimazole is teratogenic in 2nd trimester

Answer 24

False (in the first trimester)

Question 25

T/F: Levothyroxine is the first line Tx for both Hashimoto’s, Cretinism, and Myxedema coma

Answer 25

True

Question 26

T/F: Graves and Hashimotos are not autoimmune

Answer 26

False (they are)

Question 27

T/F: “Hot” thyroid nodules have a higher risk for malignancy, and need to be treated

Answer 27

False (they have a lower risk for malignancy, but need to be treated)

Question 28

T/F: Silent (lymphocytic) / Postpartum thyroiditis should not receive treatment other than aspirin.

Answer 28

True

Question 29

T/F: Patients with hypercalcemia are not usually asymptomatic.

Answer 29

False (they usually are)

Question 30

When should you Tx hypercalcemia? a) All levels of hypercalcemia need to be treated b) If >6 c) If >10 d) If >12 e) If >14

Answer 30

d) If >12

Question 31

“Salt and pepper” skull and distal clavicle reabsorption is a symptom of what? a) Primary hyperparathyroidism b) Secondary hyperparathyroidism c) Primary hypoparathyroidism d) Secondary hypoparathyroidism

Answer 31

a) Primary hyperparathyroidism

Question 32

T/F: Patients with hyperparathyroidism during pregnancy should receive surgery in the 2nd trimester if possible

Answer 32

True

Question 33

T/F: Patients with secondary hyperparathyroidism due to kidney disease may have normal serum calcium

Answer 33

True (bc the process of osteomalacia is occurring to normalize calcium)

Question 34

Which are examples of secondary hyperparathyroidism? Select all that apply a) Kidney disease b) Vitamin D deficiency c) Parathyroid adenoma d) MEN 1 and MEN 2a

Answer 34

a) Kidney disease b) Vitamin D deficiency

Question 35

Which are examples of situations in which PTH is overwhelmed? Select all that apply a) Acute renal failure b) Rhabdomyolysis c) Intestinal malabsorption d) Septic shock e) Pseudohypoparathyroidism f) DiGeorge syndrome

Answer 35

a) Acute renal failure b) Rhabdomyolysis d) Septic shock

Question 36

A patient has paresthesia (of lips, tongue, fingers, feet), facial muscle spasms, anxiety, hoarseness, and wheezing. Trousseau’s sign is positive. These symptoms later progress to a dementia-like cognitive state. **What is the most likely diagnosis?** a) Primary hyperparathyroidism b) Dementia c) Hypoparathyroidism d) Hypocortisolism

Answer 36

c) Hypoparathyroidism